Adding Psychotherapy to the Naltrexone Treatment of Alcohol Use Disorder: Meta-analytic Review

Abstract

BackgroundIt remains unclear if naltrexone combined with psychotherapy is superior to naltrexone alone in treating alcohol use disorders (AUD). The current meta-analysis examined the hypothesis that psychotherapy is a significant moderator that influences AUD-related outcomes and that naltrexone combined with psychotherapy is associated with significantly better AUD-related outcomes than naltrexone alone.MethodsA total of 30 studies (Nnaltrexone = 2317; Nplacebo = 2056) were included. Random effects model meta-analyses were carried out for each of the studied outcomes. Subsequently, the random effects model pooled estimates from studies with and without psychotherapy were compared using a Wald test. A mixed-effect model, incorporating psychotherapy as a moderator, was used to examine the impact of psychotherapy on treatment outcomes.ResultsNaltrexone had a significant treatment effect on abstinence relapse and Gamma-Glutamyl Transferase levels, but not cravings. The pooled estimates for studies with and without psychotherapy were not significantly different for any of the studied outcomes. Psychotherapy was not a significant moderator in the mixed effects models for any of the studied outcomes.ConclusionsNaltrexone treatment is efficacious in reducing alcohol consumption, but not reducing cravings. Adding psychotherapy on top naltrexone did not result in any significant additional benefit for AUD patients.

Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis

“…While this is of direct relevance to clinical practice and service planning, it means we excluded studies that investigated the effect of interventions in reducing alcohol consumption in alcohol dependent people who are still drinking (eg, nalmefene 46 and topiramate 46 ) rather than maintaining abstinence. Previous reviews of interventions in abstinent alcohol dependence (ie, post-detoxification) have reported evidence of naltrexone 47 48 49 in preventing relapse from a lapse, and for acamprosate 48 50 or disulfiram 51 in maintaining abstinence in patients with alcohol dependence. These three drugs are recommended by NICE 6 for clinical effectiveness, and choice is tailored depending on the drinking behaviour and clinical situation of a patient.…”

Gabapentinoids for treatment of alcohol use disorder: A systematic review and meta‐analysis

“…Many psychological and pharmacological treatments have been developed to manage alcohol use disorder (AUD; R. Ahmed et al, 2018; Imel, Wampold, Miller, & Fleming, 2008; Kranzler & Soyka, 2018; Swift & Aston, 2015). AUD is challenging to treat due to the symptoms of withdrawal and craving.…”