Naltrexone and Cue Exposure With Coping and Communication Skills Training for Alcoholics: Treatment Process and 1-Year Outcomes

Authors

  • Peter M. Monti,

    Corresponding author
    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Damaris J. Rohsenow,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Robert M. Swift,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Suzy B. Gulliver,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Suzanne M. Colby,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Timothy I. Mueller,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Richard A. Brown,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Alan Gordon,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • David B. Abrams,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Raymond S. Niaura,

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Marilyn K. Asher

    1. Providence VA Medical Center (PMM, DJR, RMS); the Center for Alcohol and Addiction Studies, Brown University (PMM, DJR, RMS, SBG, SMC, MKA); Butler Hospital/Brown University (TIM, RAB, AG); and Butler Hospital/Brown University School of Medicine (DBA, RSN), Providence, Rhode Island.
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  • Supported by Grant 2R01 AA07850 from the NIAAA, by Career Research Scientist awards from the Department of Veterans Affairs to PMM and DJR, and by a VA Merit Review grant from the Medical Research Service Office of Research and Development, Department of Veterans Affairs. Medication and placebo were supplied by DuPont-Merck Pharmaceutical Company.

Peter M. Monti, PhD, Center for Alcohol and Addiction Studies, Box G-BH, Brown University, Providence, RI 02912; Fax: 401-444-1888; E-mail: peter_monti@brown.edu.

Abstract

Background: Promising treatments for alcoholics include naltrexone (NTX), cue exposure combined with urge-specific coping skills training (CET), and communication skills training (CST). This study investigated the effects of combining these elements as treatment adjuncts.

Methods: A 2 × 2 design investigated the effects of CET combined with CST, as compared with an education and relaxation control treatment, during a 2-week partial hospital program (n= 165) followed by 12 weeks of NTX (50 mg/day) or placebo during aftercare (n= 128). Drinking outcomes were assessed at 3, 6, and 12 months after discharge from the partial hospital. Process measures included urge, self-efficacy (confidence about staying abstinent in risky situations), and self-reported coping skills. Medically eligible alcohol-dependent patients were recruited.

Results: Among those compliant with medication on at least 70% of days, those who received NTX had significantly fewer heavy drinking days and fewer drinks on days that they drank than those receiving placebo during the medication phase but not during the subsequent 9 months. CET/CST-condition patients were significantly less likely to report a relapse day and reported fewer heavy drinking days at the 6- and 12-month follow-ups than patients in the control treatment. Interactions of medication with behavioral treatments were not significant. Process measures showed that NTX resulted in lower weekly urge ratings, and those in CET/CST used more of the prescribed coping skills after treatment, reported fewer cue-elicited urges, and reported more self-efficacy in a posttest role-play test. Drinking reductions at 3, 6, and 12 months correlated with more use of coping skills, lower urge, and higher self-efficacy.

Conclusions: The results suggest the probable value of keeping alcoholics on NTX for longer periods of time and the importance of increasing compliance with NTX. They also support the earlier promising effects of CET and CST as adjuncts to treatment programs for alcoholics by maintaining treatment gains over at least a year. The value of the urge-specific and general coping skills and of self-efficacy and urge constructs was demonstrated in their association with drinking outcomes.

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