Early problem drinkers (i.e, those whose heavy drinking has either begun to cause them alcohol-related harm, or puts them at risk of such harm) are highly prevalent in the United States. These patients often visit primary care physicians who, increasingly, are learning to identify and intervene with this patient group. Recent, controlled trials have shown that brief interventions in the primary care setting can reduce drinking and alcohol-related problems in patients who are without substantial evidence of alcohol dependence. Although naltrexone has been approved for the treatment of alcohol dependence, few pharmacotherapy studies have been undertaken with early problem drinkers. We propose an eight-week trial of naltrexone vs. placebo, combined with coping skills treatment that either focuses on targeted use of medication or serves as background to daily use of the medication. One hundred-sixty early problem drinkers recruited through screening in primary care medical settings will be randomly assigned to one of four treatment groups (targeted daily naltrexone; targeted daily placebo). Life events, mood, desire to drink, perceived self-efficacy, and drinking will be monitored through daily self-report questionnaires. Follow-up evaluations will be conducted at the end of treatment and again three, six, and twelve months later. We hypothesize that 1) during treatment, naltrexone will result in greater reductions in desire to drink and in alcohol consumption and related problems; 2) after treatment, an advantage will emerge for the targeted medication-coping skills group; and 3) the group receiving targeted naltrexone will have the best outcomes during the follow-up period, due to the interaction of active medication and skills training, which are expected to act synergistically to enhance perceived self-efficacy. Specific mechanisms by which naltrexone exerts its beneficial effects will be examined by means of the daily process measures.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA011062-03
Application #
2769177
Study Section
Clinical and Treatment Subcommittee (ALCP)
Project Start
1996-09-01
Project End
2001-08-31
Budget Start
1998-09-01
Budget End
1999-08-31
Support Year
3
Fiscal Year
1998
Total Cost
Indirect Cost
Name
University of Connecticut
Department
Psychiatry
Type
Schools of Medicine
DUNS #
City
Farmington
State
CT
Country
United States
Zip Code
06030
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Kranzler, Henry R; Armeli, Stephen; Tennen, Howard et al. (2003) Targeted naltrexone for early problem drinkers. J Clin Psychopharmacol 23:294-304
Oslin, David W; Berrettini, Wade; Kranzler, Henry R et al. (2003) A functional polymorphism of the mu-opioid receptor gene is associated with naltrexone response in alcohol-dependent patients. Neuropsychopharmacology 28:1546-52
Feinn, Richard; Tennen, Howard; Kranzler, Henry R (2003) Psychometric properties of the short index of problems as a measure of recent alcohol-related problems. Alcohol Clin Exp Res 27:1436-41
Feinn, Richard; Tennen, Howard; Cramer, Joyce et al. (2003) Measurement and prediction of medication compliance in problem drinkers. Alcohol Clin Exp Res 27:1286-92
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Kranzler, H R; Van Kirk, J (2001) Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis. Alcohol Clin Exp Res 25:1335-41

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