Pharmacokinetics, safety, and tolerability of a depot formulation of naltrexone in alcoholics: an open-label trial

BACKGROUND: Naltrexone is an effective medication for treatment of alcohol dependence, but its efficacy is limited by lack of adherence to the oral dosage form. A long-acting depot formulation of naltrexone may increase adherence. METHODS: A single site, 6-week open label study was conducted with 16 alcohol dependent subjects each receiving 300 mg of Naltrexone Depot by intramuscular injection. The main outcomes were safety and tolerability of the Naltrexone Depot formulation, blood levels of naltrexone and its main metabolite 6-beta naltrexol, and self-reported alcohol use. All subjects received weekly individual counseling sessions. RESULTS: The medication was well tolerated with 88% of subjects completing the 6-week trial. The most common side effect experienced was injection site complications. There were no serious adverse events. Subjects had naltrexone and 6-beta-naltrexol concentrations throughout the trial with mean values ranging from 0.58 ng/mL to 2.04 ng/mL and 1.51 ng/mL to 5.52 ng/mL, respectively, at each sampling time following administration. Compared to baseline, subjects had significantly reduced number of drinks per day, heavy drinking days and proportion of drinking days. CONCLUSION: Naltrexone Depot is safe and well tolerated in alcoholics and these findings support the further investigation of its utility in larger double-blind placebo controlled trials

Evidence-based Kernels: Fundamental Units of Behavioral Influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior

Using action dynamics to assess competing stimulus control during stimulus equivalence testing

Previous studies have identified potential sources of competing stimulus control in tests for stimulus equivalence. The present experiment employed the Nintendo Wii remote (WiimoteA (R)) to investigate whether such competition would affect suboperant action dynamics (e.g., topographies of equivalence responses). Following one-to-many training on conditional discriminations sufficient to establish three 3-member equivalence classes, participants were presented with a test for equivalence responding that included five different trial types. These included "traditional" equivalence trials, on which the incorrect stimulus had previously been presented as a correct comparison stimulus during training, trials on which a novel unrelated word was provided as the incorrect comparison, and trials on which the incorrect stimulus varied in orthographical and phonological similarity to the sample stimulus. The presence of phonological and orthographic distractor stimuli significantly reduced the probability of equivalence-consistent responding, relative to neutral distractors, but this effect was almost exclusively seen in participants who failed to demonstrate equivalence on traditional equivalence trials. Analyses of correct response trajectories suggested that the prior history of reinforcement for choosing the incorrect stimulus on the traditional equivalence trial gave rise to greater competition than did phonological or orthographic similarity between the sample and incorrect comparisons