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Extended naltrexone and broad spectrum treatment or motivational enhancement therapy

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Abstract

Background

Randomized clinical trials on the effectiveness of naltrexone (NTX) in the treatment of alcohol dependence have produced conflicting results. One possible explanation for these discrepancies may lie in the various psychosocial treatments for which NTX is an adjunct. The goal of this study was to examine the interplay between psychosocial treatment and duration of NTX.

Methods

One hundred and seventy-four alcohol-dependent outpatients participated in a double-blind trial where they were randomly assigned to 12 vs. 24 weeks NTX duration and to one of two psychosocial treatments: motivational enhancement therapy (MET) and broad spectrum treatment (BST), a cognitive behavioral therapy tailored to the patient's specific needs. After an initial 12-week period of NTX and psychosocial treatment, half of each psychotherapy condition was assigned to continue NTX for an additional 12 weeks while the other half was assigned to placebo. Patient drinking outcomes were measured for the year following treatment completion. It was hypothesized that the combination of extended duration of NTX and the moderate intensity of BST would be predictive of longer time to a first heavy drinking day than any of the three alternative combinations: MET with short or extended NTX administration or BST with short NTX administration.

Results

The median time to first drink and time to first heavy drinking day were found to be significantly longer for patients who received BST and extended NTX than for patients in the other three groups.

Conclusions

These results may suggest that the kind of psychosocial treatment delivered in combination with duration of NTX administration may partially explain the inconsistent findings regarding the efficacy of NTX in the treatment of alcohol dependence.

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References

  • Anton RF, Moak DH, Latham P, Waid LR, Myrick H, Voronin K, Thevos A, Wang W, Woolson R (2005) Naltrexone combined with either cognitive behavioral or motivational enhancement therapy for alcohol dependence. J Clin Psychopharmacol 25:349–357

    Article  PubMed  CAS  Google Scholar 

  • Anton RF, Moak DH, Latham PK, Waid LR, Malcolm RJ, Dias JK, Roberts JS (2001) Posttreatment results of combining naltrexone with cognitive-behavior therapy for the treatment of alcoholism. J Clin Psychopharmacol 21:72–77

    Article  PubMed  CAS  Google Scholar 

  • Anton RF, Moak DH, Waid LR, Latham PK, Malcolm RJ, Dias JK (1999) Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial. Am J Psychiatry 156:1758–1764

    PubMed  CAS  Google Scholar 

  • Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, Gastfriend DR, Hosking JD, Johnson BA, LoCastro JS, Longabaugh R, Mason BJ, Mattson ME, Miller WR, Pettinati HM, Randall CL, Swift R, Weiss RD, Williams LD, Zweben A (2006) Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 295:2003–2017

    Article  PubMed  CAS  Google Scholar 

  • Balldin J, Berglund M, Borg S, Mansson M, Bendtsen P, Franck J, Gustafsson L, Halldin J, Nilsson LH, Stolt G, Willander A (2003) A 6-month controlled naltrexone study: combined effect with cognitive behavioral therapy in outpatient treatment of alcohol dependence. Alcohol Clin Exp Res 27:1142–1149

    Article  PubMed  CAS  Google Scholar 

  • Beattie MC, Longabaugh R, Fava J (1992) Assessment of alcohol-related workplace activities: development and testing of ‘your workplace’. J Stud Alcohol 53:469–475

    PubMed  CAS  Google Scholar 

  • Benedict RHB, Schretlen D, Groninger L (1998) Hopkins Verbal Learning Test—revised: normative data and analysis of interform and test–retest reliability. Clin Neuropsychol 12:43–55

    Article  Google Scholar 

  • Biener L, Abrams DB (1991) The contemplation ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol 10:360–365

    Article  PubMed  CAS  Google Scholar 

  • Chick J, Anton R, Checinski K, Croop R, Drummond DC, Farmer R, Labriola D, Marshall J, Moncrieff J, Morgan MY, Peters T, Ritson B (2000) A multicentre, randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of alcohol dependence or abuse. Alcohol Alcohol 35:587–593

