Use of naltrexone in the treatment of alcohol use disorders in patients with concomitant major mental illness

We report the use of naltrexone for treatment of alcohol use disorder in pa tients with major psychiatric illness. We reviewed the re cords of 72 menta lly ill outpatients treated with naltrexone for alcohol use disorders at a community mental health center. The psychiatric diagnoses included major de pression (n = 37), schizophrenia (n = 17), bipolar illness (n = 11), schizo affective disorder(n = 7), and gender identity disorder (n = 4). Sixty-one patients (85%) had histories of psychiatric hospitalization. Total retentio n in naltrexone treatment for at least eight weeks was 81.9%: 5 (6.9%) were lost to follow-up, and 8 (11.1%) discontinued the medication because of si de effects, primarily nausea. Patients showed good clinical response to nal trexone, with 82% reducing their drinking by at least 75%, and only 17% rel apsing at eight weeks. We conclude that naltrexone is useful in the treatme nt of dually-disordered patients The hypothesis that clinical response to n altrexone is facilitated by active alcohol drinking during treatment is dis cussed.