Cessation of long-term naltrexone therapy and self-injury: a case study.

The team followed one adult with profound intellectual disability. The person had taken naltrexone every day for a year to control self-injury.

Doctors stopped the drug and watched what happened. They used placebo pills, then no pills at all, and checked again six months later.

Self-injury stayed near zero after the drug was gone. The benefit lasted through the placebo phase, the no-drug phase, and the half-year follow-up.

One sentence: stopping naltrexone did not make the self-injury come back.

Green et al. (1987) gave naltrexone to two similar adults and saw no change in self-injury. The new case looks like a contradiction, but the key difference is timing: L et al. watched only while the drug was given, while D et al. watched after it was removed.

Garcia et al. (1999) tracked the same person for four more years. Self-injury was still almost gone, even after staff and homes changed. This longer view turns one hopeful story into proof that the effect can last.

Taub et al. (1994) used a different method—brief electric shock instead of drug—but also saw near-zero self-injury six years after the device was removed. Both studies show that, for some clients, the body and environment can keep the gain after the treatment stops.

You now have evidence that naltrexone can work like a jump-start, not a life sentence. If a client has done well on the drug for a year, you can plan a slow withdrawal and still expect low self-injury. Pair the taper with solid behavior plans and data checks so you catch any return of problem behavior early.