Naltrexone Favored over Acamprosate in Alcoholism Trial: Therapy Did Not Improve Drug Treatment

By Kirn, Timothy F. | Clinical Psychiatry News, June 2006 | Go to article overview

Naltrexone Favored over Acamprosate in Alcoholism Trial: Therapy Did Not Improve Drug Treatment


Kirn, Timothy F., Clinical Psychiatry News


SAN DIEGO -- A study that is perhaps the most important conducted on alcohol dependence treatment in recent years has found that use of the opiate antagonist naltrexone reduces drinking, but use of acamprosate does not.

The COMBINE (Effect of Combined Pharmacotherapies and Behavioral Interventions) study also suggests that medical management of an alcohol-dependent patient, with a physician providing a prescription for naltrexone and basic information and advice, is as effective as cognitive-behavioral therapy.

"We feel this is important, as it may broaden the options for treatment for those not currently being treated," Dr. Raymond F. Anton said in a presentation of the study results at the annual conference of the American Society of Addiction Medicine, which coincided with publication of the results (JAMA 2006;295:2003-17).

The trial enrolled 1,383 alcohol-dependent subjects and randomly assigned them to one of eight groups that could include one or both of the drugs, or placebo, with or without what the investigators termed a "cognitive-behavioral intervention." One group received the cognitive-behavioral intervention alone, without placebo.

The patients who received a pill received "medical management" that was fairly rigorous--nine appointments over 16 weeks, one lasting about 45 minutes and the others averaging 20 minutes, at which the prescribing physician or a nurse discussed their diagnosis and progress, and advised the subject to attend a self-help group such as Alcoholics Anonymous.

Those who got the cognitive-behavioral intervention received up to 20 sessions, lasting 50 minutes each, with a licensed counselor, an intervention that was somewhat comparable with a streamlined version of outpatient alcoholism treatment.

The only treatment found to be statistically superior to placebo was medical management with naltrexone without the cognitive-behavioral intervention, as measured by percentage of days abstinent.

Those who received naltrexone and the cognitive-behavioral intervention fared almost as well, though not to a degree that was statistically significant, said Dr. Anton, a professor of psychiatry at the Medical University of South Carolina, Charleston, who was the study chair.

Overall, the study had several measures of drinking behavior, and the pattern was the same as was seen with the percentage of days abstinent measure. …

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