The medication naltrexone and up to 20 sessions of alcohol counseling by a behavioral specialist are equally effective treatments for alcohol dependence when delivered with structured medical management, according to results from "Combining Medications and Behavioral Interventions for Alcoholism" (The COMBINE Study).

Results from the National Institutes of Health-supported study show that patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management (MM), an intervention consisting of nine brief, structured outpatient sessions provided by a health care professional.

Contrary to expectations, the researchers found no effect on drinking of the medication acamprosate and no additive benefit from adding acamprosate to naltrexone. Effect of Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence appears in the current issue of the Journal of the American Medical Association, Volume 295, Number 17, pages 2003-2017.

NIH's 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. The largest clinical trial ever conducted of pharmacologic and behavioral treatments for alcohol dependence, COMBINE was carried out at 11 academic sites that recruited and randomly assigned 1383 recently abstinent, alcohol-dependent patients to one of nine treatment groups.

"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 MM 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. MM's application in primary care and general mental health care settings would expand access to effective treatment dramatically, while offering patients greater choice." To expand its application, NIAAA will develop an abbreviated version of MM to be available in early summer.

Print copies of the treatment manuals used in COMBINE are available by order.

Specific findings from the COMBINE study are summarized at COMBINE Findings: Highlights. 

"The COMBINE results provide guidance for applying today's treatment tools. NIAAA continues to explore new treatment tools in more than 50 current medication trials, in studies to better understand the mechanisms of action in behavioral treatments, and in our search for new molecular targets and novel compounds for clinical testing," according to Raye Z. Litten, Ph.D., COMBINE's government director and co-leader of NIAAA medications development team.

For more information, read the complete NIH News Release online.

The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems and disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at www.niaaa.nih.gov.