Case Study Report: 2

Opening Statement: This case is of interest because it reflects the high degree of comorbidity often seen at the (treatment center name deleted) Free Clinics, sampling of alcohol without relapsing, and a subjective report of decreased craving for alcohol.

Patient Background Information: Mr A is a 46-year-old, single, white man with a 20-year history of drinking 25 oz of vodka twice per week. He had received a bachelor's degree and had worked in health care administration, but was unemployed at the time of admission. Mr A presented to treatment to comply with requirements of probation diversion, but requested intensive treatment rather than just the minimum needed to comply with the terms of his probation. other drug dependence diagnoses included cocaine, methamphetamine, and nicotine. His medical history was significant for hepatitis B and asymptomatic HIV disease since 1986 with a current CD4 count of 375, treated with zidovudine (Retrovir). His psychiatric history was significant for post- traumatic stress disorder and major depression, treated with fluoxetine (Prozac) and trazodone (Desyrel). He was homeless at the time of his admission. His family history was significant for alcohol dependence in both parents and suicide by his father. His prior treatment history consisted of two prior 28-day residential programs; he did not achieve sustained abstinence after either of those treatment efforts.

Naltrexone Treatment and Results: Mr A started naltrexone 50 mg per day on 5/9/94. He noted an immediate, although limited, reduction in his craving for alcohol. He was able to tolerate this dose without any side effects. Although his initial participation in psychosocial treatment and AA was minimal, he remained abstinent for 3 weeks, at which point he sampled alcohol without relapsing. on 6/15/94, he relapsed on crack cocaine, but remained abstinent from alcohol until 7/11/94, after having dropped out of treatment and discontinuing naltrexone. He reentered outpatient treatment and resumed naltrexone on 8/18/94, although his participation in treatment and AA was again minimal. He relapsed while visiting his alcohol-dependent mother who offered him alcohol. Upon his return to San Francisco, he also relapsed on methamphetamine and cocaine. A mild and transient transaminitis was noted after these relapses. On 12/7/94, having entered 18-month residential treatment and having resumed outpatient treatment, he restarted naltrexone. Mr A has remained abstinent from alcohol, cocaine, and methamphetamine for 3 months.

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