The first paper from this study was published in the Journal of the American Medical Association during the ASAM conference, 3 days before being described in a symposium by lead author, Raymond Anton, MD, of the Medical University of South Carolina, Charleston. Anton reported that patients who received medical management with naltrexone(Drug information on naltrexone) and/or specialist-provided "combined behavioral intervention" (CBI) had more days of abstinence and/or more days until the first heavy drinking day than did those who received acamprosate(Drug information on acamprosate) with or without CBI; acamprosate did not demonstrate greater effect than placebo. He also noted that patients who received only CBI did not do as well as either those who received CBI and placebo, or placebo alone.
Anton indicated that the researchers were surprised that acamprosate had not demonstrated effectiveness, given the number of previous positive trials and the decade of successful use of the medication in Europe before its approval in the United States. A possible contributing factor was that only 4 days of outpatient abstinence was required for admittance to this study, in contrast to the longer prestudy inpatient abstinence required in most of the positive trials with acamprosate.
"Medical management of alcohol(Drug information on alcohol) dependence with naltrexone appears to be feasible," the investigators concluded, "and, if implemented in primary and other health care settings, could greatly extend patient access to effective treatment."1
Littleton had cautioned, earlier in the symposium, that the Project COMBINE results should not obscure the previously demonstrated value of acamprosate to assist longer-term abstinent patients or to serve as a model compound from which to derive more effective products. "It indicates that we need to do a better job of ascertaining how best to apply the medication," he commented.
This is the second of 2 articles on the 2006 ASAM Medical-Scientific Conference. The first (Psychiatric Times, August 2006) reported on obstacles to provision of treatment for addiction.