Alcohol and Alcoholism Advance Access originally published online on February 8, 2006
Alcohol and Alcoholism 2006 41(3):321-327; doi:10.1093/alcalc/agl007
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COMBINED ACAMPROSATE AND NALTREXONE, WITH COGNITIVE BEHAVIOURAL THERAPY IS SUPERIOR TO EITHER MEDICATION ALONE FOR ALCOHOL ABSTINENCE: A SINGLE CENTRES' EXPERIENCE WITH PHARMACOTHERAPY
1 Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia, 2 Department of Psychiatry, The University of Queensland, Brisbane, Queensland 4102, Australia, 3 School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Queensland 4034, Australia.
* Author to whom correspondence should be addressed at: Dr Gerald Feeney, Medical Director, Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia, Tel.: +61 7 32405191; Fax: +61 7 32407211; E-mail: Gerald_Feeney{at}health.qld.gov.au
(Received 14 July 2005; first review notified 19 August 2005; in revised form 3 November 2005; accepted 17 January 2006)
Aims: To compare treatment outcomes amongst patients offered pharmacotherapy with either naltrexone or acamprosate used singly or in combination, in a 12-week outpatient cognitive behavioural therapy (CBT) programme for alcohol dependence. Methods: We matched 236 patients across gender, age group, prior alcohol detoxification, and dependence severity and conducted a cohort comparison study of three medication groups (CBT+acamprosate, CBT+naltrexone, CBT+combined medication) which included 59 patients per group. Outcome measures included programme attendance, programme abstinence and for those who relapsed, cumulative abstinence duration (CAD) and days to first breach (DFB). Secondary analyses compared the remaining matched 59 subjects who declined medication with the pharmacotherapy groups. Results: Across medication groups, CBT+ combined medication produced the greatest improvement across all outcome measures. Although a trend favoured the CBT+ combined group, differences did not reach statistical significance. Programme attendance: CBT + Acamprosate group (66.1%), CBT + Naltrexone group (79.7%), and in the CBT + Combined group (83.1%). Abstinence rates were 50.8, 66.1, and 67.8%, respectively. For those that did not complete the programme abstinent, the average number of days abstinent (CAD) were 45.07, 49.95, and 53.58 days, respectively. The average numbers of days to first breach (DFB) was 26.79, 26.7, and 37.32 days. When the focal group (CBT + combined) was compared with patients who declined medication (CBT-alone), significant differences were observed across all outcome indices. Withdrawal due to adverse medication effects was minimal. Conclusions: The addition of both medications (naltrexone and acamprosate) resulted in measurable benefit and was well tolerated. In this patient population naltrexone with CBT is as effective as combined medication with CBT, but the trend favours combination medication.
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