While certain pharmaceutical drugs can reduce acute withdrawal symptoms and/or urges to drink alcohol, clearly they will not work if patients do not adhere to a regimen. Although behavioral treatments can facilitate medication adherence, different combinations have different effects on different people. An examination of two medications for treating alcohol dependence, used in combination with two behavioral treatments, has found that medication adherence is still best for success.
Results will be published in the September issue of Alcoholism: Clinical & Experimental Research and are currently available at OnlineEarly.
"We examined data derived from the National Institute on Alcohol Abuse and Alcoholism's COMBINE Study, a large-scale and multi-site combined medication and behavioral treatment study," explained Allen Zweben, associate dean for academic affairs and research in the school of social work at Columbia University. "This study tested combinations of two medications, naltrexone and acamprosate, and two behavioral treatments, low intensity medical management (MM) and moderately intensive combined behavioral intervention (CBI)." Zweben is also the corresponding author for the study.
A total of 1,226 patients (846 males, 380 females) were randomly assigned to one of eight different combination treatments involving naltrexone, acamprosate, a placebo, MM, and CBI. After treatment completion at 16 weeks, primary outcomes – including percent days abstinent and time to first heavy drinking day – were analyzed.
"First, high medication adherents fared better than low medication adherents across all combinations of behavioral and pharmacological treatment conditions," said Zweben.
"Second, CBI – a specialty alcohol treatment – surprisingly had a beneficial impact on nonadherents receiving the placebo," Zweben added. "This raises the issue of whether or not CBI may serve as a cushion or have a protective function for these patients. Conversely, CBI did not provide similar benefits for naltrexone-treated patients; their relapse rates appeared to be more a function of inadequate exposure to naltrexone and less influenced by CBI."
The other finding worthy of mention was that, overall, specialized CBI did not perform better than the more primary-care MM. "Both of these behavioral treatments performed equally as well with regard to treatment attendance and medication adherence rates," said Zweben.
In summary, said Zweben, current findings further strengthen conclusions drawn from the COMBINE Study, namely, that combining MM and naltrexone could benefit a sizeable proportion of alcohol-dependent patients.
"Alcohol-dependent patients could be managed in nonspecialized or general healthcare settings which, in turn, could broaden the treatment options for individuals diagnosed as alcohol dependent," said Zweben. "We will need to adapt these findings to 'real world' medical settings and follow the results."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Relationship Between Medication Adherence and Treatment Outcomes: The COMBINE Study," were: Helen M. Pettinati of the University of Pennsylvania; Roger D. Weiss of McLean Hospital at Harvard University; Marston Youngblood and Christine E. Cox of the Collaborative Studies Coordinating Center in the Department of Biostatistics at the University of North Carolina; Margaret E. Mattson of the National Institute on Alcohol Abuse and Alcoholism; Prakash Gorroochurn of the Department of Biostatistics in the Mailman School of Public Health at Columbia University; and Domenic Ciraulo of the Veterans Affairs Boston Health care System, and the Boston University School of Medicine. The study was funded by the National Institute on Alcohol Abuse and Alcoholism.