High-dose naltrexone therapy for cocaine-alcohol dependence.
This randomized, double-blind, placebo-controlled study compared the effects of high-dose (100 mg/d) naltrexone versus placebo in a sample of 87 randomized subjects with both cocaine and alcohol dependence. Medication conditions were crossed with two behavioral therapy platforms that examined whether adding contingency management (CM) that targeted cocaine abstinence would enhance naltrexone effects compared to cognitive behavioral therapy (CBT) without CM. Primary outcome measures for cocaine (urine screens) and alcohol use (timeline followback) were collected thrice-weekly during 12 weeks of treatment. Retention in treatment and medication compliance rates were low. Rates of cocaine use and drinks per day did not differ between treatment groups; however naltrexone did reduce frequency of heavy drinking days, as did CBT without CM. Notably, adding CM to CBT did not enhance treatment outcomes. These weak findings suggest that pharmacological and behavioral interventions that have shown efficacy in the treatment of a single drug dependence disorder may not provide the coverage needed when targeting dual drug dependence.
Schmitz
Joy M
JM
Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Texas, USA. Joy.M.Schmitz@uth.tmc.edu
Lindsay
Jan A
JA
Green
Charles E
CE
Herin
David V
DV
Stotts
Angela L
AL
Moeller
F Gerard
FG
D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D019970:Cocaine-Related Disorders / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage* / Q000009:adverse effects; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D010349:Patient Compliance / Q000706:statistics & numerical data*
D009292:Narcotic Antagonists; D009271:Naltrexone