Naltrexone effective treatment for alcoholism, PTSD

Naltrexone was effective in decreasing the percentage of days drinking in people with alcohol dependence and posttraumatic stress disorder, according to recent study findings published in JAMA.

“This is the first study to our knowledge that used a design which allowed for separate examination of the effects of an evidence-based medication for alcohol dependence (naltrexone), an evidence-based psychotherapy for PTSD (prolonged exposure), and their combination, on both drinking and PTSD among individuals with comorbid alcohol dependence and PTSD,” Edna B. Foa, PhD, of the University of Pennsylvania and colleagues wrote. “Participants … showed a significant reduction in [percentage of days drinking]. However, at posttreatment, participants who received naltrexone showed significantly lower [percentage of days drinking] than participants who received placebo.”

Edna B. Foa

The randomized trial included 165 participants with PTSD and alcohol dependence. Participants were assigned to one of four groups: prolonged exposure therapy plus naltrexone (100 mg/d), prolonged exposure therapy plus pill placebo, supportive counseling plus naltrexone (100 mg/d) or supportive counseling plus pill placebo. All participants received counseling.

All groups displayed reductions in percentage of days drinking (PDD) during the study. Reductions were as follows: prolonged exposure therapy plus naltrexone (mean change, –63.9%; 95% CI, –73.6 to –54.2), prolonged exposure therapy plus placebo (–63.9%; 95% CI, –73.9 to –53.8), supportive counseling plus naltrexone (–69.9%; 95% CI, –78.7 to –61.2), and supportive counseling plus placebo (–61%; 95% CI, –68.9 to –53).

Participants assigned naltrexone had fewer PDDs compared with placebo patients (P=.008). Six months after treatment all participants had increased PDDs but those in the prolonged exposure therapy plus naltrexone group had the smallest.

“Importantly, our findings indicated that prolonged exposure therapy was not associated with increased drinking or alcohol craving, a concern that has been voiced by some investigators,” researchers wrote. “In fact, reduction in PTSD severity and drinking was evident for all four treatment groups. This finding contradicts the common view that trauma-focused therapy is contraindicated for individuals with alcohol dependence and PTSD because it may exacerbate PTSD symptoms and thereby lead to increased alcohol use.”

In an accompanying editorial, Katherine Mills, PhD, of the University of New South Wales, said the study “provides evidence regarding the treatment of this commonly occurring comorbidity and provides hope that the gap in treatment provision for this population may begin to narrow.”

For more information:

Foa EB. JAMA. 2013;310:488-495.

Mills K. JAMA. 2013;310:482-483.

Disclosure: See the study for a full list of relevant financial disclosures.