    PubMed  CAS  Google Scholar 

  • Davidson D, Gulliver SB, Longabaugh R, Wirtz PW, Swift R (2007a) Building better cognitive-behavioral therapy: is broad-spectrum treatment more effective than motivational-enhancement therapy for alcohol-dependent patients treated with naltrexone? J Stud Alcohol Drugs 68:238–247

    PubMed  Google Scholar 

  • Davidson D, Palfai T, Bird C, Swift R (1999) Effects of naltrexone on alcohol self-administration in heavy drinkers. Alcohol Clin Exp Res 23:195–203

    PubMed  CAS  Google Scholar 

  • Davidson D, Swift R, Fitz E (1996) Naltrexone increases the latency to drink alcohol in social drinkers. Alcohol Clin Exp Res 20:732–739

    Article  PubMed  CAS  Google Scholar 

  • Davidson D, Wirtz PW, Gulliver SB, Longabaugh R (2007b) Naltrexone's suppressant effects on drinking are limited to the first 3 months of treatment. Psychopharmacology (Berl) 194:1–10

    Article  CAS  Google Scholar 

  • Donovan DM, Anton RF, Miller WR, Longabaugh R, Hosking JD, Youngblood M (2008) Combined pharmacotherapies and behavioral interventions for alcohol dependence (the COMBINE study): examination of posttreatment drinking outcomes. J Stud Alcohol Drugs 69:5–13

    PubMed  Google Scholar 

  • Donovan JM, Elliott MR, Heitjan DF (2007) Predicting event times in clinical trials when randomization is masked and blocked. Clin Trials 4:481–490

    Article  PubMed  Google Scholar 

  • Epstein NB, Baldwin LM, Bishop DS (1983) The McMaster family assessment device. J Marital Fam Ther 9:171–180

    Article  Google Scholar 

  • First M, Spitzer RL, Gibbon M, Williams J (1996) Structured clinical interview for DSM-IV axis I disorders—patient edition (SCID-I/P-Version 2.0). Biometrics Research Department, New York State Psychiatric Institute, New York

    Google Scholar 

  • Gastpar M, Bonnet U, Boning J, Mann K, Schmidt LG, Soyka M, Wetterling T, Kielstein V, Labriola D, Croop R (2002) Lack of efficacy of naltrexone in the prevention of alcohol relapse: results from a German multicenter study. J Clin Psychopharmacol 22:592–598

    Article  PubMed  CAS  Google Scholar 

  • Guardia J, Caso C, Arias F, Gual A, Sanahuja J, Ramirez M, Mengual I, Gonzalvo B, Segura L, Trujols J, Casas M (2002) A double-blind, placebo-controlled study of naltrexone in the treatment of alcohol-dependence disorder: results from a multicenter clinical trial. Alcohol Clin Exp Res 26:1381–1387

    PubMed  CAS  Google Scholar 

  • Gulliver SB, Longabaugh R, Davidson D, Swift R (2005) The development of a broad spectrum treatment for patients with alcohol dependence in early recovery. Adapting CBT for recalcitrant populations. Cogn Behav Pract 12:53–63

    Article  Google Scholar 

  • Kranzler HR, Modesto-Lowe V, Van Kirk J (2000) Naltrexone vs. nefazodone for treatment of alcohol dependence. A placebo-controlled trial. Neuropsychopharmacology 22:493–503

    Article  PubMed  CAS  Google Scholar 

  • Kranzler HR, Van Kirk J (2001) Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis. Alcohol Clin Exp Res 25:1335–1341

    Article  PubMed  CAS  Google Scholar 

  • Kranzler HR, Wesson DR, Billot L, Drug Abuse Sciences Naltrexone Depot Study Group (2004) Naltrexone depot for treatment of alcohol dependence: a multicenter, randomized, placebo-controlled clinical trial. Alcohol Clin Exp Res 28(7):1051–1059

