A complex study of alcoholism treatment medications and counseling has found that most standalone and combined therapies were effective in promoting short-term abstinence.
The three-year COMBINE study, funded by the National Institute on Alcohol Abuse and Alcoholism, involved 1,383 subjects who were diagnosed as alcohol-dependent and had recently quit drinking. Patients were broken into smaller study groups, including those who received 16 weeks of naltrexone (100 mg/d) or acamprosate or Campral (3 g/d), both, with or without placebos, and with or without a combined behavioral intervention (CBI).
One group received CBI only, with no pills. Some groups also received medication management -- counseling to ensure that patients took their medication and remained abstinent from alcohol.
A four-month evaluation found that all groups demonstrated reduced drinking. The best results were found among those who received naltrexone (ReVia) and medication management, who stayed abstinent 80.6 percent of the days in the study period. Also found highly effective were CBI plus medical management and placebos (79.2 percent) and naltrexone and CBI plus medical management (77.1 percent).
"No combination produced better efficacy than naltrexone or CBI alone in the presence of medical management," the study concluded, noting that, "Naltrexone with medical management could be delivered in healthcare settings, thus serving alcohol-dependent patients who might otherwise not receive treatment."
However, some critics questioned the value of the study, noting that participants -- unlike most alcoholics -- were highly motivated to quit.
Some also said that four months was too short a study period to determine treatment efficacy. Stuart Gitlow, an addiction specialist at Mount Sinai School of Medicine, said such short-term measures were "worthless."
The research also did not report how many subjects remained entirely abstinent, although it showed that about half still had their drinking under control after a year. "What happens is that, after treatment is over, a certain number of people relapse," Anton told the New York Times. "And like many chronic conditions, the farther out you go, the more people relapse."
But to Gitlow, the bottom line is, "Either you drink or you don't. Alcoholism is like pregnancy: you are or you're not. No middle ground."
A one-year follow-up study by the COMBINE researchers did show that the patients treated with medications tended to remain abstinent for more days than the placebo-only patients, and that those who received CBI did better than those who had only received medication management.
"This study and others have shown that people should be optimistic about treatment for their alcohol problems, that treatment does work," Anton told Reuters.