In Brief

Both the opioid-blocking drug naltrexone and a four-month behavioral intervention proved effective in treating alcoholism in a four-year study by the National Institute on Alcohol Abuse and Alcoholism.

Surprisingly, though, a combination of the two treatments worked no better than either alone, according to the study. And another Food and Drug Administration-approved, commercially available drug--acamprosate, which is marketed as Campral--was not effective at all. The study was published in the Journal of the American Medical Association in May (Vol. 295, No. 17, pages 2,003-2,017).

In the study, researchers--including Yale University psychologist Stephanie O'Malley, PhD, and 19 others--divided 1,383 alcoholics into nine groups. Four of the groups received pills--either naltrexone alone, acamprosate alone, naltrexone and acamprosate in combination, or a placebo pill--and nine medical-management sessions with a nurse or physician to make sure the participants were taking the pills correctly.

Four groups received the pills (either real or placebo) with medical management, plus a 20-session course of behavioral therapy administered by a psychologist, counselor or social worker. And one group received only the behavioral therapy, with no pills.

To assess the treatments' effectiveness, the researchers looked at the amount of time between the end of the study and the participants' first relapse to heavy drinking. Those who received naltrexone, behavioral therapy or behavioral therapy plus naltrexone held out longer (80.6 days, 79.2 days and 77.1 days, respectively, on average) than those who received placebo pills only (75.1 days). The researchers also tallied the percentage of days the participants drank heavily during the year after the study, and again found both naltrexone and therapy effective.

"We were surprised that acamprosate was no more effective than a placebo alone," says Raymond Anton, MD, the lead researcher on the study and a professor of psychiatry at the Medical University of South Carolina, adding that more research needs to be done to verify and examine the effectiveness of the drug, which works through the neurotransmitter GABA, or gamma-aminobutyric acid. But, he adds, overall the research is a cause for optimism: "It shows that treatment does work."

--L. WINERMAN