Drug therapy plus counseling useful for alcoholism

Counseling and treatment with naltrexone, either alone or in combination, are effective therapies for alcohol dependence, new research suggests. By contrast, the drug acamprosate seems to offer no benefits for the condition.

The findings, which appear in the Journal of the American Medical Association, are based on a study of 1,383 alcoholic patients who were randomly assigned to one of nine treatment groups featuring various combinations of naltrexone, which decreases alcohol craving, acamprosate, which helps normalize brain function in alcoholics, and behavioral counseling.

With the exception of one group that received only counseling, all of the groups received medical management in a 9-session program designed to improve medication adherence and alcohol abstinence. Alcoholism treatment specialists offered counseling based on standard principles.

Naltrexone, counseling, or both were significantly better than fake "placebo" pills plus drug treatment in increasing the number of days abstinent, lead author Dr. Raymond F. Anton, from the Medical University of South Carolina in Charleston, and colleagues note. Treatment with naltrexone also reduced the risk of a heavy drinking day by 28 percent.

As noted, acamprosate, either alone or with behavioral counseling, did not improve abstinence rates. When it was added to naltrexone therapy, no further improvements were seen.

Further analysis showed that behavioral counseling worked better when combined with naltrexone than when given alone.

Treating alcohol dependence with naltrexone appears to be feasible and could greatly extend patient access to effective treatment, if implemented in primary and other healthcare settings, the authors conclude.

The benefits of naltrexone were observed in treatments that were similar to those routinely available in primary care practices, Dr. Henry R. Kranzler, from the University of Connecticut School of Medicine in Farmington, notes in a related editorial. "This offers the prospect that an efficacious treatment for alcohol dependence can be made as widely available as are current treatments for smoking cessation and major depression."

SOURCE: Journal of the American Medical Association, May 3, 2006.