Naltrexone and cue exposure with coping and communication skills training for alcoholics: Treatment process and 1-year outcomes

Background: Promising treatments for alcoholics include naltrexone (NTX), c ue exposure combined with urge-specific coping skills training (CET), and c ommunication skills training (CST). This study investigated the effects of combining these elements as treatment adjuncts. Methods: A 2 X 2 design investigated the effects of CET combined with CST, as compared with an education and relaxation control treatment, during a 2- week partial hospital program (n = 165) followed by 12 weeks of NTX (50 mg/ day) or placebo during aftercare (n = 128). Drinking outcomes were assessed at 3, 6, and 12 months after discharge from the partial hospital. Process measures included urge, self-efficacy (confidence about staying abstinent i n risky situations), and self-reported coping skills. Medically eligible al cohol-dependent patients were recruited. Results: Among those compliant with medication on at least 70% of days, tho se who received NTX had significantly fewer heavy drinking days and fewer d rinks on days that they drank than those receiving placebo during the medic ation phase but not during the subsequent 9 months. CET/CST-condition patie nts were significantly less likely to report a relapse day and reported few er heavy drinking days at the 6- and 12-month follow-ups than patients in t he control treatment. Interactions of medication with behavioral treatments were not significant. Process measures showed that NTX resulted in lower w eekly urge ratings, and those in CET/CST used more of the prescribed coping skills after treatment, reported fewer cue-elicited urges, and reported mo re self-efficacy in a posttest role-play test. Drinking reductions at 3, 6, and 12 months correlated with more use of coping skills, lower urge, and h igher self-efficacy. Conclusions: The results suggest the probable value of keeping alcoholics o n NTX for longer periods of time and the importance of increasing complianc e with NTX. They also support the earlier promising effects of CET and CST as adjuncts to treatment programs for alcoholics by maintaining treatment g ains over at least a year. The value of the urge-specific and general copin g skills and of self-efficacy and urge constructs was demonstrated in their association with drinking outcomes.