Petrakis 2005: naltrexone and disulfiram with a psychiatric illness

What they tested

People with alcohol dependence and an Axis I psychiatric disorder, the term then used for major mental illnesses, were treated for 12 weeks at three Veterans Administration outpatient clinics. Each was randomly placed in one of four groups: naltrexone alone, placebo alone, disulfiram plus naltrexone, or disulfiram plus placebo.

Disulfiram was given openly, so people knew if they were taking it, while naltrexone and placebo were blinded. Pill-taking was tracked with electronic caps on the pill bottles. The main outcomes were measures of drinking; psychiatric symptoms, craving, the liver blood test GGT and side effects were also tracked.

What they found

Rates of abstinence were high in every group.

People treated with an active medicine had significantly more consecutive weeks of abstinence and less craving than those on placebo. There were no significant group differences in other measures of drinking.

Combining disulfiram and naltrexone gave no advantage over either alone.

Limits

• Disulfiram was given openly, so people on it knew, which can affect how they drink and what they report.
• Abstinence was high in all groups, which makes differences between medicines harder to find.
• The trial was run in VA clinics, and the abstract gives no numbers on the size of the effects.

What it means if you're considering naltrexone

Before this trial, neither medicine had been rigorously tested in people with both alcohol dependence and a psychiatric disorder. It found a modest benefit from either naltrexone or disulfiram, and no reason to combine them. For someone in that situation, it suggests naltrexone is a reasonable option to discuss with a prescriber, with modest expectations.