Which medication is appropriate for a patient with a history of abusing opioid medications and binge drinking, who is not committed to abstain from using?

In a scenario where a patient has a history of opioid abuse and binge drinking without a commitment to abstain from use, naloxone would be the least appropriate choice among the options provided for addressing their substance use issues. Naloxone is primarily an opioid antagonist used to reverse the effects of opioid overdose and is not a treatment for opioid use disorder or alcohol use disorder. It does not address cravings or help with managing substance dependence effectively in someone who is still using substances.

In contrast, buprenorphine is a partial opioid agonist intended for treating opioid dependence, allowing for some opioid effect without the full euphoric high, thereby supporting those who may be in recovery. Naltrexone can help with cravings for both opioids and alcohol by blocking the euphoric effects of these substances, which can be helpful for patients who are committed to reducing or abstaining from use. Disulfiram is used to maintain abstinence from alcohol by inducing unpleasant reactions when alcohol is consumed, but it requires a firm commitment to abstain from alcohol consumption, making it inappropriate for someone not ready to commit.

Therefore, the right choice must consider pharmacological effectiveness for substance use disorders as well as the patient’s commitment to treatment, making naloxone the least