Behavioral therapies plus pharmacotherapies can add up to success

eligible for the medication for medical reasons."

In this study, researchers looked at the effects of prescribing naltrexone versus a placebo during the 90 days after alcoholics completed a two-week daily alcohol treatment program. The two-week program consisted of either CST/CET training, or educational discussions and relaxation training.

"Alcoholics who took naltrexone for at least two months of the 90 days that they were prescribed it drank alcohol significantly less heavily as compared to alcoholics who were given a placebo," said Monti. "While naltrexone did not affect whether alcoholics had any drinks at all, alcoholics using naltrexone had fewer heavy drinking days, had fewer drinks if they drank, and had fewer urges to drink. The beneficial effects of naltrexone lasted only while the alcoholics were taking naltrexone, suggesting that it would be helpful to prescribe naltrexone for longer than 90 days."

Naltrexone has been used for the treatment of alcoholism since its 1994 approval by the federal Food and Drug Administration. Naltrexone acts as an opioid antagonist within the opioid neurotransmitter system, which is a part of the brain's reward system. When opioids are stimulated, levels of a neurotransmitter called dopamine are increased. Dopamine activity is thought to be key to experiencing the "high" of a variety of different drugs, including alcohol. Naltrexone achieves its effects by "blocking" this domino-type chain of events that lead to the desire to continue drinking. In short, naltrexone decreases the rewarding effects of drinking and reduces the craving for alcohol that often leads people to relapse.

"One thing that is new about this study," said Stephanie S. O'Malley, professor of psychiatry at Yale University School of Medicine, "is the sequencing of therapies. The behavioral interventions were provided during day hospital treatment, while the pharamcotherapy occurred after discharge when the patient


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