It is estimated that eight million people in the United States have alcohol dependence, also known as alcoholism . Unfortunately, only a minority of these people ever receive treatment, even though a number of effective treatment options are available. Specialized behavioral therapy programs and two Food and Drug Administration-approved drugs, naltrexone and acamprosate, have been shown to help people stop drinking.

A new study in the May 3, 2006 issue of the Journal of the American Medical Association investigated the effectiveness of treating alcohol dependence with different combinations of medical management, naltrexone, acamprosate, placebo, and behavioral intervention. The researchers found that the most effective treatments involved medical management combined with naltrexone and/or the behavioral intervention.

About the Study

This study included 1,383 people diagnosed with alcohol dependence who abstained from drinking for 4-21 days before starting the study treatment. The participants were randomly assigned to one of nine groups.

In eight of the groups, participants received medical management, consisting of regular sessions with a healthcare professional to encourage medication adherence and alcohol abstinence. Participants in these groups were assigned to receive 16 weeks of naltrexone, acamprosate, both, or placebo. For each medication assignment, there were two groups—one received behavioral intervention and one did not.

The ninth group received behavioral intervention alone, which was conducted by licensed behavioral health specialists and included a 12-step program, motivational interviewing, and involvement in outside support systems (eg, Alcoholics Anonymous).

Overall, alcohol consumption decreased by 80% during the treatment period. Medical management was most effective when combined with either behavioral intervention or naltrexone, although combining medical management with behavioral intervention plus naltrexone had no added benefit. Surprisingly, acamprosate, even in combination with naltrexone, showed no advantage over the placebo.

This study is limited because it did not include people with psychiatric illness or drug abuse, so its findings cannot be generalized to these populations.

How Does This Affect You?

These findings suggest that naltrexone and behavioral intervention yield similar benefits when combined with medical management. Importantly, the medical management component of this study was designed to simulate an intervention that could be implemented in most healthcare settings under the direction of a primary care provider.

The authors suggest that a possible reason acamprosate did not show any benefit in this study may have been because the period of abstinence before starting treatment was significantly shorter that it has been in other studies. In other words, acamprosate may be more effective after a longer period of abstinence.

Hopefully, this study will encourage the majority of alcohol dependent individuals or their families to step forward and seek treatment, either with medications or without. Alcohol dependency can be effectively and conveniently managed in most doctors’ offices without resorting to less accessible, highly specialized services.