EXCEEDTHESPACE PROVIDED. Alcohol dependence is a chronic disorder that requires cliniciansto focus on both acute and long-term management. When patients relapse or fail treatment, it is imperativethat the overall management of patients be adjusted appropriately in order to provide the best long-term outcomes. Naltrexone has been established as an efficacious medication to treat alcohol dependence but studies thus far have focused mostly on the acute phase of treatment rather than long-term management and have not offered alternative treatment strategics when patients do not respond to an initial course of naltrexone. For these initial non-responders naltrexone, it is unclear what adjustments to treatment should be made to increase the likelihoodof treatment success. We are unaware of >revious research focused specifically on naltrexone non-response. Pilot data from ongoing trials at our center, lowever, suggest that up to a third of patients fail to respond to naltrexone. Moreover, these non-responsive patients go on to have the worst outcomes during the next 6 months of treatment if maintained on the same ombination of naltrexone and Medication Management (MM). We propose to augment medication management with a combination of motivational enhancement therapy and cognitive behavioral therapy (Combined Behavioral ntervention -CBI) and to tent the benefits of continued/discontinued treatment with naltrexone in a randomized lacebo-controlled trial. Clinical strategies for second line treatments often favor switching treatments rather than ugmentation. However, there may be synergies between naltrexone and CBI that were not apparent with medication management. Specifically, CBI may have advantages in motivatingpatients to greater medication dherence (a leadingcause of naltrexone treatment failure) and CBI may address psychosocial factors that limited or ttenuated the effects of naltrexone.
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