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Naltrexone Plus Management Best for Alcohol Dependence

Acamprosate not significantly better than placebo

TUESDAY, May 2 (HealthDay News) -- Patients with alcohol dependence do best if treated with naltrexone combined with sessions with a medical professional to enhance adherence to medication and to encourage abstinence from drinking, according to the results of a large-scale, randomized, controlled study published in the May 3 issue of the Journal of the American Medical Association.

Raymond F. Anton, M.D., of the Medical University of South Carolina in Charleston, and colleagues evaluated a range of treatment combinations in 1,383 alcohol-abstinent volunteers with primary alcohol dependence. Of the nine subject groups, eight received medical management plus 16 weeks of naltrexone or acamprosate, both drugs, and/or both placebos, with or without combined behavioral intervention (CBI) from a behavioral health specialist. The ninth group received no active drug or placebos, but underwent CBI.

All of the treatments produced substantial reductions in drinking. However, the groups receiving naltrexone and medical management; placebos, CBI and medical management; or naltrexone, CBI and medical management fared the best in terms of the percentage of days abstinent (80.6, 79.2 and 77.1, respectively). In addition, naltrexone reduced the risk of a heavy drinking day over time, with medical management boosting the effect. Acamprosate, in contrast, was not significantly better than placebo.

"No combination produced better efficacy than naltrexone or CBI alone in the presence of medical management," the authors conclude. "Naltrexone with medical management could be delivered in health care settings, thus serving alcohol-dependent patients who might otherwise not receive treatment."

In an accompanying editorial, Henry R. Kranzler, M.D., of the University of Connecticut School of Medicine in Farmington, called the study "well designed and well executed" and said that its findings offer "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."

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