Study Defines Most Effective Alcoholism Treatments
Updated February 07, 2013.
A three-year study of 1,383 of alcohol dependent patients in treatment has shown that the medication naltrexone and up to 20 sessions of alcohol counseling by a behavioral specialist are equally effective treatments for alcohol dependence when combined with structured outpatient medical management.
Surprisingly the "Combining Medications and Behavioral Interventions for Alcoholism," or COMBINE study as it is known, also found that adding acamprosate (Campral) to the treatment program did not improve treatment outcomes.
The study, published in the Journal of the American Medical Association, showed that patients that received naltrexone, specialized alcohol counseling, or both had the best drinking outcomes after 16 weeks of outpatient treatment. All of the patients in the study also received Medical Management -- an intervention consisting of nine brief, structured outpatient sessions provided by a health care professional.
"These results demonstrate that either naltrexone or specialized alcohol counseling -- with structured medical management -- is an effective option for treating alcohol dependence," said Mark L. Willenbring, M.D., Director, Division of Treatment and Recovery Research, NIAAA. "Although medical management is somewhat more intensive than the alcohol dependence interventions offered in most of today's health care settings, it is not unlike other patient care models such as initiating insulin therapy in patients with diabetes mellitus.
"Medical management's application in primary care and general mental health care settings would expand access to effective treatment dramatically, while offering patients greater choice."
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) launched COMBINE in 2001 to identify the most effective current treatments and treatment combinations for alcohol dependence. It is the largest clinical trial ever conducted of pharmacologic and behavioral treatments for alcohol dependence. The COMBINE study was conducted at 11 academic sites that recruited and randomly assigned 1,383 recently abstinent, alcohol-dependent patients to one of nine treatment groups.
According to a NIAAA news release, "eight treatment groups received medical management; four of these received naltrexone (100 milligrams a day), acamprosate (3 grams a day), both naltrexone and acamprosate, or placebo pills. The other four groups received in addition received specialized alcohol counseling.
"To test for any effects of pill taking (placebo), the researchers assigned some patients to a ninth group that received specialized alcohol counseling, but no pills, and no more than four visits with a health professional for general medical advice."
A three-year study of 1,383 of alcohol dependent patients in treatment has shown that the medication naltrexone and up to 20 sessions of alcohol counseling by a behavioral specialist are equally effective treatments for alcohol dependence when combined with structured outpatient medical management.
Surprisingly the "Combining Medications and Behavioral Interventions for Alcoholism," or COMBINE study as it is known, also found that adding acamprosate (Campral) to the treatment program did not improve treatment outcomes.
The study, published in the Journal of the American Medical Association, showed that patients that received naltrexone, specialized alcohol counseling, or both had the best drinking outcomes after 16 weeks of outpatient treatment. All of the patients in the study also received Medical Management -- an intervention consisting of nine brief, structured outpatient sessions provided by a health care professional.
"These results demonstrate that either naltrexone or specialized alcohol counseling -- with structured medical management -- is an effective option for treating alcohol dependence," said Mark L. Willenbring, M.D., Director, Division of Treatment and Recovery Research, NIAAA. "Although medical management is somewhat more intensive than the alcohol dependence interventions offered in most of today's health care settings, it is not unlike other patient care models such as initiating insulin therapy in patients with diabetes mellitus.
"Medical management's application in primary care and general mental health care settings would expand access to effective treatment dramatically, while offering patients greater choice."
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) launched COMBINE in 2001 to identify the most effective current treatments and treatment combinations for alcohol dependence. It is the largest clinical trial ever conducted of pharmacologic and behavioral treatments for alcohol dependence. The COMBINE study was conducted at 11 academic sites that recruited and randomly assigned 1,383 recently abstinent, alcohol-dependent patients to one of nine treatment groups.
According to a NIAAA news release, "eight treatment groups received medical management; four of these received naltrexone (100 milligrams a day), acamprosate (3 grams a day), both naltrexone and acamprosate, or placebo pills. The other four groups received in addition received specialized alcohol counseling.
Combined Behavioral Intervention
"Called Combined Behavioral Intervention (CBI), the counseling integrated cognitive-behavioral therapy, motivational enhancement, and techniques to enhance mutual help group participation -- all treatments shown in earlier studies to be beneficial. Patients assigned to the specialized alcohol counseling could receive up to twenty 50-minute sessions in addition to medical management; the median number received was 10 sessions."To test for any effects of pill taking (placebo), the researchers assigned some patients to a ninth group that received specialized alcohol counseling, but no pills, and no more than four visits with a health professional for general medical advice."
COMBINE Study Highlights
Here are the highlights of the COMBINE study results after 16 weeks:- All groups substantially reduced drinking during treatment. Overall percent days abstinent tripled, from 25 to 73 percent, and alcohol consumption per week decreased from 66 to 13 drinks, a decrease of 80 percent.
- Patients who received medical management plus either naltrexone or specialized counseling showed similarly improved outcomes (PDA= 80.6 percent and 79.2 percent, respectively), compared with patients who received medical management and placebo pills (75.1 percent).
- Patients who received naltrexone reported less craving for alcohol.
- The odds of a good composite clinical outcome relative to patients who received medical management and placebo were 1.82 for patients who received medical management plus Combined Behavioral Intervention (but no naltrexone), 1.92 for patients who received medical management, Combined Behavioral Intervention, and naltrexone, and 2.16 for patients who received medical management and naltrexone (but no Combined Behavioral Intervention). That is, adding either naltrexone or specialized alcohol counseling to medical management almost doubled the chance to do well.
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