Case Study Report: 12

Opening Statement: This case is of interest because it includes psychiatric comorbidity, repeated sampling of alcohol without relapsing, concurrent use of disulfiram, and a subjective report of decreased craving for alcohol.

Patient Background information: Mr B is a 39-year-old, single, white man with a 7-year history of drinking 36 oz of beer daily. He had completed 3 years of college and had previously worked in telemarketing but was unemployed at the time of his admission. Mr B sought admission in order to receive medication other than disulfiram (Antabuse) as an adjunct to his efforts to achieve sobriety. His psychiatric history was significant for depression with psychotic features, which was treated with fluoxetine (Prozac) and amitriptyline. The depression had led to several hospitalizations. His family history was significant for alcohol dependence in both parents and major depression in his mother. His prior treatment history consisted of a brief course of outpatient treatment and sporadic AA attendance; he did not achieve sustained abstinence prior to his use of naltrexone.

Naltrexone Treatment and Results: Mr B started naltrexone 50 mg per day on 6/6/94. He noted an immediate, although limited, reduction in his craving for alcohol. He was able to tolerate this dose without any side effects. The frequency and amount of Mr B's drinking decreased immediately upon starting naltrexone. He never met the criteria for relapse, although he did not achieve sustained abstinence until September of 1994, when he started Antabuse. Mr B had a psychotic episode on 8/18/94, three weeks after he had discontinued Prozac for financial reasons. During this episode, he had suicidal ideation, drank alcohol, ingested a "few" 50-mg trazodone (Desyrel) tablets, and was held overnight on a medical ward; he was released the next day without sequelae. Mr B continues to take antidepressants, Antabuse, and naltrexone, attends group counseling 4 days per week and AA 2 days per week; he has been abstinent for 4 months.

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