Naturalistic outcomes and durations of treatment episodes for individuals with alcohol or opioid use problems who were treated with extended-release naltrexone (XR-NTX) were compared to those treated with psychosocial treatment only and also to other medication-assisted therapies in Missouri during 2010 to 2011.

Group differences were controlled statistically using propensity scores that were based on 18 intake variables.

Patients with alcohol use problems and also those with opioid problems receiving XR-NTX in real-world clinical settings remained in treatment longer than those receiving psychosocial treatment only.

For both alcohol and opioid samples, patients who received XR-NTX had superior outcomes compared to those who receive oral naltrexone on a measure combining abstinence, self-help participation, employment, and arrests. The XR-NTX-treated group also has greater improvement on the composite outcome compared to buprenorphine/naloxone is the opioid sample.

These hypothesis-generating findings deserve further study in randomized clinical trials.