Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme.
BACKGROUND
The anti-craving drug, naltrexone, is used as a pharmacotherapeutic adjunct in the treatment of alcohol dependence. In addictive disorders, compliance issues remain central. There are limited data on compliance with naltrexone treatment regimens within formalized rehabilitation programs and even less data that identifies factors that have an impact on this.


OBJECTIVE
To study patient adherence to naltrexone medication regimens and examine whether patients' reported pre-treatment alcohol use, dependence severity and measures of psychological health are predictive of medication compliance.


METHODS
Fifty outpatients meeting DSM IV criteria for alcohol dependence enrolled in a 12-week rehabilitation programme. This included cognitive behavioural therapy (CBT) and naltrexone, 50 mg orally daily. Measures included: pharmacy prescription pick-up including number of tablets dispensed, programme attendance and patient pre-treatment alcohol use variables. Measures of psychological health included somatic symptoms, anxiety, social dysfunction and depression as measured by the General Health Questionnaire (GHQ-28).


RESULTS
Classifying the sample into compliant (> or = 90% medication pick-up) and less compliant groups, 66% of subjects were naltrexone-compliant. Pre-treatment alcohol use variables were not predictive of compliance. Although social dysfunction and depression tended towards poorer prescription filling, measures of psychological distress (GHQ-28) did not identify factors predictive of medication non-compliance. One patient withdrew from treatment because of naltrexone-induced dysphoria.


CONCLUSIONS
Patients with alcohol dependence demonstrated high levels of anti-craving medication compliance, good rehabilitation programme participation and favourable outcomes. Naltrexone was well tolerated. Medication compliance in this study group compared well with those of other hospital populations with chronic disorders. Factors predictive of anti-craving medication compliance in alcohol dependence require further study.
Feeney
G F
GF
Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia. Gerald-Feeney@health.qld.gov..au
Connor
J P
JP
Young
R M
RM
Tucker
J
J
Czajkowski
F
F
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000188:drug therapy* / Q000523:psychology / Q000534:rehabilitation; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010349:Patient Compliance
D009292:Narcotic Antagonists; D009271:Naltrexone