The objective of this research program is to improve treatment for alcoholism by investigating the combined effectiveness of a proven type of psychotherapy, cognitive behavioral therapy (Coping Skills Training and Cue Exposure Treatment - CSTCET), with pharmacotherapy (Naltrexone), in a balanced 2X2 factorial randomized clinical trail. Recent advances in cognitive behavioral and pharmacological theories and research suggest that a clinical trial of the separate and interactive effectiveness of these treatments on drinking over 72 weeks. Matching hypotheses regarding cue reactivity and naltrexone will be investigated. Finally, theoretically important mediating mechanisms such as cue reactivity (e.g., urge to drink and salivary response) and appetitive responses (e.g., hunger and weight) will be assessed, and exploratory analyses will be conducted. 160 male and female alcoholics, recently detoxified for their alcohol use, will be recruited into this study. Subjects will receive 2 weeks of CSTCET or a control treatment while inpatients and will then receive either naltrexone or placebo for 12 consecutive weeks as outpatients. Assessment of cue reactivity will occur at the start of the psychological treatment condition, and at its completion, to insure that subjects have learned certain skills prior to pharmacotherapy. This assessment will be repeated at the end the medication condition, after subjects have utilized these skills while on the medication in the natural environment. Subjects and their significant other will be contacted for follow-up at 24, 48, and 72 weeks after all treatment is completed. This study will go beyond currently available data on both factors under study (CSTCET and medication) by being the first test of the interaction between these cutting edge treatments with alcoholics severely impaired enough to have been hospitalized. It will also be the first test of a theoretically relevant matching variable (cue reactivity) with naltrexone. Finally, the study will tell us more about the long term interaction of CSTCET and naltrexone by conducting follow-ups for a period of time considerably longer than any other available in the naltrexone literature.
Showing the most recent 10 out of 41 publications
