Naltrexone combined with either cognitive behavioral or motivational enhancement therapy for alcohol dependence
Naltrexone combined with either cognitive behavioral or motivational enhancement therapy for alcohol dependence
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DOI：
10.1097/01.jcp.0000172071.81258.04
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发表时间：
2005-08-01
影响因子：
2.9
通讯作者：
Woolson, R
中科院分区：
文献类型：
--
作者：
Anton, RF;Moak, DH;Woolson, R
尽管纳曲酮已经被证明在治疗酒精依赖方面是有效的，但当它与不同的行为疗法相结合时，其有效性却知之甚少。以前的研究表明，纳曲酮与每周认知行为疗法(CBT)相结合效果最好。这项研究检测了纳曲酮联合CBT或激励增强疗法的疗效，该疗法与患者接触较少。门诊酗酒患者(N=160)被随机分配到纳曲酮(50 mg/d)或安慰剂和CBT(12个疗程)或激励增强疗法(4个疗程)，4个细胞设计，并在12周内治疗。定期评估受试者的饮酒、渴求和饮酒的生物标志物(碳水化合物缺乏的转铁蛋白和伽马谷氨基转移酶)。在试验中，治疗和药物治疗的保留率和依从性很高，各治疗组之间没有显着差异。纳曲酮，与治疗分配无关，增加了首次复发的时间。然而，CBT-纳曲酮组在各种结果指标上比其他组做得更好。接受CBT-纳曲酮治疗的受试者复发率较低，而接受CBT-纳曲酮治疗的受试者复发率较低，两次复发者之间的时间间隔较长。这项随机对照试验与先前关于联合应用纳曲酮和CBT的有效性的报道一致。尽管激励增强疗法和纳曲酮的联合用药更有效，但效果不如CBT和纳曲酮。由于CBT和纳曲酮具有共同的作用机制，如减少渴求和预防复发，这些疗法很可能很适合联合使用。
Although naltrexone has been shown to be effective in the treatment of alcohol dependence, less is known about its efficacy when combined with different behavioral therapies. Previous work has suggested that naltrexone works best when combined with weekly cognitive behavioral therapy (CBT). This study examined the efficacy of naltrexone when combined with CBT or a motivational enhancement therapy involving less patient contact. Outpatient alcoholics (N = 160) were randomly assigned to either naltrexone (50 mg/d) or placebo and either CBT (12 sessions) or motivational enhancement therapy (4 sessions), in a 4-cell design, and treated over a 12-week period. Subjects were evaluated periodically for alcohol consumption, craving, and biologic markers of drinking (carbohydrate-deficient transferrin and gamma-glutamyltransferase). There was high retention and adherence to therapy and medication in the trial with no significant difference across the treatment groups. Naltrexone, independent of therapy assignment, increased the time to first relapse. However, the CBT-naltrexone group did better than the other groups on a variety of outcome measures. Fewer CBT-naltrexone-treated subjects relapsed, and those that did had both fewer, and more time between, subsequent relapses.This randomized controlled trial is consistent with previous reports about the utility of combining naltrexone with CBT. Despite being more efficient to administer, the combination of motivational enhancement therapy and naltrexone is less effective than CBT and naltrexone. Because CBT and naltrexone share common mechanisms of action, such as craving reduction and relapse prevention, these therapies are likely to be well suited to use in combination.