研究背景與目的：研究指出naltrexone可以有效降低酒慾，而降低酒癮的復發率，但其使用在國人的療效未明。另在酒癮的心理治療上，國外文獻指出預防復發因應訓練及動機增強法，亦為改善酒癮嚴重度的方法。因此，naltrexone與心理治療合併使用是否可以產生較好的效果，值得探討。在健康保險由第三者與醫療服務者議價的情形下，成本效益分析資料即成為支付標準客觀的價格協商工具。本研究目的是以成本效益的方法評估：(1)使用naltrexone與否，(2)支持性治療、預防復發因應技巧訓練及預防復發因應技巧訓練加上動機治療等三種心理治療模式，及(3) naltrexone結合三種心理治療後一年在效益及益本值上的差異比較。

研究方法：在北、中、南六家醫院的精神科以系列取樣的方式收入240位酒癮患者，以隨機分派的方式在門診接受一般支持性心療、復發因應技巧訓練及復發因應技巧訓練結合動機治療等三種心理治療組別共12週，患者同時在雙盲設計下接受安慰劑或naltrexone之治療，治療結束後一年進行追蹤，以結構式問卷透過電話訪問方式調查成本(cost)項目，效益(benefit)及根據所獲得之成本及效益計算出益本值(benefit-cost ratio)。在12週的治療中，接受至少6週治療的共185位，其中118位完成一年後之追蹤調查。

結果：以二因子變異數分析探討在「成本」、「效益」及「益本值」上，是否使用naltrexone跟使用三種心理治療之交互作用均無達顯著差異。結果顯示，在「成本」項目中，naltrexone明顯高於placebo；「預防復發因應訓練加動機治療」明顯高於「支持性治療」，「預防復發因應訓練」與「支持性治療」或「預防復發因應訓練加動機治療」均無顯著差異；而在「效益」項目中，naltrexone和placebo無顯著差異；預防復發因應訓練加動機治療高於預防復發因應訓練，且預防復發因應訓練高於支持性治療；而在「益本值」的項目中，naltrexone低於placebo，「預防復發因應訓練加動機治療」高於「預防復發因應訓練」及「支持性治療」。

　　Aims. The present study was designed to examine the differences of costs, benefits, and benefit-cost ratio (1) between the medical treatment condition with naltrexone under a 12 week session or with a placebo; (2) among the three psychotherapy treatments, including supportive therapy, and coping skills therapy, coping skills psychotherapy plus motivational enhancement therapy; and (3) among naltrexone treatment condition with the three psychotherapy treatments. Design. A multicenter, double-blind, placebo-controlled design. Setting. Six treatment sites in Taiwan. Participants. One hundred and eighteen patients diagnosed with alcohol dependence. Intervention. All the patients had received a 12-week treatment and were followed up for twelve months after the end of the treatment program Measurements. Patients were interviewed to obtain the data to evaluate costs and benefits by using the structured interview scale.. Findings. We found that (1) there were no significant beneficial differences between the treatments with naltrexone and placebo, (2) coping skills psychotherapy plus motivational enhancement therapy had the highest benefits and benefit/cost ratio among the three psychotherapies, and (3) there were no interactions between medication and psychotherapy on benefits and benefit/cost ratios. Conclusions. Treatment with Naltrexone did not demonstrate a superior benefit or benefit-cost ratio when compared to the placebo treatment. Coping skills psychotherapy plus motivational enhancement therapy could increase benefits and benefit/cost ratios by enhancing the patient’s motivation for change.

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