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Pill proven effective to treat alcoholism by Tim Gehret Public Relations A seven-year study by MUSC researchers offers proof that alcoholism is treatable in more than one way, beginning with a trip to the doctor’s office and a prescribed medication with appropriate medical management.   Drs. Raymond Anton and Carrie Randall review and discuss the findings in the COMBINE study. Research led by MUSC’s Raymond Anton, M.D., and Carrie Randall, Ph.D., found  that using a combination of pills and outpatient general medical management  resulted in a dramatic increase in alcohol abstinent days, from 25 percent to 73 percent, in those that participated in the national study, Combining Medications and Behavioral Treatment of Alcoholism (COMBINE).   The COMBINE study, funded by the National Institutes of Health, focused on the use of the prescribed drug, naltrexone, an opioid antagonist, which has been used to treat alcoholism for some years in the context of specialty programs. Naltrexone or another newer drug, acamprosate, was combined with outpatient medical management or  specialty counseling. Medical management could be carried out by general health care professionals including nurses and physicians assistants. Specialty counseling was delivered by master and doctorate level alcohol counselors.   The results of the study, announced in the Journal of the American Medical Association (JAMA) released May 3, conclude behavioral counseling is not required when naltrexone is prescribe to achieve successful results.   The COMBINE study is the first of its kind funded by NIH. Researchers also say the study proves that alcoholism does not necessarily require treatment from a behavioral specialist, but that more discreet options exist for those unwilling, or unable, to seek psychotherapy.   “There is an unfortunate stigma that still exists for alcoholism,” Anton said. “With improved treatments, access to care, and expected good outcomes, individuals and their families will hopefully seek the help they need while physicians, employers, educators, and health insurers will see the wisdom of providing support.”   According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), more than 8 million people suffer from alcoholism in the United States in any given year.   Although drugs such as naltrexone have been used in alcoholism treatment for more than a decade, the social stigma and lack of insurance support associated with the disease caused most alcohol-dependent individuals to bypass medical  treatment and seek help  from mutual help groups such as Alcoholics Anonymous or specialty alcohol counseling programs. In fact, the NIAAA reports that only 12 percent of alcohol-dependent patients seek professional help, partially due to lack of access to care.   “The primary message we want to convey is that there is a choice,” Anton said. “The results from the COMBINE study are important because it broadens the treatment possibilities for those who have alcohol problems.“   From 2001-2004, investigators at 11 academic sites recruited about 1,400 participants. During the course of 16 weeks, various patients were given a different combination of general care, specialized counseling, naltrexone; another drug, acamprosate, or a placebo. Although reported effective in other studies conducted outside of the United States, researchers in the COMBINE study found acamprosate to have little to no effect in treating alcoholism.   Drug therapies have not been used because most clinicians  have difficulty understanding the complex nature of the disease and the role the brain plays in it.   “One reason that medications like naltrexone have not been widely used is the lack of knowledge that alcoholism is an acquired brain disease with a specific chemical basis that can be modified by medications under the right circumstances,” