Pharmacotherapy for Clients Dependent on a Substance Essay

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Medications approved by the FDA for treatment of alcohol and opioid dependence, including acamprosate, disulfiram, naltrexone, methadone, and buprenorphine, have not been widely studied in the dually diagnosed population. Often, study participation criteria exclude individuals with co-occurring substance use disorders and mental illness, and it is only in recent years that research specifically focused on this population has become more common. Pharmacotherapy has also been underutilized in practice. A survey of 955 bipolar individuals found that while 8% met criteria for a current alcohol use disorder and 5% met criteria for a current non-alcohol substance use disorder, only 0.4% received disulfiram, methadone, naltrexone, and/or…show more content…
There is a dearth of research on the use of acamprosate in the collective dually diagnosed population, attributable perhaps to its relatively recent approval in 2004. There is, however, evidence supporting the use of disulfiram and naltrexone. In a landmark study, Croop et al. (1997) found naltrexone to be safe among 865 clients. Although this study did not specifically focus on dually diagnosed clients, such clients were common in both the treatment and placebo groups, so the research is clinically relevant. A later review of 72 clients receiving naltrexone for alcoholism showed good treatment retention (81.9% completed the 8 week study) and good clinical response (82% reduced drinking by at least 75% and only 17% relapsed at 8 weeks) (Maxwell & Shinderman, 2000). In a later placebo-controlled study of 254 outpatient clients with diverse psychiatric disorders and co-occurring alcohol dependence, Petrakis and colleagues (2005) found that use of disulfiram or naltrexone was associated with a significant reduction in drinking days per week, and an increase in consecutive days of abstinence, compared to placebo. Clients were randomly assigned to receive (open-label) disulfiram and (blinded) naltrexone, naltrexone only, disulfiram only, or placebo only. In this multisite, placebo-controlled study of VA clients, there
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