Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Use of naltrexone in reducing self-injurious behavior: A single case analysis

  • 61 Accesses

  • 9 Citations


The efficacy of the opiate antagonist, naltrexone, in the treatment of self-injurious behavior (SIB) was examined in a 10-year-old mildly mentally retarded boy with SIB of 9 years duration. Naltrexone was demonstrated to be effective in both an open trial (100 mg of naltrexone resulted in a 69.3% decrease in SIB from baseline), and in a double-blind, placebo-controlled trial using a B1-B2-A1-B2 design (B1=100 mg naltrexone; A1=placebo; B2=200mg naltrexone). A dose-response relationship was demonstrated insofar as the greatest decrease in SIB of 92.1% was achieved at 200 mg of naltrexone. This study lends clinical support to the hypothesis that the endogenous opiate system may be involved in the maintenance of SIB and suggests that naltrexone may be effective in the treatment of severe SIB.

This is a preview of subscription content, log in to check access.


  1. Akil, H., Watson, S. I., Young, E., Lewis, H. E. Khachaturian, H., and Walker, J. M. (1984). Endogenous opioids: Biology and function.Annu. Rev. Neurosci 7: 223–255.

  2. Amir, S., and Amit, Z. (1979). The pituitary gland mediates acute and chronic pain: Responsiveness in stressed rats.Life Sci. 24: 439–448.

  3. Antee, L. (1974). Catalepsy and stereotypies in rats treated with methadone; relation to striatal dopamine.Eur. J. Pharm. 27: 222–230.

  4. Atkinson, R. L. (1984). Endocrine and metabolic effects of opiate antagonists.J. Clin. Psychiatry 45: 20–24.

  5. Azrin, N. H., and Nunn, R. G. (1973). Habit-reversal: A method of eliminating nervous tics and habits.Behav. Res. Ther. 11: 619–628.

  6. Barrett, R. P., Feinstein, C., and Hole, W. T. (1989). Effects of naloxone and naltrexone on self-injury: A double-blind, placebo-controlled analysis.Am. J. Ment. Retard. 93:644–651.

  7. Barron, J. L., and Sandman, C. A. (1984). Self-injurious behavior and stereotypy in an institutionalized mentally retarded population.Appl. Res. Ment. Retard. 5: 499–511.

  8. Barron, J., and Sandman, C. A. (1985). Paradoxical excitement to sedative-hypnotics in mentally retarded clients.Am. J. Ment. Def. 2: 124–129.

  9. Baumeister, A. A., and Frye, G. D. (1985). The biochemical basis of the behavioral disorder in the Lesch-Nyhan Syndrome.Neurosci. Biobehav. Rev. 9: 169–178.

  10. Beckwith, B. E., Couk, D. I., and Schumacker, K. (1986). Failure of naloxone to reduce selfinjurious behavior in two developmentally disabled females.Appl. Res. Ment. Retard. 7: 183–188.

  11. Belluzzi, J. D., and Stein, L. (1977). Enkephalin may mediate euphoria and drive-reduction reward.Nature (London) 266: 556–558.

  12. Bernstein, G. A., Huges, J. R., Mitchell, J.E., and Thompson, T. (1987). Effects of narcotic antagonists on self-injurious behavior.Ann. Rev. Psychol. 33: 87–101.

  13. Bortz, W. M., III, Angwin, K., Mefford, I. N., Boarder, M. R., Noyce, N., and Barchas, J. D. (1981). Catecholamines, dopamine, and endorphin levels during extreme exercise.New Eng. J. Med. 8: 466–467.

  14. Brahen, L. S., Capone, T. J., and Capone, D. M. (1988). Naltrexone: Lack of effect on hepatic enzymes.J. Clin. Pharm. 28: 64–70.

  15. Burns, M. E. (1980). Droperidol in the management of hyperactivity, self-mutilation, and aggression in mentally handicapped patients.J. Int. Med. Res. 8: 31–33.

