Patient and Provider Attitudes towards Monitored Naltrexone Treatment of Alcohol Dependence in Schizophrenia

Objective: To describe the attitudes of patients and their mental health providers regarding participation in a controlled trial of directly monitored naltrexone (NTX) treatment for alcohol dependence in schizophrenia. Method: Ninety participants with schizophrenia and their providers were asked to report opinions of treatment with oral NTX or placebo 3 times per week for 12 weeks, motivational counseling (MI), and voucher-based incentives (VBI) for attendance. Results: Seventy-nine percent of participants "liked the study a lot," and 94% reported that it was helpful. Study components rated as helpful by participants were: VBI (95% of participants), meeting with staff 3 times per week (84%), reporting alcohol use (82%), MI (82%), reporting psychiatric symptoms (73%), breath alcohol testing (72%), and study medication (57%). Benefits reported by patients were: feeling better mentally (67%), drinking less (52%), feeling better physically (49%), and stopping drinking (27%). Seventy percent of providers reported that the study was helpful. Benefits noted by providers included: reduced drinking (33%), better treatment adherence (32%), stopping drinking (23%), and reduced psychiatric symptoms (22%). Patient/provider responses agreed on helpfulness with stopping or reducing drinking. Conclusions: Most participants with schizophrenia liked participating in a clinical trial of directly observed naltrexone treatment for alcohol dependence, and found incentives for attendance, frequent staff contact and monitoring of drinking, and motivational counseling to be the most helpful. Most participants reported improvement in mental health and reduced drinking. Mental health providers also reported that the study was helpful, but they did not describe the same degree of benefit as did patients.