Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

594 V. TREATMENTS FOR ADDICTIONSreduce alcohol craving, days of drinking per week, and the rate of relapseamong those who drank. The second study (O’Malley et al., 1992) involved 97subjects and used a 2 × 2 design in which two of the groups receivednaltrexone, 50 mg daily, and two of the groups received placebo combined witheither coping skills therapy or a supportive therapy. During this 12-week trial,the rate of relapse in those patients treated with naltrexone was 45%, whereaspatients on placebo had a 90% relapse rate. Naltrexone was well tolerated andappeared to reduce alcohol consumption and relapse rates. The psychotherapyalso had an interesting interaction with naltrexone treatment. Although thepatients in the coping skills group were more likely to initiate drinking, theywere less likely to relapse than were patients treated with supportive therapy.For those subjects who drank during the study, the most success in avoidingrelapse was attained by the naltrexone and coping skills group, which had arelapse rate of less than 35%. The worst outcome was in the placebo and supportivetherapy group, where 90% relapsed, and for this placebo group, most ofthe relapses occurred within 30 days of initiating the study. Thus, the secondstudy showed promise for not only this pharmacotherapy but also its combinationwith a specific psychotherapeutic intervention.A 6-month follow-up study reported on the persistence of naltrexone andpsychotherapy effects following discontinuation after 12 weeks of treatment foralcohol dependence (O’Malley et al., 1996). Subjects who received naltrexonewere less likely to drink heavily (defined as more than 5 drinks/day in men, andmore than 4 drinks/day in women) or meet criteria for alcohol abuse or dependencethan those who received placebo, but only through the first month offollow-up, suggesting that some patients may benefit from a period of naltrexonetreatment exceeding 12 weeks. Others have also demonstrated a modestbut consistent effect of naltrexone treatment on drinking outcomes (Anton etal., 1999).Other drugs and administration forms include long-acting, depot formulationsof naltrexone being developed as an alternative to daily or thrice weeklyoral dosing of the drug. (Volpicelli, Rhines, & Rhines, 1997). The opiateantagonist, nalmefene, is also being examined as a treatment for alcoholdependence. It may have advantages over naltrexone in that it is active notonly at mu opioid receptors but also at kappa and delta opioid receptors. It mayhave fewer gastrointestinal side effects, better bioavailability, and less liver toxicityassociated with its use (Mason, Salvato, & Williams, 1999).Serotonergic agents, including buspirone (5-HT 1Aagonist) (Kranzler et al.,1994), SRIs, and ondansetron (5-HT 3antagonist) (Sellers, Higgins, Tompkins,& Romach, 1992), have been studied as treatments for alcohol dependence butresults have been limited. The possible matching of medications to patient typeor comorbid condition may be an effective approach to treatment of alcoholdependence, but this remains to be demonstrated in clinical trials (Myrick etal., 2001). Studies showed that ondansetron reduced alcohol craving in early-