Case Study Report: 6

Opening Statement: After multiple treatment approaches and modalities, this patient was finally able to maintain sobriety.

Patient Background Information: This is a 51-year-old, divorced, white man who is a successful salesperson. The patient's alcohol use dates back to his early 20s, when he was an officer in the Air Force. At that time, his alcohol use was on a near daily basis, with at least 6 oz of alcohol per day. In spite of heavy alcohol use, this patient remained very high functioning until his early 30s. His marriage began to deteriorate at this time, and he lost a high paying job. This represented his first attempt to control alcohol use. He was moderately successful, to the point that he was able to modify the consumption from near daily to weekly; by his late 30s, he was able to abstain for several months. He was able to rebuild his life, and for several years his alcohol use pattern became episodic. Specifically, he was able to abstain from alcohol use up to several months at any one time, only to resume alcohol use for brief, though very destructive alcohol binges. By age 40, he entered his first treatment, and from age 40 to age 48, he had been in three different treatments, two of which were outpatient. The patient's alcohol use pattern modified significantly, but he continued to have, on average, bi-yearly alcohol relapses. The CEO of his company finally intervened, and he was sent to us for treatment. The patient did quite well in our intensive outpatient program and was gradually decreased to less intensive outpatient treatments. in 2 years, he had two short-lived relapses, each with more significant consequences regarding his job and family environment. In view of this recalcitrant disease, he was extensively investigated. He underwent psychiatric workups, neuropsychiatric testing, and medical workups, none of which found any type of pathology. He was placed on disulfiram (Antabuse) but developed elevated liver enzymes. In view of the above results, he was asked to participate in the naltrexone study.

Naltrexone Treatment and Results: The patient was begun on naltrexone,. a dose of 50 mg per day, which he tolerated quite well. He was continued initially on a three times per week outpatient treatment, which consisted of group therapy sessions. By the second month, this was increased to weekly sessions. He was motivated to attend self-help groups (AA). Initially he attended AA only to become compliant, although he later began to enjoy this type of social support. He was quite optimistic regarding the possibility of naltrexone being able to help in maintaining his sobriety. He was quite compliant and enthusiastic throughout his naltrexone treatment. He was able to maintain sobriety throughout his treatment and chose to enter the phase 2 naltrexone protocol. To this date, 10 months after his initiation to naltrexone, he continues to be sober and is enjoying the fruits of this lifestyle.

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