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High-dose naltrexone therapy for cocaine-alcohol dependence
Joy M Schmitz1, Jan A Lindsay, Charles E Green
1Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Texas, USA. Joy.M.Schmitz@uth.tmc.edu
The American Journal on Addictions
|October 31, 2009
Summary
High-dose naltrexone and cognitive behavioral therapy (CBT) showed limited effects for dual cocaine and alcohol dependence. Adding contingency management (CM) did not improve outcomes for this patient group.
Area of Science:
- Addiction medicine
- Clinical psychology
- Psychopharmacology
Background:
- Dual diagnosis of substance use disorders presents unique treatment challenges.
- Naltrexone and cognitive behavioral therapy (CBT) are established treatments for single substance use disorders.
- The efficacy of these interventions for co-occurring cocaine and alcohol dependence requires further investigation.
Purpose of the Study:
- To compare high-dose naltrexone with placebo in individuals with both cocaine and alcohol dependence.
- To examine if adding contingency management (CM) to CBT enhances treatment outcomes compared to CBT alone.
- To assess the combined effects of pharmacological and behavioral interventions for dual drug dependence.
Main Methods:
- Randomized, double-blind, placebo-controlled trial with 87 participants.
- Naltrexone (100 mg/d) or placebo crossed with CBT with or without CM.
- Cocaine abstinence assessed via urine screens; alcohol use via timeline followback over 12 weeks.
Main Results:
- Low retention and medication compliance were observed across all groups.
- No significant differences in cocaine use or daily drinks between naltrexone and placebo groups.
- Naltrexone and CBT without CM reduced heavy drinking days; adding CM did not enhance outcomes.
Conclusions:
- Pharmacological and behavioral interventions effective for single substance use may not suffice for dual dependence.
- Current treatment strategies may need refinement to address the complexities of co-occurring cocaine and alcohol use disorders.
- Further research is needed to develop more effective treatments for individuals with multiple substance use disorders.
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