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A Combined Behavioral Intervention for Treating Alcohol Dependence [for the COMBINE Study]
Miller, Moyers, and Arciniega; from: Miller (Ed): Combined Behavioral Intervention Therapist Manual (COMBINE); 2005.
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Comment (DeLuca):
CBI 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 treatment goal.
 
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.
 
See also:
 A Group Motivational Treatment for Chemical Dependency
Foote, 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, Controlled Trials - Srisurapanont, 2005
 
 

 
New! - Design and Analysis of Trials of Combination Therapies [in the COMBINE Study]
Hoskings et. al; J Stud. Alcohol; 2005
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Choosing Pharmacotherapies for the COMBINE Study - Process and Procedures
Swift and Pettinati; J Stud. Alcohol; 2005
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When Worlds Collide: [The COMBINE Study] Blending Pharmacotherapy and Psychotherapy Research
W.R. Miller, et al.; J Stud. Alcohol; 2005
 
Comment (DeLuca):
The 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.
 
Related resources: 
Disulfiram collection  ;  Acamprosate collection  ;  Naltrexone collection
Abstinence and Harm Reduction for Alcohol - Academic Literature archives 
 
See also:
Comparing and Combining Naltrexone and Acamprosate - A Double-blind, Placebo-Controlled Study
Falk 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
Bouza  Carmen, et al.; Addiction; 99(7):811-828; 2004
A 1-Year Pragmatic Trial of Naltrexone vs. Disulfiram in the Tx of Alcohol Dependence - deSouza and deSouza; Alcohol and Alcoholism; 2004.
Harm Reduction: Meeting Clients Where They Are - Kate Jackson, Social Work Today, 4(6), 2004.
 

 Long-Acting Injectable Naltrexone [Vivitrol] for Alcohol Dependence - A Randomized Controlled Trial - Garbutt et al; JAMA; 293; 2005-04-06
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"Compared 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 therapy."
 
See also:
[Vivitrol] Wins Initial FDA Approval - Join Together; 2006
 

2Updated! (2005-12-30)
Does Naltrexone Cause Permanent Liver Disease? (No) - Can Naltrexone be Used in the Presence of Liver Disease (Carefully)
[References with Abstract from Medline Search for 'naltrexone' and 'hepatotoxicity'] - Alex DeLuca, M.D.; 2001-06-16; Updated: 2005-12-30
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"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 .Biology; 2004]
 

See also news item about the about above article:
Medication [naltrexone] Helps Alcoholics Control Drinking Medical News Today item; 2/18/2005
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"Naltrexone is most effective, says Volpicelli, in a program 'designed to support the notion that... what you really want to stop is excessive drinking.”
 

NOTE:
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]
 

Comment:
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.   ..alex...
 

"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."
 

"The combined medication was most effective with significantly lower relapse rates than placebo and acamprosate but not naltrexone... Naltrexone and acamprosate, especially in combination, considerably enhance the potential of relapse prevention."
 

"The 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."
 

"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 tolerated..."
 

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.
Abstinence vs 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 included.] 
 

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
 

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 any better.
 

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 abstinence.
 

Comment:
A very thorough review.
**Oct 16, 2004: TOC added: now easier to get around doc**
 

Conclusion from the Abstract:
"The data 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."
 

From the Abstract:
"Naltrexone 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." 
 

From the Abstract: 
"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."

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."
 

Comment:
Naltrexone group had greater abstinence, fewer relapses, and drank less. There was no difference between the naltrexone and placebo groups regarding adverse effects.