An orally administered opiate blocker, naltrexone, attenuates self-injurious behavior

Several recent reports have indicated that opioid blockers are effective in attenuating self-injurious behavior (SIB). In the present study, four patients with SIB were challenged with four fixed doses (0, 25, 50, 100 mg) of naltrexone. In a double-blind procedure, all patients received each dose on a different week as determined by latin square design. Naltrexone was given on Monday and Wednesday of each week, and patients were videotaped daily for 10 minutes in the morning and afternoon. The tapes were scored for incidents of SIB, stereotypy, and activity, with interrater reliability of 0.93. The Conners Teacher Rating Scale was administered by staff in the morning and afternoon each day. The Vineland was completed each week (Thursday). All patients had decreased SIB when treated with naltrexone. Three patients decreased their SIB as dose of naltrexone increased. There were no consistent effects of naltrexone on stereotypy, activity, or performance on the Conners or the Vineland. These results suggest that endogenous opioids are implicated in SIB and that naltrexone is a powerful tool for examination of this treatment-resistant behavior.