    Article  PubMed  CAS  Google Scholar 

  • Krystal JH, Cramer JA, Krol WF, Kirk GF, Rosenheck RA (2001) Naltrexone in the treatment of alcohol dependence. N Engl J Med 345:1734–1739

    Article  PubMed  CAS  Google Scholar 

  • Longabaugh R, Wirtz PW, Zweben A, Stout RL (1998) Network support for drinking, alcoholics anonymous and long-term matching effects. Addiction 93:1313–1333

    Article  PubMed  CAS  Google Scholar 

  • Longabaugh R, Zweben A, Locastro JS, Miller WR (2005) Origins, issues and options in the development of the combined behavioral intervention. J Stud Alcohol 66(Suppl 15):179–187

    Google Scholar 

  • McLellan AT, Alterman AI, Metzger DS, Grissom GR, Woody GE, Luborsky L, O’Brien CP (1994) Similarity of outcome predictors across opiate, cocaine, and alcohol treatments: role of treatment services. J Consul Clin Psychol 62(6):1141–1158

    Article  CAS  Google Scholar 

  • Miller WR, Wilbourne PL (2002) Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction 97(3):265–277

    Article  PubMed  Google Scholar 

  • Miller WR, Rollnick S (1991) Motivational interviewing: preparing people to change addictive behavior. Guilford, New York

    Google Scholar 

  • Miller WR, Rollnick S (2002) Motivational interviewing: preparing people to change, 2nd edn. Guilford, New York

    Google Scholar 

  • Miller WR, Zweben A, diClemente CC, Rychtarik RG (1995) Motivational enhancement therapy manual: a clinical research guide for therapists treating individuals with alcohol abuse and dependence. National Institute on Alcohol Abuse and Alcoholism project MATCH monograph series 2. National Institute on Alcohol Abuse and Alcoholism, Rockville

    Google Scholar 

  • Monterosso JR, Flannery BA, Pettinati HM, Oslin DW, Rukstalis M, O'Brien CP, Volpicelli JR (2001) Predicting treatment response to naltrexone: the influence of craving and family history. Am J Addict 10:258–268

    Article  PubMed  CAS  Google Scholar 

  • Monti PM, Rohsenow DJ, Swift RM, Gulliver SB, Colby SM, Mueller TI, Brown RA, Gordon A, Abrams DB, Niaura RS, Asher MK (2001) Naltrexone and cue exposure with coping and communication skills training for alcoholics: treatment process and 1-year outcomes. Alcohol Clin Exp Res 25:1634–1647

    Article  PubMed  CAS  Google Scholar 

  • O'Malley SS, Jaffe AJ, Chang G, Rode S, Schottenfeld R, Meyer RE, Rounsaville B (1996) Six-month follow-up of naltrexone and psychotherapy for alcohol dependence. Arch Gen Psychiatry 53:217–224

    PubMed  Google Scholar 

  • O'Malley SS, Jaffe AJ, Chang G, Schottenfeld RS, Meyer RE, Rounsaville B (1992) Naltrexone and coping skills therapy for alcohol dependence. A controlled study. Arch Gen Psychiatry 49:881–887

    PubMed  Google Scholar 

  • O'Malley SS, Rounsaville BJ, Farren C, Namkoong K, Wu R, Robinson J, O'Connor PG (2003) Initial and maintenance naltrexone treatment for alcohol dependence using primary care vs specialty care: a nested sequence of 3 randomized trials. Arch Intern Med 163:1695–1704

    Article  PubMed  Google Scholar 

  • Oslin DW, Lynch KG, Pettinati HM, Kampman KM, Gariti P, Gelfand L, Ten Have T, Wortman S, Dundon W, Dackis C, Volpicelli JR, O'Brien CP (2008) A placebo-controlled randomized clinical trial of naltrexone in the context of different levels of psychosocial intervention. Alcohol Clin Exp Res 32(7):1299–1308

