Many patients with alcohol dependence do not receive the full benefits of treatment because they do not adhere to it. In part to address issues with adherence, extended-release naltrexone, which is released over a month after one injection, was developed.

In the pivotal randomized, placebo-controlled trial that showed the efficacy of naltrexone combined with psychosocial therapy, subjects with ≥7 days of abstinence benefited the most from the drug. However, achieving 7 days of abstinence before treatment is difficult. Therefore, researchers assessed naltrexone’s efficacy, in that same clinical trial, among the subgroup of 82 subjects with ≥4 days of abstinence. 

• increased the time to first drink (median days, 41 versus 12);
• increased continuous abstinence over 6 months (32% versus 11%);
• increased time to first heavy drinking (>180 versus 20 days);
• decreased days with any drinking (median days per month, 0.7 versus 7.2);
• decreased days with heavy drinking (median days per month, 0.2 versus 2.9).

Smaller benefits, which were not always statistically significant, were found among the 28 subjects treated with 190 mg of naltrexone.

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