Naltrexone in the treatment of adolescent sexual offenders.
BACKGROUND
Naltrexone is a long-acting opioid used clinically in alcoholism, drug abuse, bulimia nervosa, obsessive-compulsive disorder, and impulse-control disorders. This study investigated whether naltrexone can decrease sexual arousal in legally adjudicated adolescent sexual offenders.


METHODS
In an open-ended prospective study, naltrexone was given to 21 adolescents participating in an inpatient adolescent sexual offenders program who met any of the self-reported criteria of (1) masturbating 3 or more times per day, (2) feeling unable to control arousal, (3) spending more than 30% of awake time in sexual fantasies, or (4) having sexual fantasies or behavior that regularly intruded into and interfered with their functioning in the treatment program. After having been treated for more than 2 months, 13 patients had their naltrexone administratively stopped, thus providing a before, during, after, and resumption-of-treatment design. Behavioral changes were monitored daily with a fantasy-tracking log and a masturbation log. A positive result was recorded if there was more than a 30% decrease in any self-reported criterion that was applicable to each specific patient and this benefit lasted at least 4 months. Data were collected from July 2000 to December 2002. Leuprolide was given if naltrexone was not sufficiently helpful in controlling sexual impulses and arousal.


RESULTS
Fifteen of 21 patients were considered to have a positive result and continued to respond for at least 4 months to an average dose of 160 mg per day with decreased sexual fantasies and masturbation. Dosages above 200 mg per day were not more helpful. Administrative discontinuation of naltrexone in a subset of 13 patients resulted in reoccurrence of symptoms that began when the dose taper reached 50 mg per day. There were no changes in clinical chemistries. Five of 6 patients who did not benefit from naltrexone responded favorably to leuprolide.


CONCLUSIONS
Naltrexone at dosages of 100 to 200 mg per day provides a safe first step in treating adolescent sexual offenders. It is possible that the benefits observed here will generalize to the larger population of non-socially deviant hypersexual patients or "sexual addicts."
Ryback
Ralph S
RS
Potomac Ridge Behavioral Health/Adventist Health Care Systems, Rockville, MD 20850, USA. rsryback@givarya.org
D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D002650:Child Abuse, Sexual / Q000331:legislation & jurisprudence / Q000523:psychology; D015897:Comorbidity; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005201:Fantasy; D006760:Hospitalization; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D007989:Libido / Q000187:drug effects; D008297:Male; D008418:Masturbation / Q000188:drug therapy / Q000523:psychology; D001523:Mental Disorders / Q000453:epidemiology; D009271:Naltrexone / Q000494:pharmacology / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D010262:Paraphilic Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D012742:Sex Offenses / Q000331:legislation & jurisprudence / Q000523:psychology*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D009292:Narcotic Antagonists; D009271:Naltrexone; D016729:Leuprolide