Case Study Report: 13

Patient Background information: (Patient) is a 43-year-old, white, separated salesman who entered the naltrexone study on 2/l/94.

Naltrexone Treatment and Results: (Patient) had been in treatment at this office since 7/2/90 for alcoholism and depression. He had a long-standing history of alcoholism, with 18 years of heavy drinking. He had been drinking on a daily basis when he was arrested for his fifth DUI in 1985. He was given a chance to go to treatment or go to jail. He chose a 28-day alcohol treatment program. He continued AA after that time. He had three relapses during the first period out of the hospital but continued with AA and maintained abstinence after October 1985. He developed depression in 1990 and was first seen at this office in July 1990. He was treated with psychotherapy and fluoxetine (Prozac), 20 mg by mouth every day. His depression lessened. However, he separated from his wife in the fall of 1993 and started to relapse with periodic drinking. He continued AA meetings, but drank for a 24-hour period 1 week prior to entering the naltrexone study on 2/l/94. He stated that he had taken disulfiram (Antabuse) in the past but did not want to have medicine of this nature, which could create severe illness if he should drink and use the medication.

Family history was significant. His father died in his 50s of alcoholism. His father had never been in treatment and had developed cirrhosis of the liver. His father also had suffered seizures.

In the course of treatment at this office in 1990, (patient) made a decision to make amends with his two children. He had been divorced prior to gaining sobriety in 1972. At that time, he had signed a divorce agreement, which stated that he would not have to pay alimony or child support if he relinquished contact with his children. He had not seen them, nor did he have any knowledge of their whereabouts. In psychotherapy and group sessions at this office, and in working with his sponsor, he made a decision to make amends. He wrote to his ex-mother-in-law, who was able to locate the children. Through letter writing, he was able to contact the children. He was very fearful that he would learn that his children, like himself and his father, were alcoholic. He did establish contact and his worst fear came true; they were indeed alcoholics. However, they had entered into treatment at ages 15 and 17, respectively, and each had gained 3 years of sobriety through 12-step programs. They told him that they had his picture in their room throughout their childhood and had always wondered what happened to him. He made arrangements to have them visit him. They did. The visits went well, and he has maintained contact with them. His relationship with his second wife, however, deteriorated over conflict with a daughter from her first marriage, who was living at home, keeping late hours, and bringing men into the home. She did not have an alcohol or chemical dependency problem. He felt a parental role and set limits. His wife has much guilt over the daughter's lack of contact with her own father and had been very permissive in her upbringing. Conflict in the second marriage escalated, leading to the separation in the fall of 1993. Living by himself, he became more depressed and, for the first time since 1985, began drinking. He felt hopeless over his relapse and requested additional help. He was motivated to enter the naltrexone study on the chance that it might aid him in regaining his recovery.

He has been maintained on naltrexone, 50 mg by mouth every day throughout the study and is now nearing the end of the 1.year period (which started in February 1994). After starting the study, he remained abstinent from alcohol for the first 10 weeks, but then relapsed. For the first time after his separation from his wife, he dated a woman. He stated that he did not want to let her know that he was alcoholic. They were out to dinner and she ordered wine. He relapsed, drinking at dinner. However, he did not drink after going home and stated that it was the first time in his life that after having alcohol he did not go into at least a 24-hour binge with complete loss of control. He maintained sobriety until week 32, when he relapsed and drank one-half quart of scotch. He was depressed with unresolved anger regarding his divorce and a woman whom he was dating at the time. However, he was surprised that he did not continue drinking the next day, and remained abstinent after week 32. At week 44, he had another relapse after going out with friends to a bar. He drank again that night, but did not continue with uncontrolled drinking. He continues in outpatient psychotherapy and group sessions on a weekly basis, with individual visits as needed. He continues his 12-step program. He continues on Prozac, 20 mg, POQD. Throughout the study, depressive symptoms have waxed and waned, but never reached the severity that he had experienced prior to starting Prozac in 1990.

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