Long-Term Sobriety with a Single Naltrexone Implant

PRESENTING COMPLAINT — A 38-year-old male, married, with a 12-year history of severe alcohol dependence (ICD-11) presented with declining hepatic function, marital discord, and multiple prior relapses within 3 months of every attempt at abstinence. ASSESSMENT — CAGE 4/4; AUDIT 28. Mildly elevated GGT and AST. No overt psychiatric comorbidity. Motivational interviewing revealed high readiness for change but low self-efficacy. INTERVENTION — Supervised medical detoxification with tapered benzodiazepines and thiamine over 7 days. On day 8, a slow-release naltrexone implant was placed subcutaneously in the gluteal region under local anaesthesia. Concurrent weekly relapse-prevention therapy and monthly family sessions were maintained. OUTCOME — Complete abstinence sustained at 14 months post-implant. AUDIT dropped to 3. Liver function normalised by month 4. Return to full-time employment; marital counselling ongoing with reported reconciliation. DISCUSSION — Long-acting naltrexone dramatically improves adherence in the highest-relapse window (first 90 days). Combined with structured psychosocial care, it is a powerful tool in the deaddiction armamentarium — particularly for patients with prior daily-pill non-adherence.