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Naltrexone and therapy reduce relapse in comorbid alcohol dependence, PTSD

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Small sample size, poor retention

The findings certainly shed light on treatment for comorbid alcohol dependence and PTSD but must be considered in the context of the study’s limitations, said Katherine Mills, Ph.D.


Dr. Katherine Mills

The sample size was relatively small, especially considering that this was a four-group, randomized controlled trial. And the retention rate was particularly low, with only 56% completing the posttreatment and follow-up interviews. "This is not surprising given the nature of the research, in which participants are asked to confront some of the most terrifying events that have ever happened to them, and simultaneously try to abstain from using alcohol and other drugs, which are often the only means by which they have felt that they could cope with the consequences of those events," she noted. Still, the study "provides hope that the gap in treatment provision for this population may begin to narrow."

Dr. Mills is with the National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use at the University of New South Wales, Sydney. She reported no relevant financial conflicts of interest. These remarks were taken from her editorial accompanying Dr. Foa’s report (JAMA 2013;310:482-3).


 

FROM JAMA

Regarding PTSD, all the study groups showed symptom reductions during treatment. After treatment ended, patients who had undergone prolonged exposure therapy showed decreases in PTSD symptoms, but the reductions did not reach statistical significance.

This null finding was attributed to the low attendance at these sessions. Also, all participants received some supportive counseling, which might have masked the effects of prolonged exposure therapy, the researchers said.

An exploratory analysis was performed to elucidate this unexpected result. It showed that 70% of participants who received naltrexone plus prolonged exposure therapy achieved a "low" level of PTSD severity at 12 months, as did 55% of those who received prolonged exposure therapy plus placebo. In comparison, 44% of those who received naltrexone only and 37% of those who received placebo only achieved a low level of PTSD severity.

This, taken together with the lower relapse rate among patients who received prolonged exposure therapy, suggests that the therapy protects against relapses in alcohol dependence, Dr. Foa and her colleagues said.

It was also "encouraging" that patients who attended six (half) or more of the prolonged exposure therapy sessions "benefitted substantially from treatment, suggesting that a relatively low dose of prolonged exposure therapy is effective in this population," they added.

This study was funded by the National Institute on Alcohol Abuse and Alcoholism. No relevant financial conflicts of interest were reported.

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