Case Study Report: 3

Opening Statement: This case reports on a woman with a long history of alcoholism who experienced a significant relapse during the naltrexone protocol but was able to return to sobriety. In addition, she experienced some changes in craving for sweets/chocolate on and off naltrexone. This case demonstrates that naltrexone may be able to help someone even after they go through a relapse. The possibility of other actions of naltrexone, e.g., reducing craving for sweets, is also suggested.

Patient Background Information: Ms A is a 37-year-old, divorced" white woman with a partial college education. At the time of enrollment in the naltrexone protocol, she was working part- time as a telemarketer. She did not describe a recent history of substance abuse other than alcohol. She noted alcohol consumption of a fifth of scotch, two-fifths of peach schnapps, or three bottles of wine per day. She had been consuming alcohol excessively for 3 months prior to enrollment in the study. She gave a history of mixed depressive and anxiety symptoms beginning at age 11 years. These symptoms did meet criteria for a major depressive disorder, although the chronicity of her symptoms suggests a dysthymic disorder as well. She denied symptoms of mania, psychosis, obsessive-compulsive disorder or eating disorders. She did not describe any acute or chronic medical problems. She was receiving paroxetine (Paxil), 20 mg. per day, for depression.
Her alcohol history was that of a social drinker between the ages of 23 and 27 years; at age 27 years, her consumption increased. Her first detoxification and treatment occurred at age 34. She admitted to-multiple criteria necessary for the diagnosis of alcohol dependence, including tolerance and withdrawal symptoms. She denied a family history of alcoholism or mental illness. She was admitted for detoxification and enrollment in the naltrexone study on 5/31/94 and was hospitalized until 6/23/94.

Naltrexone Treatment and Results: Ms A began 25 mg of naltrexone per day for 2 days on 6/3/94. From 6/5/94 on she received 50 mg of naltrexone per day. She did not experience side effects with naltrexone. During her inpatient treatment, she received group therapy three times per week and individual counseling using a cognitive-behavioral model. She attended AA meetings during this time as well. Following discharge, she was seen at 1- to 2-week intervals for individual counseling and was also attending AA and seeing a therapist at a local mental health center for psychotherapy. She remained on Paxil, 20 mg per day. During initial treatment with naltrexone, Ms A described that her craving for alcohol was not a problem and that her mood was good. on 8/23/94, Ms A got into a disagreement a t work and became angry. She then returned home and began to drink; she got into a verbal fight with her boyfriend and her drinking escalated. She was briefly hospitalized locally and then jailed for 2 days for trespassing. She was then admitted to our program from 9/7/94 to 10/5/94. She received naltrexone sporadically-during the relapse. During the admission', she received group and individual therapy. Since her discharge, she has not relapsed and has been attending AA two to three times per week. She briefly went off naltrexone in December 1994 because of failure to make an appointment. She described a significant increase in craving for chocolate that went away when naltrexone was restarted. As of this writing, she is sober and managing her life better and attending AA.

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