Outcome predictors for problem drinkers treated with combined cognitive behavioral therapy and naltrexone.
BACKGROUND
The opioid antagonist naltrexone, combined with cognitive behavioural therapy (CBT), has proven efficacious for patients with alcohol dependence, but studies examining how this treatment works in a naturalistic treatment setting are lacking.


OBJECTIVE
This study examined predictors of the outcome of targeted naltrexone and CBT in a real-life outpatient setting. Participants were 315 patients who attended a treatment program providing CBT combined with the targeted use of naltrexone.


METHODS
Mixture models for estimating developmental trajectories were used to examine change in patients' alcohol consumption and symptoms of alcohol craving from treatment entry until the end of the treatment (20 weeks) or dropout. Predictors of treatment outcome were examined with analyses of multinomial logistic regression. Minimal exclusion criteria were applied to enhance the generalizability of the findings.


RESULTS
Regular drinking pattern, having no history of previous treatments, and high-risk alcohol consumption level before the treatment were associated with less change in alcohol use during the treatment. The patients with low-risk alcohol consumption level before the treatment had the most rapid reduction in alcohol craving. Patients who drank more alcohol during the treatment had lower adherence with naltrexone.


CONCLUSIONS
Medication non-adherence is a major barrier to naltrexone's effectiveness in a real-life treatment setting. Patients with more severe alcohol problems may need more intensive treatment for achieving better treatment outcome in real-word treatment settings.
Institute of Behavioural Sciences, University of Helsinki , Finland .
Salla
S
Vuoristo-Myllys
Jari
J
Lipsanen
Jari
J
Lahti
Hely
H
Kalska
Hannu
H
Alho
D000437:Alcoholism / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D011379:Prognosis; D016896:Treatment Outcome
D009292:Narcotic Antagonists; D009271:Naltrexone