Outpatient cognitive behavioural therapy programme for alcohol dependence impact of naltrexone use on outcome

Objective: Cognitive-behavioural therapy (CBT) has been effectively used in the treatment of alcohol dependence. Clinical studies report that the anti craving drug naltrexone, is a useful adjunct to treatment. Currently, few d ata are available on the impact of adding this medication to programmes in more typical, outpatient, and rehabilitation settings. The objective of thi s study was to examine the impact on outcome of adding naltrexone to an est ablished outpatient alcohol rehabilitation program which employed CBT. Method: Fifty patients participated in an established 12-week, outpatient, 'contract'-based alcohol abstinence programme which employed CBT. They also received naltrexone 50 mg orally daily (CBT + naltrexone). Outcomes were c ompared with 50 historical, matched controls, all of whom participated in t he same programme without an anticraving medication (CBT alone). All patien ts met DSM-IV criteria for alcohol dependence. Results: Programme attendance across the eight treatment sessions was lower in the CBT alone group (p < 0.001). Relapse to alcohol use occurred sooner and more frequently in the CBT alone group (p < 0.001). Rehabilitation pro gramme completion at 12 weeks was 88% (CBT + naltrexone) compared with 36% for (CBT alone) (p < 0.001). Alcohol abstinence at 12 weeks was 76% (CBT naltrexone) compared with 18% (CBT alone) (p < 0.001). Conclusion: When employing the same outpatient rehabilitation programme and comparing outcomes using matched historical controls, the addition of nalt rexone substantially improves programme attendance, programme completion an d reported alcohol abstinence. In a typical outpatient programme, naltrexon e addition was associated with significantly improved programme participati on, better outcomes and was well tolerated.