Naltrexone Prescribed in Doctor's Offices Effective in Treating Alcohol Dependence

Naltrexone, a drug that blocks the effects of opiates in the brain and is now used to treat alcohol dependence, Yale researchers have found, is as effective when prescribed in doctors’ offices as it is when prescribed along with specialized alcoholism counseling.

Less than 10 percent of persons in need of treatment actually receive it, according to a report of the National Institute on Alcohol Abuse and Alcoholism National Advisory Council.

Treating alcohol dependence in primary care settings is important because studies show that one in six patients or as many as one in three patients who see physicians in primary care settings are problem drinkers, the researchers said.

“Primary care (doctors) to date usually have referred out and not managed these patients themselves. These data suggest that they could,” said Stephanie O’Malley, professor of psychiatry at Yale School of Medicine and principal investigator of the study published in the July issue of the Archives of Internal Medicine.

“The major benefit of this may be to increase access to effective treatment for alcohol dependence by enlisting primary care providers into the treatment system,” said Patrick O’Connor, M.D., section chief in internal medicine and senior author of the study. “These findings increase both the treatment options for patients with alcohol dependence and the ability of our health care system to address a major problem for which resources historically have not measured up to need.”

This study also evaluated whether longer term treatment with naltrexone is effective for patients who respond to short term therapy. The overall benefit depended on the nature of the behavioral intervention. Continued naltrexone helped maintain improvements when used in the primary care setting; whereas naltrexone was less essential among those who received specialized counseling. Co-authors of the study included Bruce Rounsaville, M.D., Connor Farren, M.D., Ran Wu, and Jane Robinson, all of the Department of Psychiatry at Yale, and Kee Namkoong, M.D., of Yonsi University College of Medicine, Seoul, Korea. The study was supported by grants from the National Institutes of Health and by the Veterans Administration New England Mental Illness Research Education and Clinical Center in West Haven.