  16. Cain, A. C. (1961). The presuperego ‘turning-inward’ of aggression.Psychoanal. Quart. 30: 171–208.

  17. Campbell, M., Adams, P., Small, A. M., McVeigh Tesch, L., and Curren, E. L. (1988). Naltrexone in infantile autism.Psychopharm. Bull. 24: 35–139.

  18. Campbell, M., Perry, R., Bennett, G., Small, A. M., Green, W. H., Grega, D., Schwartz, V., and Anderson, L. (1983). Long-term therapeutic efficacy and drug-related abnormal movements. A prospective study of haloperidol in autistic children.Psychopharm. Bull. 19: 80–83.

  19. Carr, E. G. (1977). The motivation of self-injurious behavior: A review of some hypotheses.Psychol. Bull. 84: 800–816.

  20. Carr, E. G., and Durand, M. M. (1985). Reducing behavior problems through functional communication training.J. Appl. Behavior. Anal. 18: 11–126.

  21. Carr, E. G., and Lovaas, O. I. (1983). Contingent electric shock as a treatment for severe behavior problems. In Axelrod, S., and Apsche, S. (eds.),Punishment: Its Effects on Human Behavior, Academic Press, New YOrk, pp. 219–254.

  22. Cataldo, M. F., and Harris, J. (1982). The biological basis for self-injury in the mentally retarded.Anal. Intervent. Dev. Dis. 2: 21–39.

  23. Chee, F. K. W., Kreutzberg, J. R., and Clark, D. L. (1978). Semicircular canal stimulation in cerebral palsied children.Phys. Ther. 58: 1071–1075.

  24. Cools, A. R., Weigant, V. M., and Gispan, W. H. (1978). Distinct dopaminergic systems in ACTH-induced grooming.Eur. J. Pharm. 50: 265–268.

  25. Dashieff, R. M. (1980). Benzodiazepine treatment for Lesch-Nyhan Syndrome?Dev. Med. Child Neurol. 20: 101–102.

  26. Davidson, P. W., Keene, B. M., Carroll, M., and Rockowitz, R. J. (1983). Effects of naloxone on self-injurious behavior: A case study.Appl. Res. Ment. Retard. 4: 1–4.

  27. Day, R. M., Rea, J. A., Schussler, N. G., Larsen, S. E., and Johnson, W. L. (1988). A functionally based approach to the treatment of self-injurious behavior.Behav. Mod. 12: 565–589.

  28. Dehen, H., Willer, J. C. Boureau, F., and Cambier, J. (1977). Congenital insensitivity to pain and endogenous morphine-like substances.Lancet 2: 293–294.

  29. DeLissovoy, V. (1963). Head banging in early childhood, a suggested cause.J. Genet. Psychol. 102: 109–114.

  30. Deutsch, S. I. (1986). Rationale for the administration of opiate antagonists in treating infantile autism.Am. J. Ment. Def. 90: 631–635.

  31. Edelson, S. M. (1984). Implications of sensory stimulation in self-destructive behavior.Am. J. Ment. Def. 89: 140–145.

  32. Farber, J. M. (1987). Psychopharmacology of self-injurious behavior in the mentally retarded.J. Am. Acad. Child Adol. Psychiatry 26: 296–302.

  33. Favell, J. E., Azrin, N. H., Baumeister, A. A., Carr, E. G., Dorsey, M. F., Forehand, R. M., Lovaas, O. I., Rincover, A., Risley, T. R., Romanczyk, R. G., Russo, D. C., Schroeder, S. R., and Solnick, J. V. (1982). The treatment of self-injurious behavior.Behav. Ther. 13: 529–554.

  34. Forness, S. R., Thornton, R. L., and Horton, A. (1981). Assessment of applied academic and social skills.Educ. Training Ment. Retard. 16: 104–109.

  35. Girardot, M. N., and Holloway, F. A. (1985). Chronic stress, aging, and morphine analgesia: Chronic stress affects the reactivity to morphine in young mature but not old rats.J. Pharm. Exp. Ther. 233–544-553.

