Efficacy of Opioid Antagonists in Attentuating Self-Injurious Behavior

Abstract

Self-injurious behavior (SIB) is a primary reason that individuals either are retained in restrictive environments or are administered psychotropic medication. There are no known causes and no universally accepted treatments for this complex behavior. There is developing evidence, however, that individuals exhibiting SIB have a disturbance of the opiate-mediated pain and pleasure system. For instance, many self-injurious individuals do not exhibit the usual signs of pain after their “injurious” behavior. Moreover, for some individuals the addictive properties of elevated endogenous opiates (euphoria) may be responsible for maintaining their SIB. A review [Symons, Thompson & Rodriguez, (2004)] of the recent scientific literature concluded that 80% of the subjects were reported to significantly reduce their SIB after acute treatment with opiate blockers (naltrexone). Although the long term effects of opiate blockers on SIB are unknown, reduction in SIB following acute treatment provides support that a specific biological system may be dysregulated in a subgroup of patients. Reports that levels of endogenous opiates at rest and after SIB episodes predict positive responses to opiate blockers provide further support for opiate-mediated SIB and form the basis for a rational treatment strategy. It is concluded that naltrexone produces a clinically significant reduction in the serious and life-threatening behavior of self injury for individuals who have not been responsive to any other type of treatment. Several suggestions and cautions are provided for regimens of naltrexone treatment of SIB.