Alcoholism afflicts roughly eight million Americans. Despite significant health and social impacts from excessive drinking, few alcoholics receive any form of specialized care and few researchers have studied the relative merits of counseling, medical visits and pharmaceutical interventions. Now a major nationwide study has shown that medical visits mixed with either counseling or drug therapy--but not both--cuts down on drinking.
"Medical care works and alcoholics don't need to check into a specialty treatment program to get it," says Robert Swift of Brown University, one of the team of doctors at 11 sites nationwide who conducted the trial. "We found that just nine 20-minute sessions with a medical professional, in conjunction with [the drug] naltrexone or intensive counseling, yields good clinical results."
Launched in 2001, the trial followed nearly 1,400 alcoholics during a 16-week treatment period and a year of follow-up interviews. Divided into nine groups, the alcoholics received treatments ranging from medical sessions, two drugs and intensive counseling to just intensive counseling. Through January 2004, every group substantially cut back on alcohol consumption with average days without a drink tripling from 25 to 73 percent. Participants cut back on alcoholic beverages from an average of 66 drinks a week to only 13.
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Surprisingly, however, the researchers found that the drug acamprosate--which had shown effectiveness in European trials--produced no benefits and combining modes of treatment did not improve outcomes. Patients taking placebos also improved more than those who only received intensive counseling. The latter group also proved most likely to have a relapse. The researchers speculate that this may have been due to disappointment at not receiving pills, optimism about the efficacy of pills, not having a pill-taking regimen as a daily reinforcement of good behavior, or some other cause.
Patients who received medical visits and either naltrexone--which blocks pleasure receptors in the brain and cuts down on cravings--or intensive counseling improved the most, according to the results published in the current issue of JAMA. "Having someone check on a patient's progress, assess their health and provide encouragement--routine practice in treating high blood pressure or diabetes--speaks to the power of sustained, professional medical care," Swift notes. "What was really compelling is that people did well, regardless of the specific treatment."
