Soru

A 29-year-old man comes to the outpatient clinic to establish care following successful completion of a 28-day residential substance use treatment program. He has a long history of severe opioid use disorder and alcohol use disorder. The patient reports that he has maintained complete abstinence from all opioids and alcohol for the past 24 days. He states, 'I am determined to stay clean this time, but my cravings for both heroin and alcohol are overwhelming.' His past psychiatric history is significant for major depressive disorder. During a previous attempt at outpatient treatment two years ago, he exhibited poor medication adherence and was ultimately discharged from the practice after admitting to diverting his prescribed sublingual buprenorphine-naloxone. Liver function tests obtained at the residential facility last week were within normal limits. Vital signs today are within normal limits. Physical examination shows no signs of intoxication or withdrawal. Which of the following is the most appropriate pharmacotherapy to prevent relapse in this patient?