title: Aversion to injection limits acceptability of extended-release naltrexone among homeless, alcohol-dependent patients.
abstract: BACKGROUND
  Ending homelessness is a major priority of the Department of Veteran Affairs (VA), and alcohol use can be a barrier to stable housing. Clinical trials suggest that depot extended-release naltrexone (XR-NTX) is efficacious in reducing alcohol consumption among alcohol-dependent subjects.
  
  
  METHODS
  An open-label, randomized pilot study sought to examine the feasibility and effectiveness of XR-NTX versus oral naltrexone to improve alcohol consumption and housing stability among homeless, alcohol-dependent veterans at the Providence Veteran Affairs Medical Center.
  
  
  RESULTS
  Of 215 potential candidates approached over a 16-month recruitment period, only 15 agreed to consider study entry and 7 were randomized. The primary reasons given for refusal were not wanting an injection; fear of needles; and not wanting to change drinking habits. Only 1 participant in the XR-NTX group returned after the first injection. Three participants in the oral naltrexone group attended all 7 visits and had good outcomes.
  
  
  CONCLUSIONS
  Although XR-NTX has demonstrated efficacy in reducing heavy drinking, limited acceptance of the injection might reduce its effectiveness among homeless, alcohol-dependent patients.
authors.affiliation: Center on System, Outcomes & Quality in Chronic Disease & Rehabilitation, Research Service , Providence Veterans Affairs Medical Center , Providence , Rhode Island , USA. pfriedmann@lifespan.org
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
authors.forename: Dawn
authors.initials: D
authors.lastname: Mello
authors.forename: Sean
authors.initials: S
authors.lastname: Lonergan
authors.forename: Claire
authors.initials: C
authors.lastname: Bourgault
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
mesh_terms: D000284:Administration, Oral; D000437:Alcoholism / Q000188:drug therapy / Q000523:psychology*; D003692:Delayed-Action Preparations; D005239:Fear / Q000523:psychology*; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D009339:Needles; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010865:Pilot Projects; D014728:Veterans / Q000523:psychology
chemical_list: D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D009271:Naltrexone