Naltrexone reduces drinking in alcoholics with post-traumatic stress disorder

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1. Patients receiving naltrexone had reduced drinking behavior. 

2. Prolonged exposure therapy for PTSD (post-traumatic stress disorder) was not associated with worsening alcohol abuse. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: All patients in this study with both PTSD (post-traumatic stress disorder) and alcoholism receiving naltrexone treatment showed significantly reduced drinking behavior, and those in the exposure therapy groups did not experience worsening alcohol abuse. This study is importantly unique because patients with comorbid PTSD and alcohol abuse relapse sooner than alcoholics with other Axis I psychiatric diagnoses. It’s also novel in its inclusion since alcoholics are often excluded from PTSD studies due to the thought that PTSD exposure therapy may worsen drinking behavior, which this study did not show. Further studies may be needed to delineate the counseling versus exposure therapy null result since prior studies have shown exposure therapy to be superior to counseling. This study adds important evidence to the treatment approach of alcoholics with comorbid PTSD.

Click to read the study published today in JAMA

Click to read an accompanying editorial published today in JAMA

Relevant Reading: Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (The COMBINE Study): Examination of Posttreatment Drinking Outcomes

In-Depth [single-blind, randomized study]: This study of 165 treatment-seeking participants were randomized to 4 different groups that compared naltrexone and prolonged exposure therapy, separately and in combination, along with supportive counseling at one Philadelphia center. Those who received naltrexone had lower percentages of days drinking than those who received placebo (P = .008). PTSD symptoms were also reduced in all 4 groups, but prolonged exposure therapy did not significantly stand out as superior to counseling. All groups had increases in drinking at 6 months follow up, but those in the prolonged exposure therapy plus naltrexone group had the smallest increases.

By Mike Hoaglin and Brittany Hasty

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