Rohsenow D J, Colby S M, Monti P M, Swift R M, Martin R A, Mueller T I, Gordon A, Eaton C A
Providence VA Medical Center, Brown University, Rhode Island 02912, USA.
Alcohol Clin Exp Res. 2000 Oct;24(10):1542-9.
Naltrexone has been found to be an effective adjunct to treatment to reduce the rate of drinking among alcoholics. However, adherence to the medication has been of considerable concern; the high rates of noncompliance with the medication limits the benefits that could potentially be realized from this pharmacotherapy. Knowledge of predictors of noncompliance could result in interventions targeted at these variables.
Participants were 128 alcohol-dependent patients who participated in a clinical placebo-controlled trial of naltrexone. Upon discharge from a 1- to 2-week partial hospital program, patients were randomly placed into 12 weeks of naltrexone (50 mg/day) or placebo (n = 64 per condition). Patients met with a physician and a research assistant weekly for 4 weeks then biweekly for 8 weeks.
Compliance (number of days taking medication) was not predicted by demographic or pretreatment alcohol use variables. Number and severity of side effects in the first week, particularly nausea and fatigue, predicted early termination. Compliance was not predicted by commitment to abstinence or self-efficacy about abstinence, but was greater among patients who believed more strongly that the medication would help them stay sober. Compliance was not predicted by general level of urge to drink during the first week on medication but compliance was greater among those with a higher urge to drink in response to alcohol stimuli in the laboratory.
Implications for approaches to increase compliance include reducing side effects and increasing patients' beliefs in the efficacy of naltrexone.
已发现纳曲酮是一种有效的辅助治疗药物，可降低酗酒者的饮酒率。然而，药物依从性一直备受关注；药物不依从率很高，限制了这种药物疗法可能实现的益处。了解不依从的预测因素可能会带来针对这些变量的干预措施。
参与者为128名酒精依赖患者，他们参与了一项纳曲酮的临床安慰剂对照试验。在完成1至2周的部分住院项目出院后，患者被随机分为接受12周的纳曲酮（50毫克/天）或安慰剂治疗（每组64人）。患者在第1至4周每周与医生和研究助理会面，之后在第5至12周每两周会面一次。
人口统计学或治疗前饮酒变量无法预测依从性（服药天数）。第一周副作用的数量和严重程度，尤其是恶心和疲劳，可预测早期停药。戒酒承诺或戒酒自我效能无法预测依从性，但那些更坚信药物能帮助他们保持清醒的患者依从性更高。服药第一周的总体饮酒冲动水平无法预测依从性，但在实验室中对酒精刺激有更高饮酒冲动的患者依从性更高。
提高依从性的方法包括减少副作用以及增强患者对纳曲酮疗效的信念。
