A Combined Behavioral Intervention for Treating Alcohol Dependence
[for the COMBINE Study]
from: Miller (Ed): Combined Behavioral Intervention Therapist Manual (COMBINE); 2005.
is a modular, manual-guided, semi-structured therapy integrating
evidence based behavioral methods developed as the state of the art
psychotherapy to be tested in the COMBINE Study. Structured around
Motivational Interviewing, CBI includes assessment, feedback, and highly
individualized treatment plan development that is flexible regarding
This Poster Presentation is a sneak preview of the CBI Therapist
Manual (in press). CBI is probably the most thoughtfully
designed, research based substance abuse therapy ever created. Clinicians, especially, will want to study this.
Group Motivational Treatment for Chemical Dependency
DeLuca, Magura, Warner, Grand, Rosenblum and Stahl; J. Substance
Abuse Treatment; 17(3); 1999
Naltrexone for the Treatment of Alcoholism - a Meta Analysis of Randomized,
Design and Analysis of Trials of Combination Therapies
[in the COMBINE Study]
Hoskings et. al;
J Stud. Alcohol; 2005
Pharmacotherapies for the
Study - Process and Procedures
Swift and Pettinati;
J Stud. Alcohol; 2005
When Worlds Collide:
[The COMBINE Study] Blending
Pharmacotherapy and Psychotherapy Research
W.R. Miller, et al.; J Stud. Alcohol; 2005
COMBINE trial is designed to study the efficacy (alone and combined) of
naltrexone and acamprosate with 'medical management' and a
psychotherapy treatment known as the Combined Behavioral Intervention.
The Study is in progress. I will post more interim articles soon.
Disulfiram collection ;
Abstinence and Harm Reduction for Alcohol - Academic Literature archives
Comparing and Combining Naltrexone and Acamprosate - A Double-blind,
Kiefer, et. al.; Archives of General Psychiatry; 60(1); 2003
Efficacy and Safety of Naltrexone and Acamprosate in the Treatment Of
Alcohol Dependence: A Systematic Review
et al.; Addiction; 99(7):811-828; 2004
1-Year Pragmatic Trial of Naltrexone vs. Disulfiram in the Tx of Alcohol
- deSouza and deSouza; Alcohol and Alcoholism;
Harm Reduction: Meeting Clients Where They Are -
Kate Jackson, Social Work Today, 4(6), 2004.
Injectable Naltrexone [Vivitrol] for Alcohol Dependence
A Randomized Controlled
Garbutt et al; JAMA; 293;
with placebo, 380 mg of [Vivitrol] resulted in a 25% decrease in heavy
drinking days... [Men] and those with lead-in abstinence [exhibited]
greater treatment effects... Conclusion:
[Vivitrol] resulted in reductions in heavy drinking among
treatment-seeking alcohol-dependent patients during 6 months of
Initial FDA Approval -
Does Naltrexone Cause Permanent
Liver Disease? (No) - Can Naltrexone be Used in the Presence of Liver
[References with Abstract from Medline Search for 'naltrexone' and
Alex DeLuca, M.D.; 2001-06-16; Updated: 2005-12-30
"A review of the literature
indicates that even when given at much higher doses than are needed for
treating heroin or alcohol abusers, there is no evidence that naltrexone
causes clinically significant liver disease or exacerbates, even at high
doses, serious pre-existing liver disease."
[Brewer et al.; Addiction
Naltrexone for the treatment of alcoholism: a meta-analysis of
Randomized Controlled Trials -
Manit Srisurapanont and Ngamwong Jarusuraisin; Int. J Neuropsychopharmacology; 8; 1-14;
See also news
item about the about above article:
Medication [naltrexone] Helps Alcoholics Control Drinking
Medical News Today item; 2/18/2005
is most effective, says Volpicelli, in a program 'designed to support
the notion that... what you really want to stop is excessive drinking.”
A One-Year Pragmatic Trial
of Naltrexone vs. Disulfiram in the Treatment of Alcohol Dependence
by deSouza & deSouza; Alcohol & Alcoholism; 39(6);
2004 -- "[T]he
number of patients that remained abstinent with Disulfiram were twice
that with Naltrexone. The survival time till the first relapse was
greater with Disulfiram [and the] number who were abstaining at the end
of one year was [much greater]. Naltrexone patients had significantly
lower [craving] scores..."
[naltrexone] Helps Alcoholics Control Drinking -
Medical News Today; 2/18/2005 -- "Naltrexone
is most effective, says Volpicelli, in a program 'designed to support the
notion that... what you really want to stop is
Above is a brief news item from
Medical News Today which is primarily about a recently published
review paper entitled, "Naltrexone for the treatment of alcoholism:
a meta-analysis of randomized, controlled trials;" by Srisurapanont,M.;
Int. J Neuropsychopharmacology; 8; 1-14; 2005.
Full Text of this article is available as PDF: [Naltrexone
for the Treatment of Alcoholism]
Naltrexone improves outcome of a
controlled drinking program by Gabriel Rubio, et
al.; J. Subs. Abuse Treatment;
naltrexone] group showed significantly less craving
[during the 3 mon. treatment period]. In the 12-month
follow-up period, the [naltrexone] group showed
significantly fewer drinking days and heavy drinking
days and less craving than the CD group. The results of
this study suggest a role for naltrexone in controlled
Interesting and potentially useful
study by a good team who ask the right question.
However, good luck finding those "controlled drinking
programs" - they hardly exist. That is the problem. 90%
of treatment centers are abstinence oriented, and for
them this article is irrelevant or anathema.
