Most Effective Alcoholism Treatments Today

A Look at Medications, Counseling and Behavioral Therapies

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Multiple Treatment Approaches Work. © Getty Images

Thanks to years of research, doctors and health professionals now have a full menu of options to treat alcohol use disorders. Building on this progress, scientists continue to work on new medications and discover new ways to improve the effectiveness, accessibility, quality, and cost-­effectiveness of treatment for people who have alcohol use disorders.

Standing on the Shoulders of Giant Studies

A massive study published in 2006 followed more than 1,300 study participants at 11 academic locations over a three-year period to determine what combination of treatment, medication, and counseling was the most effective for treating alcohol abuse disorders.

The Combining Medications and Behavioral Interventions for Alcohol Dependence (COMBINE) study produced some surprising results when it revealed that one of the newer medications used for the treatment of alcoholism failed to improve treatment outcomes on its own.

As shown in COMBINE, no single medication or treatment strategy is effective in every case or in every person.

Anti-Alcohol Drugs Revia, Vivitrol and Campral

The study did find that when combined with a structured outpatient medical management intervention consisting of nine brief sessions conducted by a healthcare professional that the alcohol-deterrent medications Revia and Vivitrol (naltrexone) and up to 20 sessions of alcohol counseling were equally effective treatments for alcoholism.

"These results demonstrate that either naltrexone or specialized alcohol counseling— with structured medical management— is an effective option for treating alcohol dependence," said Mark L. Willenbring, M.D., director, division of treatment and recovery research, National Institute of Alcohol Abuse and Alcoholism . "Although medical management is somewhat more intensive than the alcohol dependence interventions offered in most of ​today's health care settings, it is not unlike other patient care models such as initiating insulin therapy in patients with diabetes mellitus."

The study found that combining another alcohol-deterrent drug Campral (acamprosate) with the medical management program did not improve outcomes. Campral did not perform better than the placebo or dummy pill. This finding stumped researchers since previous studies performed in Europe using Campral had yielded positive treatment outcomes.

COMBINE Study Highlights

After 16 weeks, the COMBINE study showed overall positive outcomes for study participants.

COMBINE Study Results
All groups studied substantially reduced drinking during treatment. Overall percent days abstinent tripled, from 25 to 73 percent, and alcohol consumption per week decreased from 66 to 13 drinks, a decrease of 80 percent.
Patients who received medical management plus either Revia or Vivitrol (naltrexone) or specialized counseling showed similarly improved outcomes of alcohol abstinence (80 percent) compared with patients who received medical management and placebo pills (75 percent).
Patients who received Revia or Vivitrol reported less craving for alcohol.
Adding either Revia or Vivitrol or specialized alcohol counseling to medical management almost doubled the chance to do well.

Combined Behavioral Intervention

Combined behavioral intervention (CBI)— which includes counseling integrated cognitive-behavioral therapy, motivational enhancement, and techniques to enhance mutual help group participation—has shown beneficial outcomes in studies. 

Medication Gave Patients an Advantage

According to research, medications seem to be a positive part of the winning combination for alcohol use disorders.

And, it is underused as a method for treating alcoholism.

"The most robust finding in the study is that those receiving any medication did much better than those who received no pills at all," says Professor Barbara Mason, Scripps Research Institute, and an author of the study. "This should be a wake-up call. With less than one percent of those seeking help for alcohol dependence receiving a prescription, medication is underutilized. Medication for alcoholism can offer patients an advantage for their recovery, especially in a real-world setting."

The Sinclair Method

In 2001, David Sinclair, Ph.D., a researcher in Finland claimed an 80 percent cure rate for alcohol dependence when anti-alcohol drugs Revia or Vivitrol are prescribed according to his Sinclair Method.

Dr. Sinclair's research has been published in the peer-reviewed journals Alcohol and Alcoholism and the Journal of Clinical Psychopharmacology. The Sinclair Method is the standard treatment protocol for alcohol dependence in Finland, the method is also used in the U.K., but the method has yet to catch on in the United States. 

With the Sinclair Method, people only take Revia or Vivitrol before drinking and never otherwise. Revia and Vivitrol are not like other anti-alcohol drugs that cause intense sickness and hangover sensations when taken with alcohol. The change in behavior only appears over time. With the Sinclair Method, Revia or Vivitrol is taken one hour before drinking alcohol. At the end of four to six months of treatment with the Sinclair Method, 80 percent of people who had been overusing alcohol are either drinking moderately or abstaining entirely.

The way it works is when people normally drink alcohol, endorphins are released into the brain, and this reinforces the behavior of drinking alcohol. Revia and Vivitrol block the feel-good endorphins. Much like when Pavlov's dogs were presented with food when a bell was rung, these dogs became conditioned to salivate at the sound of the bell alone. However, when these dogs continued to be presented with the ringing bell and no food, the salivating stopped.

It is believed that the main reason the Sinclair Method has not caught on in the U.S. is two-fold. In the U.S., 12-step programs seem to dominate treatment plans prescribed by doctors, that, and doctors do not like that the Sinclair Method encourages people with alcohol dependency problems to continue drinking.

Sources:

Anton, RF, et al. "Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence. The COMBINE Study: A Randomized Controlled Trial." Journal of the American Medical Association. May 2006

National Institute on Alcohol Abuse and Alcoholism. Advances in Alcoholism Treatment, Alcohol Research and Health, Volume 33, Number 4. 2011. 

Sinclair, J.D. Drugs to Decrease Alcohol Drinking. Annals of Medicine 22: 357‑362, 1990.

Sinclair, JD. Evidence About the Use of Naltrexone and for Different Ways of Using it in the Treatment of Alcoholism. Alcohol and Alcoholism. 36 (1): 2-10. 2001.

Heinälä P, Alho H, Kiianmaa K, Lönnqvist J, Kuoppasalmi K, Sinclair JD.Targeted Use of Naltrexone Without Prior Detoxification in the Treatment of Alcohol Dependence: A Factorial Double-Blind, Placebo-Controlled Trial.  J Clin Psychopharmacol. 2001 Jun;21(3):287-92.

 

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