Opening Statement: This was an extremely interesting case because the patient had a number of slips without a true relapse.
Patient Background Information: This is a 33-year-old, single, white, male patient with a 20-year history of alcohol abuse, which became clear alcoholism over the past 10 years. The patient and his father came to the initial interview because the patient had lost his driving license for repeated DUIs. The patient is complaining of binge drinking, liver problems, loss of memory, sexual dysfunction, work problems, problems with parents/relatives and other consequences as a direct result of alcohol. The patient had tried AA, local psychiatrists who at various times had prescribed antidepressants, and had previous residential treatments at prestigious treatment centers in a number of states. CAGE was positive 3.of 4. MAST was strongly positive. The patient gave a history of past cocaine, amphetamine, prescription anxiolytic, marijuana, and hallucinogen abuse. Presently, only alcohol and nicotine dependence were reported. No other drugs were reported in the past month by history or urinanalysis. The patient is interested in an evaluation for bloating, tender liver, exercise intolerance, and memory dysfunction.
Naltrexone Treatment and Results: The patient was started on 50 mg of naltrexone per day. The first dose produced a state of calm and almost euphoria. The patient almost immediately drank less and began to lose weight. Liver function abnormalities returned to baseline by 30 days. The patient continued in individual counseling with a CAC and visits to the psychiatrist. The patient reported a slip during a football game but noted that the beer did not taste right. It was described as “bad beer”. The patient's alcohol intake of one bottle of vodka every other day dropped to zero. The most drinking that occurred was two beers or two glasses of wine. The patient is maintained on 100 mg per day and has moved into his own house, has a girlfriend, and has improved all social and interpersonal relationships. Most recently, he has been in treatment on naltrexone for 12 months and started exercising. The patient attributes decreased drinking to naltrexone's effect of making drinking less interesting. He has started smoking marijuana again every morning.