    Article  PubMed  CAS  Google Scholar 

  • Pettinatti HM, Weiss RD, Miller WR, Donovan D, Ernest DB, Rounsaville BJ (2004) Medical management (MM) treatment manual: a clinical research guide for medically trained clinicians providing pharmacotherapy as part of the treatment for alcohol dependence. National Institute on Alcohol Abuse and Alcoholism, Bethesda

    Google Scholar 

  • Rapeli P, Service E, Salin PA (1997) Dissociation between simple and complex span impairment in alcoholics. Memory 5:741–762

    Article  Google Scholar 

  • Reitan RM (1958) Validity of the Trail-Making Test as an indicator of organic brain damage. Percept Mot Skills 8:271–276

    Article  Google Scholar 

  • Rice C, Longabaugh R, Stout RA (1997) Comparison sample validation of “your workplace”: an instrument t measure alcohol support and consequences at work. Addict Behav 22:711–722

    Article  PubMed  CAS  Google Scholar 

  • Rohsenow DJ (2004) What place does naltrexone have in the treatment of alcoholism? CNS Drugs 18:547–560

    Article  PubMed  CAS  Google Scholar 

  • Sobell LC, Brown J, Leo GI, Sobell MB (1996) The reliability of the alcohol timeline followback when administered by telephone and by computer. Drug Alcohol Depend 42:49–54

    Article  PubMed  CAS  Google Scholar 

  • Sobell MB, Sobell LC, Klajner F, Pavan D, Basian E (1986) The reliability of a timeline method for assessing normal drinker college students' recent drinking history: utility for alcohol research. Addict Behav 11:149–161

    Article  PubMed  CAS  Google Scholar 

  • Spanier GB (1976) Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam 38:15–28

    Article  Google Scholar 

  • Stein LAR, Minugh PA, Longabaugh R, Wirtz PW (2009) Readiness to change as a mediator of the effect of a brief motivational intervention on post-treatment alcohol related consequences of injured emergency department hazardous drinkers. Psychol Addict Behav 23:185–195

    Article  PubMed  CAS  Google Scholar 

  • Swift RM, Whelihan W, Kuznetsov O, Buongiorno G, Hsuing H (1994) Naltrexone-induced alterations in human ethanol intoxication. Am J Psychiatry 151:1463–1467

    PubMed  CAS  Google Scholar 

  • Volpicelli JR, Alterman AI, Hayashida M, O'Brien CP (1992) Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry 49:876–880

    PubMed  CAS  Google Scholar 

  • Volpicelli JR, Clay KL, Watson NT, O'Brien CP (1995a) Naltrexone in the treatment of alcoholism: predicting response to naltrexone. J Clin Psychiatry 56(Suppl 7):39–44

    PubMed  Google Scholar 

  • Volpicelli JR, Watson NT, King AC, Sherman CE, O'Brien CP (1995b) Effect of naltrexone on alcohol “high” in alcoholics. Am J Psychiatry 152:613–615

    PubMed  CAS  Google Scholar 

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Acknowledgments

This research was supported by the National Institute on Alcohol Abuse and Alcoholism R01 AA12696-01A1. The authors have no financial interest in this manuscript. All of the authors on this paper were actively involved in the design of the study, overseeing the conduct of the study, overseeing data collection and management, analysis and interpretation of the data, as well as the preparation, review, and approval of the manuscript. The PI of this grant (Dr. Davidson) had full access to the data of the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA

    Richard Longabaugh

  2. The George Washington University, Washington, D.C., USA

    Philip W. Wirtz

  3. Department of Veteran’s Affairs VISN 17 Center of Excellence and Texas A & M College of Medicine, College Station, TX, USA

    Suzy Bird Gulliver

  4. Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, USA

    Dena Davidson

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  1. Richard Longabaugh
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  4. Dena Davidson
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Correspondence to Dena Davidson.

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Longabaugh, R., Wirtz, P.W., Gulliver, S.B. et al. Extended naltrexone and broad spectrum treatment or motivational enhancement therapy. Psychopharmacology 206, 367–376 (2009). https://doi.org/10.1007/s00213-009-1615-3

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  • DOI: https://doi.org/10.1007/s00213-009-1615-3

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