Case Study Report: 15

Opening Statement: The patient it an intelligent person whose low self-esteem has only been exacerbated by years of failed attempts at achieving sobriety. His alcoholism treatment has been complicated by his clinical depression, anxiety disorder, and history of panic attacks. His participation in the naltrexone study has made a very positive contribution to his attaining sobriety and exceeding all expectations-his own, our treatment team's, and other professionals who have worked with him.

Patient Background information: The patient is a 42-year old white man, never married, who completed his GED but whose employment history has been continually interrupted by his drinking. He is currently unemployed and receiving public assistance. The son of a father who died in an alcohol related fire, the patient began drinking at age 12; smoking marijuana at age 17; dropping LSD while in the military at age 18; and experimenting with cocaine at age 37. He has an equally long- standing history of depression, suicidal ideation, hospitalizations, and outpatient mental health treatment. As he has never achieved long-term sobriety in the past, it has been difficult to determine the interrelationship of his chemical dependency and his psychiatric disorders. Previous addictions-treatment---has included inpatient rehabilitation in 1989, 1990, and 1991, and outpatient treatment off and on from 1988 through 1992. When the patient first began treatment at our agency, his anxiety disorder and panic attacks combined with distrust to make him an elusive figure whose attendance was sporadic at best. Gradually gaining-trust in his individual counselors the patient began to feel some measure of hope and became more willing to try adjunctive treatments he had not tried before.

Naltrexone Treatment and Results: The patient began treatment with naltrexone in May 1994 and has continued participation beyond completion of the initial study period to the present. He has continuously taken naltrexone (50 mg per day). Concomitant medications have included: sertraline (Zoloft), albuterol (ventolin) inhaler, imipramine (Janimine/Tofranil), hydroxyzine (Vistaril), trazodone (Desyrel), and now lithium carbonate (Lithonate) (depression diagnosis upgraded to bipolar disorder, January 1995). The patient has consistently stated that he feels the naltrexone "helps me in my sobriety." On two occasions when he relapsed, he experienced the naltrexone as "taking any of the fun out .of' drinking by removing the high and leaving him with a 'flat* feeling. It is of course difficult to say whether some of the benefit the patient has derived from naltrexone has been due to a placebo effect. However, his participation in the usage study was certainly an important, positive--Action he could commit to-something to do, in addition to something (alcohol) to give up. The patient has increased his psychosocial treatment program throughout the duration of his naltrexone use, overcoming his distrust and anxiety to the point that he is now attending on a weekly basis: one regular alcohol therapy group, two dual diagnoses groups, and one individual session. In addition, he has begun attending AA and a self-help group for dually diagnosed persons known as "Double Trouble"; he makes frequent use of acupuncture for craving reduction and stress management in recovery. In the view of the clinical team, naltrexone was one of the factors contributing to the recovery and successful participation in treatment of a person formerly presenting as a chronic relapser too anxious and introverted to participate effectively in group treatment or self help.

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