To evaluate the efficacy of naltrexone in patients with dual diagnosis- alcohol dependence and personality disorder.

A group of 24 patients, mean age 38.7, admitted in our department for alcohol dependence, were also diagnosed with axis II pathology. The diagnosis of personality disorder was based upon Structured Clinical Interview for DSM IV Disorder (SCID -II) and clinical psychiatric evaluation. Patients received naltrexone 50 mg/day, after the initial detoxification period. Patients were monitored using Inventory of Drug Taking Situations- alcohol focused version (IDTS), Global Assessment of Functioning (GAF) and Clinical Global Impressions (CGI-S/I). These measurements were applied every week during the first month and every 4 weeks for another 5 months.

At week 24, patients had an overall improved IDTS score (−45.2 points to baseline, p < 0.05), with greater improvements observed in areas like “physical discomfort” (p = .0463) and testing personal control (p = .0374). Cluster B personality disorders were associated with a better response in IDTS score and with a lower rate of relapses (p < 0.01) and missed treatment doses (p < 0.01). GAF values increased in the treatment group with 24.5 points, compared to baseline, with a non-significant trend in favor of cluster B and C personality disorders. CGI-I decreased from a mean value of 4.5 to 1.5 at week 20 and remained at the same value until the endpoint, without significant differences between clusters.

Naltrexone decreased significantly alcohol consumption in situations of “physical discomfort” and testing of personal control in patients with associated personality disorders.