Combination Treatments Help Alcoholics Stay Sober

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Medical management was delivered by a health-care professional, such as a doctor, nurse or physician's assistant. It included a discussion of the consequences of heavy alcohol intake and advice on stopping drinking. Medical management also included encouragement for attending self-help groups, such as Alcoholics Anonymous. Follow-up visits, lasting an average of 20 minutes each, reviewed drinking history and provided additional encouragement.

Specialized therapy, dubbed Combined Behavioral Intervention (CBI), was provided by a mental health-care specialist, such as a psychologist or social worker. This therapy included aspects of cognitive behavioral therapy, motivation, parts of the 12-step program and a support system. Study participants who received CBI had as many as 20 sessions.

The study participants were assessed for drinking behavior at 16 weeks, and then again a year later.

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During the treatment phase of the study, the researchers found that medical management combined with naltrexone alone, CBI plus placebo, or CBI alone were the most effective treatments, allowing alcoholics to stay abstinent about 80 percent of the time.

Acamprosate didn't perform better than placebo, even when it was combined with naltrexone.

"We found no evidence of efficacy for acamprosate, and also no evidence of incremental efficacy for combinations of naltrexone, acamprosate and CBI. Somewhat unexpectedly, we observed a positive effect of receiving placebo medication and medical management," wrote the study's authors.

Willenbring said that past studies on acamprosate done in Europe have found a benefit from this medication, and he suspects there is probably a subgroup of people that benefit from this drug. The researchers will be reviewing the acamprosate data to see if there is a group of people who were helped by acamprosate. Like antidepressant medications, Willenbring said that people with alcohol dependence may need to try more than one drug to find the one that works.

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