Targeting Behavioral Therapies to Enhance Naltrexone Treatment of Opioid Dependence

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Abstract
IN THE TREATMENT of opioid dependence, naltrexone, an opioid antagonist that blocks the subjective effects of opioids, has tremendous potential. Relative to methadone hydrochloride and other maintenance therapies, naltrexone is nonaddicting, has a benign adverse effect profile, and can be prescribed without concerns about diversion (eg, naltrexone is rarely traded in the illicit drug market).1 Moreover, naltrexone is not subject to the restrictive regulatory requirements associated with methadone and levomethadyl acetate and hence can be delivered in a range of settings, which may make it more attractive to those opioid-dependent individuals who would not enter traditional drug abuse treatment programs. Furthermore, naltrexone may be less costly, in terms of demands on professional time and patient time, than the near-daily clinic visits required for methadone maintenance therapy.2 Also important are the behavioral aspects of naltrexone, as unreinforced opioid use allows extinction of relationships between drug cues, craving, and drug use.