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Behavioral therapy to augment oral naltrexone for opioid dependence: a ceiling on effectiveness?
Am J Drug Alcohol Abuse. 2006; 32(4):503-17.AJ

Abstract

The effectiveness of antagonist maintenance with oral naltrexone for opioid dependence has been limited by high dropout rates. Behavioral Naltrexone Therapy (BNT) was developed to improve retention on oral naltrexone by integrating voucher incentives, Motivational and Cognitive Behavioral therapies, and a significant other for monitoring medication adherence. In a 6-month, randomized, controlled trial in heroin dependent patients, BNT (N = 36) improved retention in treatment compared to a standard treatment control (Compliance Enhancement (CE); N = 33) (log rank = 4.28; p = .04). Most patients retained beyond 3 months achieved abstinence from opioids, but retention at 6 months was only 22% on BNT and 9% on CE. A systematic review of related controlled trials revealed similar effect sizes in the small to medium range, and substantial dropout. There may be a limit on the extent to which behavioral therapy can overcome poor adherence to oral naltrexone. Future research should consider combinations of behavioral methods with new long-acting injectable or implantable naltrexone formulations.

Authors+Show Affiliations

New York State Psychiatric Institute, Division on Substance Abuse, New York, New York 10032, USA. nunesed@pi.cpmc.columbia.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17127538

Citation

Nunes, Edward V., et al. "Behavioral Therapy to Augment Oral Naltrexone for Opioid Dependence: a Ceiling On Effectiveness?" The American Journal of Drug and Alcohol Abuse, vol. 32, no. 4, 2006, pp. 503-17.
Nunes EV, Rothenberg JL, Sullivan MA, et al. Behavioral therapy to augment oral naltrexone for opioid dependence: a ceiling on effectiveness? Am J Drug Alcohol Abuse. 2006;32(4):503-17.
Nunes, E. V., Rothenberg, J. L., Sullivan, M. A., Carpenter, K. M., & Kleber, H. D. (2006). Behavioral therapy to augment oral naltrexone for opioid dependence: a ceiling on effectiveness? The American Journal of Drug and Alcohol Abuse, 32(4), 503-17.
Nunes EV, et al. Behavioral Therapy to Augment Oral Naltrexone for Opioid Dependence: a Ceiling On Effectiveness. Am J Drug Alcohol Abuse. 2006;32(4):503-17. PubMed PMID: 17127538.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Behavioral therapy to augment oral naltrexone for opioid dependence: a ceiling on effectiveness? AU - Nunes,Edward V, AU - Rothenberg,Jami L, AU - Sullivan,Maria A, AU - Carpenter,Kenneth M, AU - Kleber,Herbert D, PY - 2006/11/28/pubmed PY - 2007/3/23/medline PY - 2006/11/28/entrez SP - 503 EP - 17 JF - The American journal of drug and alcohol abuse JO - Am J Drug Alcohol Abuse VL - 32 IS - 4 N2 - The effectiveness of antagonist maintenance with oral naltrexone for opioid dependence has been limited by high dropout rates. Behavioral Naltrexone Therapy (BNT) was developed to improve retention on oral naltrexone by integrating voucher incentives, Motivational and Cognitive Behavioral therapies, and a significant other for monitoring medication adherence. In a 6-month, randomized, controlled trial in heroin dependent patients, BNT (N = 36) improved retention in treatment compared to a standard treatment control (Compliance Enhancement (CE); N = 33) (log rank = 4.28; p = .04). Most patients retained beyond 3 months achieved abstinence from opioids, but retention at 6 months was only 22% on BNT and 9% on CE. A systematic review of related controlled trials revealed similar effect sizes in the small to medium range, and substantial dropout. There may be a limit on the extent to which behavioral therapy can overcome poor adherence to oral naltrexone. Future research should consider combinations of behavioral methods with new long-acting injectable or implantable naltrexone formulations. SN - 0095-2990 UR - https://www.unboundmedicine.com/medline/citation/17127538/Behavioral_therapy_to_augment_oral_naltrexone_for_opioid_dependence:_a_ceiling_on_effectiveness L2 - https://www.tandfonline.com/doi/full/10.1080/00952990600918973 DB - PRIME DP - Unbound Medicine ER -