  36. Goldstein, M., Anderson, L. T., Reuben, R., and Dancis, J. (1985). Self-mutilation in Lesch-Nyhan disease in caused by dopaminergic denervation.Lancet 1: 338–339.

  37. Goldstein, M., Kuga, M., Kusano, N., Meller, E., Dancis, J., and Schwarcz, R. (1986). Dopamine agonist induced self-mutilative biting behavior in monkeys with unilateral ventromedial tegmental lesions of the brainstem: Possible pharmacological model for Lesch-Nyhan Syndrome.Brain Res. 367: 113–120.

  38. Herman, B. H., and Panksepp, J. (1978). Effects of morphine and naloxone on separation distress and approach attachment: Evidence for opiate mediation of social affect.Pharm. Biochem. Behav. 9: 213–220.

  39. Herman, B. H., Hammock, M. K., Arthur-Smith, A., Egan, J., Chatoor, I., Werner, A., and Zelni, N. (1987). Naltrexone decreases self-injurious behavior.Ann. Neurol. 22: 550–553.

  40. Herman, B. H., Arthur-Smith, A., Hammock, M. K., and Joseph S. (1988). Ontogeny of Bendorphin and cortisol in the plasma of children and adolescents.J. Clin. Endocrin. Metabol. 67: 186–190.

  41. Hersen, M., and Barlow, D. H. (1976).Single Case Experimental Designs: Strategies for Studying Behavior Change, Pergamon Press, New York.

  42. Hill, B. K., Balow, E. A., and Bruiniks, R. H. (1985). A national study of prescribed drugs in institutions and community residential facilities for mentally retarded people.Psychopharm. Bull. 21: 279–284.

  43. Intagliata, J., and Rinck, C. (1985). Psychoactive drug use in public and community residential facilities for mentally retarded persons.Psychopharm. Bull. 21: 269–278.

  44. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982). Toward a functional analysis of self-injury.Anal. Intervent. Dev. Dis. 2: 3–20.

  45. Jolles, J., Rompa-Barendregt, J., and Gispen, W. H. (1979). ACTH-induced excessive grooming in the rat: The influence of environmental and motivational factors.Horm. Behav. 12: 60–72.

  46. Jones, I. H., and Barraclough, B. M. (1978). Automutilation in animals and its relevance to self-injury in man.Acta Psych. Scand. 58: 40–47.

  47. Katz, R. J., and Roth, K. A. (1979). Stress-induced grooming in the raan endorphin mediated syndrome.Neurosci. Lett. 13: 209–212.

  48. Lapierre, Y. D., and Reesal, R. (1986). Pharmacologic management of aggressivity and self-mutilation in the mentally retarded.Psychiatr. Clin. North Am. 9: 745–754.

  49. Madden, J., Akil, H., Patrick, R. L., and Barchas, J. D. (1977). Stress-induced parallel changes in central opioid levels and pain responsiveness in the rat.Nature (London) 265: 356–360.

  50. Margolin, D. I., and Moon, B. H. (1979). Naloxone blockade of apomorphine-induced stereotyped behavior.J. Neurol. Sci 43: 13–17.

  51. Mello, N. K., and Mendelson, J. H. (1978). Self-administration of an enkephalin analog by rhesus monkey.Pharm. Biochem. Behav. 9: 579–586.

  52. Mendelson, J. H., Ellingboe, J., Keuhnle, J. C., and Mello, N. K. (1979). Effects of naltrexone on mood and neuroendocrine function in normal adult males.Psychoneuroend. 3: 231–236.

  53. Micev, V., and Lunch, D. M. (1974). Effects of lithium on disturbed severely mentally retarded patients.Br. J. Psych. 125: 110.

  54. Mizuno, T., and Yugari, Y. (1974). Self-mutilation in Lesch-Nyhan Syndrome.Lancet 1: 761.

  55. Nyhan, W. L., Johnson, H. G., Kaufaman, I.A., and Jones, K. L. (1980). Serotonergic approaches to the modification of behavior in the Lesch-Nyhan Syndrome.Appl. Res. Ment. Retard. 1: 25–40.

