Drug-therapy combination helps alcoholics in treatment

November 14, 2001

Alcoholism treatment that includes both the drug naltrexone and coping skills training can help reduce the severity of any relapse or even prevent a relapse from occurring, finds a new study of 165 alcoholics.

"The results suggest that individuals in alcoholism treatment get benefits from both medication and coping skills training," said lead author Peter Monti. "Where one leaves off, the other may pick up.

"The importance to someone in alcoholism treatment is knowing that many people benefit from it, and that methods of helping alcoholics are improving all the time."

Approved for use in alcoholism treatment, naltrexone disrupts chemical activity in brain sites associated with receiving pleasure from alcohol. Drug therapy is often combined with behavioral counseling in alcoholism treatment.

Nonetheless, "naltrexone in alcoholism treatment is probably underused," Monti said. "But it's pretty clear that it works."

Published in the current issue of Alcoholism: Clinical & Experimental Research, the study provides fresh evidence that naltrexone can have a beneficial effect in reducing the severity of relapses among alcoholics who continue to take it, said Monti, professor in the Department of Community Health and director of the Center for Alcohol and Addiction Studies at the Brown Medical School.

Monti and 10 colleagues looked at the effects of prescribing naltrexone versus placebo during the 90 days after alcoholics completed a two-week daily alcohol treatment program. Alcoholics who took naltrexone for at least two months of the 90 days it was prescribed had fewer heavy drinking days, fewer drinks if they drank, and fewer urges to drink.

Naltrexone's beneficial effects lasted only while patients took it, suggesting that patient outcomes would improve further if the drug were prescribed for more than 90 days, Monti said.

The researchers also found that just four or five sessions of coping skills training, as part of the two-week intensive alcohol treatment, can have lasting benefits for preventing relapse and reducing relapse severity, compared to alcoholics who received the same medical treatment but not the coping skills training. During the following year, individuals who received the coping skills training were less likely to relapse and had fewer heavy drinking days.

This means that even a few sessions of skills training added to alcohol treatment can result in lasting benefits, Monti said. Many treatment programs already use some form of coping skills training, often including some aspects of communication skills training, he said.

In the study, coping skills training was designed to help alcoholics develop more healthy social networks to help make relapse less likely. Alcoholics also were taught how to cope with urges to drink while in high-risk situations.

"Approaches using skills training warrant further study to find ways to improve outcomes even more," Monti said. "Clearly, the skills training approach is one of the more beneficial approaches to treating alcoholics."
The National Institute on Alcohol Abuse and Alcoholism funded the study.

Brown University

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