Predictors of compliance with naltrexone among alcoholics

Objective: Naltrexone has been found to be an effective adjunct to treatmen t to reduce the rate of drinking among alcoholics. However, adherence to th e medication has been of considerable concern; the high rates of noncomplia nce with the medication limits the benefits that could potentially be reali zed from this pharmacotherapy. Knowledge of predictors of noncompliance cou ld result in interventions targeted at these variables. Method: Participants were 128 alcohol-dependent patients who participated i n a clinical placebo-controlled trial of naltrexone. Upon discharge from a 1- to 2-week partial hospital program, patients were randomly placed into 1 2 weeks of naltrexone (50 mg/day) or placebo (n = 64 per condition). Patien ts met with a physician and a research assistant weekly for 4 weeks then bi weekly for 8 weeks. Results: Compliance (number of days taking medication) was not predicted by demographic or pretreatment alcohol use variables. Number and severity of side effects in the first week, particularly nausea and fatigue, predicted early termination. Compliance was not predicted by commitment to abstinence or self-efficacy about abstinence, but was greater among patients who beli eved more strongly that the medication would help them stay sober. Complian ce was not predicted by general level of urge to drink during the first wee k on medication but compliance was greater among those with a higher urge t o drink in response to alcohol stimuli in the laboratory. Conclusions: Implications for approaches to increase compliance include red ucing side effects and increasing patients' beliefs in the efficacy of nalt rexone.