  56. Panksepp, J., Herman, B., Conner, R., Bishop, P., and Scott, J. P. (1978). The biology of social attachments: Opiates alleviate separation distress.Biol. Psychiatry 13: 607–618.

  57. Richardson, J. S., and Zaleski, W. A. (1983). Naloxone and self-mutilation.Biol. Psychiatry 18: 99–101.

  58. Rogol, A. D., Veldhuis, J. D., Williams, F. A., and Johnson, M. L. (1984). Pulsatile secretion of gonadotropins and prolactin in male marathon runners. Relation to the endogenous opiates system.J. Androl. 5: 21–27.

  59. Romanczyk, R. G., and Goren, E. R. (1975). Severe self-injurious behavior: The problem of clinical control.J. Consult. Clin. Psychol. 43: 730–739.

  60. Ross, R. R., and McKay, H. B. (1979).Self-Mutilation, Lexington Books, Toronto.

  61. Sandman, C. A., Datta, P. C., Barron, J., Hoehler, F. K., Williams, C., and Swanson, J. M. (1983). Naloxone attenuates self-abusive behavior in developmentally disabled clients.Am. J. Ment. Def. 88: 177–186.

  62. Sandyk, R. (1985). Naloxone abolishes self-injury in a mentally retarded childAnn. Neurol. 17: 520.

  63. Schroeder, S. R., Schroeder, C. S., Smith, B., and Daldorf, J. (1978). Prevalence of self-injurious behaviors in a large state facility for the retarded: A three-year follow-up study.J. Autism Child. Schizophr. 8: 261–269.

  64. Schroeder, S. R. Schroeder, C. S., Rojahn, J., and Mulick, J.A. (1980). Self-injurious behavior: An analysis of behavior management techniques. In Matson, J. L., and McCartney, J. R. (eds.),Handbook of Behavior Modification with the Mentally Retarded, Plenum Press, New York, 1981.

  65. Singh, N. N., and Millichamp, C. J. (1985). Pharmacological treatment of self-injurious behavior in mentally retarded persons.J. Autism Dev. Discord. 15: 257–267.

  66. Snyder, S. H. (1977). Opiate receptors in the brain.New Eng. J. Med. 296: 266–27.

  67. Sovner, R., and Hurley, A. (1981). The management of chronic behavior disorders in mentally retarded adults with lithium carbonate.J. Nerv. Ment. Dis. 169: 191–195.

  68. Szymanski, L., Kedesdy, J., Sulkes, S., and Cutter, A. (1987). Naltrexone in treatment of self-injurious behavior: A clinical study.Res. Dev. Disb. 8: 179–190.

  69. Tu, J., and Smith, J. T., (1982). The eastern Ontario survey: A study of drug treated psychiatric problems in the mentally handicapped.Canad. J., Psychiatry 28: 270–276.

  70. Verebey, K. G. (1982).Clinical Pharmacology of Naltrexone, Proceedings of the 135th Annual Meeting of the American Psychiatric Association, Toronto.

  71. Verebey, K., Volavka, J., Mule, S. J., and Resnick, R. B. (1976). Naltrexone disposition, metabolism and effects after acute and chronic dosing.Clin. Pharm. Therap. 20: 315–328.

  72. Warren, S. A., and Burns, N. R. (1970). Crib confinement as a factor in repetitive and stereotyped behavior in retardates.Ment. Retard. 8: 25–28.

  73. Weizman, R., Weizman, Tyanos, S., Szekely, G., Weissman, B. A., and Sarne, Y. (1984). Humoral-endorphin blood levels in autistic, schizophrenic, and healthy subjects.Psychopharmacology 82: 368–370.

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ryan, E.P., Helsel, W.J., Lubetsky, M.J. et al. Use of naltrexone in reducing self-injurious behavior: A single case analysis. Journal of the Multihandicapped Person 2, 295–309 (1989).

Download citation

Key words

  • self-injurious behavior
  • opiate antagonist
  • endogenous opiate
  • endogenous endorphin