Targeted naltrexone treatment of early problem drinkers

Naltrexone is approved for daily use in the treatment of alcohol dependence. We evaluated the feasibility of using targeted naltrexone (i.e., on an ''as-needed'' basis) to treat early problem drinkers. Twenty-one subjects (52% male) received brief coping skills training weekly for 4 weeks, along with naltrexone (50 mg), which they were instructed to use 2 to 5 times per week in anticipation of high-risk drinking situations. During treatment, statistically and clinically significant declines were observed across a variety of drinking-related outcomes, including the intensity of drinking, the decline in which was correlated with medication use. Beneficial effects of the intervention were still evident during the 3-month posttreatment period. Further research, including a placebo-controlled evaluation of targeted naltrexone, is needed to determine the optimal treatment strategy for early problem drinkers, many of whom are seen in the primary-care medical setting. (C) 1997 Elsevier Science Ltd.