Naltrexone and disulfiram in patients with alcohol dependence and comorbid post-traumatic stress disorder.
BACKGROUND
Although disulfiram and naltrexone have been approved by the Food and Drug Administration for the treatment of alcoholism, the effect of these medications on alcohol use outcomes and on psychiatric symptoms is still unknown in patients with co-occurring disorders post-traumatic stress disorder (PTSD).


METHODS
Patients (n = 254) with a major Axis I psychiatric disorder and comorbid alcohol dependence were treated for 12 weeks in a medication study at three Veterans Administration outpatient clinics. Randomization included (1) open randomization to disulfiram or no disulfiram; and (2) double-blind randomization to naltrexone or placebo. This resulted in four groups: (1) naltrexone alone; (2) placebo alone; (3) disulfiram and naltrexone; or (4) disulfiram and placebo. Outcomes were measures of alcohol use, PTSD symptoms, alcohol craving, GGT levels and adverse events.


RESULTS
93 individuals (36.6%) met DSM-IV criteria for PTSD. Subjects with PTSD had better alcohol outcomes with active medication (naltrexone, disulfiram or the combination) than they did on placebo; overall psychiatric symptoms of PTSD improved. Individuals with PTSD were more likely to report some side effects when treated with the combination.


CONCLUSIONS
The results of this study suggest that disulfiram and naltrexone are effective and safe for individuals with PTSD and comorbid alcohol dependence.
Petrakis
Ismene L
IL
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06516, USA. ismene.petrakis@yale.edu
Poling
James
J
Levinson
Carolyn
C
Nich
Charla
C
Carroll
Kathleen
K
Ralevski
Elizabeth
E
Rounsaville
Bruce
B
D000328:Adult; D000427:Alcohol Deterrents / Q000008:administration & dosage*; D000437:Alcoholism / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D000704:Analysis of Variance; D017831:Diagnosis, Dual (Psychiatry); D004221:Disulfiram / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D013695:Temperance; D016896:Treatment Outcome
D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D009271:Naltrexone; D004221:Disulfiram