Versus Acamprosate - One Year Follow Up of Alcohol Dependence Treatment
(PDF) by Rubio et. al.; Alcohol & Alcoholism;
"At the end of one
year, 41% receiving naltrexone and 17% receiving acamprosate had not
relapsed. The cumulative number of days of abstinence was significantly
greater, and the number of drinks consumed at one time and the severity
of craving were significantly less in the naltrexone group... as was the
percentage of drinking days."
and Combining Naltrexone and Acamprosate in Relapse Prevention of
Alcoholism by Kiefer et. al.; Arch Gen
Psychiatry; 60(1); 2003.
combined medication was most effective with significantly
lower relapse rates than placebo and acamprosate but not
acamprosate, especially in combination, considerably enhance
the potential of relapse prevention."
of the combination of naltrexone and acamprosate on alcohol intake in
mice by Kim et. al; Psychiatry
Clin. Neurosci.; 58(1); 2004.
results demonstrate that naltrexone, at the higher dose... significantly
reduced alcohol consumption. When combined with naltrexone, acamprosate
reduced alcohol consumption across both doses of naltrexone."
& Safety of Naltrexone and Acamprosate in the Treatment of Alcohol
Dependence - A Systematic Review
by Carmen et. al.; Addiction; 99(7); 811 - 828; 2004.
"Acamprosate appears to be especially
useful in a therapeutic approach targeted at achieving abstinence,
whereas naltrexone seems more indicated in programmes geared to
controlled consumption. Both drugs are safe and acceptably
Alcohol Abuse vs. Dependence and the Evolving Role of Naltrexone as
Adjunctive Pharmacotherapy -
a HTML slide-show lecture by Alex
DeLuca, January 2002.
Considers the following questions and issues:
Are alcohol abuse and alcohol dependence part of the same continuum
of illness or are they distinct disorders?
The problem with 'radical
abstinence' as a universal treatment suggestion.
Extinction theories of naltrexone are different and consequently lead to
very different medication regimens.
[As of 3/18/02 - approximately 1/2 of the talk has lecture notes
Dopey Doctors and Naltrexone Prescriptions
(aka "Naltrexone FAQ");
Alex DeLuca; 2003.
Includes: Simple Truths About Naltrexone
Naltrexone as an Aid to Controlled Drinking
// Resources and Links
Medications that can help us avoid relapse
in early recovery. Alex DeLuca; 1996.
A patient hand-out regarding the use of Antabuse (disulfiram) and
naltrexone (ReVia) as pharmacologic aids in early recovery from
alcohol, cocaine, or opiate dependence. I just can't say this stuff
Medications that might help problem drinkers achieve moderation goals
Alex DeLuca; 2001.
A patient hand-out regarding the use of naltrexone (ReVia) as an aid
to early recovery for people with a goal of moderation rather than
Collected experiences of Moderation Management members (from
an MM listserv) with naltrexone (ReVia) as an aid to moderate drinking.
Compiled by Alex DeLuca, M.D., 2000, 2001.
Naltrexone: The Magic Bullet for Alcoholism -
Honors thesis by Al Turner (owner of the ADDICT_L listServ and finder of addiction
- related jewels amidst the chaff of the web)
[Top of Page]
Naltrexone and Alcoholism Treatment
by Stephanie O'Malley; SAMHSA TIP # 28;
A very thorough review.
**Oct 16, 2004:
TOC added: now easier to get around doc**
Year Clinical Course Associated with DSM IV Alcohol Abuse
or Dependence in a Large Group of Men and Women
by Marc Schuckit et al.; 2001;
American Journal of Psychiatry, Vol. 158(7); 1084-1090.
Conclusion from the Abstract:
suggest that over 5 years the DSM IV diagnosis of alcohol
dependence predicts a chronic disorder with a relatively severe
course, while DSM IV alcohol abuse predicts a less persistent,
milder disorder that does not usually progress to dependence."
About the Use of Naltrexone and for the Different Ways of Using It
in the Treatment of Alcoholism
by John Sinclair; 2001;
Alcoholism, Vol. 36, No. 1, pp. 2-10.
is most effective when paired with drinking but ineffective when
given during abstinence... naltrexone should be administered to
patients who [are] still ... drinking ... and when drinking [is]
anticipated; this treatment should continue indefinitely."
naltrexone treatment of early problem drinkers
by Kranzler et al.; 1997; Addictive
Behaviors, 22(3); pg 431.
"Twenty-one subjects received brief coping skills
training weekly for four weeks, along with naltrexone 50mg, which they
were to use two to five times per week in anticipation of high-risk
drinking situations. [Statistically] and clinically significant
declines were observed across a variety of drinking-related
outcomes... Beneficial effects of the intervention were still evident
during the 3-month posttreatment period."
Naltrexone in the Treatment of Alcohol Dependence;
Krystal et al.; 2001;
From the Abstract:
"Results: At 13 weeks, we found no significant difference in the number of days to
relapse between patients in the two naltrexone groups and the placebo
group. At 52 weeks, there were no significant differences among the three groups in the percentage of days on which drinking occurred and the number of drinks per drinking day."
Naltrexone in the Treatment of Alcohol Dependence;
Gordis & Fuller; 2001; NEJM; 345(24).
And Alcoholism Treatment
- O'Malley; 1998; Treatment Improvement Protocol (SAMHSA TIP #28)
and Cognitive Behavioral Therapy for the Treatment of Outpatient
Alcoholics: Results of Placebo-Controlled Trial;
Anton; 1999; American
Journal of Psychiatry, Vol. 156, pp 758-64.
A Relapse Prevention Maintenance Treatment of Alcohol Dependence: A
Meta-Analysis of Randomized Controlled Trials;
Streeton; 2001; Alcohol & Alcoholism, Vol. 36, No. 2, pp 544-52.
group had greater abstinence, fewer relapses, and drank less. There
difference between the naltrexone and placebo groups regarding adverse effects.