A pilot randomized controlled trial of medication adherence therapy: Psychosocial leverage using a significant other (MAT-PLUS) for individuals on extended-release naltrexone

• Published in: Journal of substance use and addiction treatment Vol. 163; p. 209366
• Main Authors: Wenzel, Kevin, Thomas, Julia, Carrano, Jennifer, Stidham, Jennifer, Fishman, Marc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2024
• Subjects: Adult; Alcohol use disorder; Alcoholism - drug therapy; Assertive outreach; Delayed-Action Preparations - therapeutic use; Family involvement; Female; Humans; Male; Medication adherence; Medication Adherence - psychology; Medication-assisted treatment; Middle Aged; Naltrexone - administration & dosage; Naltrexone - therapeutic use; Narcotic Antagonists - administration & dosage; Narcotic Antagonists - therapeutic use; Opioid use disorder; Opioid-Related Disorders - drug therapy; Pilot Projects; Treatment Outcome; Treatment significant other; Medication adherence; Alcohol use disorder; Assertive outreach; Family involvement; Treatment significant other; Opioid use disorder; Medication-assisted treatment
• ISSN: 2949-8759; 2949-8759
• DOI: 10.1016/j.josat.2024.209366

Extended-release naltrexone (XR-NTX) is an important treatment option for individuals with opioid use disorder (OUD) and/or alcohol use disorder (AUD). However, problems with retention are a major barrier to its overall effectiveness, and interventions to improve adherence are underdeveloped. The purpose of this study was to pilot test the MAT-PLUS intervention, which combines assertive outreach and involvement of a treatment significant other (TSO) to improve adherence to XR-NTX. Adults (N = 41) seeking treatment for OUD and/or AUD with XR-NTX were recruited from an inpatient addiction treatment center and randomized to the MAT-PLUS intervention or treatment as usual (TAU) for 16-weeks. TSOs (N = 19) of individuals in the MAT-PLUS condition were also enrolled. The primary outcome was the number of XR-NTX doses received and relapse to regular heavy use (opioid or alcohol) was a secondary outcome. Participants in the MAT-PLUS group received 3.4 doses compared to 2.5 in TAU, which was significant after controlling for SUD diagnosis (p < 0.05). Rates of receipts of all prescribed doses were 61.1 % in MAT-PLUS compared to 30.4 % in TAU, giving an NNT of 3.3. Relapse rates and days of heavy use did not vary by treatment group. This study demonstrates preliminary efficacy of the MAT-PLUS intervention for XR-NTX adherence. This study was limited by its small sample size and future research should broaden the intervention to apply across medications for SUD in larger samples. Family support with an emphasis on medication adherence has strong potential for improving addiction treatment outcomes. •The MAT-PLUS intervention increased adherence to extended-release naltrexone.•The MAT-PLUS intervention did not have an effect on relapse or days of heavy use.•The MAT-PLUS intervention demonstrates preliminary feasibility and efficacy.