Drug and Alcohol Dependence

Sandra A. Springer, Angela Di Paola, Marwan M. Azar, Russell Barbour, Archana Krishnan*, Frederick L. Altice



Background: Alcohol use disorders (AUDs) are highly prevalent among persons living with HIV (PLH) within the criminal justice system (CJS). Extended-release naltrexone (XR-NTX) has not been previously evaluated among CJS-involved PLH with AUDs.
Methods: A randomized, double-blind, placebo-controlled trial was conducted among 100 HIV+ prisoners with AUDs. Participants were randomized 2:1 to receive 6 monthly injections of XR-NTX or placebo starting one week prior to release. Using multiple imputation strategies for data missing completely at random, data were analyzed for the 6-month post-incarceration period. Main outcomes included: time to first heavy drinking day; number of standardized drinks/drinking day; percent of heavy drinking days; pre- to post-incarceration change in average drinks/day; total number of drinking days; and a composite alcohol improvement score comprised of all 5 parameters.
Results: There was no statistically significant difference between treatment arms for time-to-heavy-drinking day. However participants aged 20-29 years who received XR-NTX had a longer time to first heavy drinking day compared to the placebo group (24.1 vs. 9.5 days; p < 0.001). There were no statistically significant differences for other individual drinking outcomes. A sub-analysis found participants who received ≥4 XR-NTX were more likely (p < 0.005) to have improved composite alcohol scores than the placebo group. Post-hoc power analysis revealed that despite the study being powered for HIV outcomes, sufficient power (.94) was available to distinguish the observed differences.
Conclusions: Among CJS-involved PLH with AUDs transitioning to the community, XR-NTX is safe and may improve alcohol treatment outcomes when using a composite alcohol consumption score.

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* Denotes CSDA Associates, Affiliates, and Staff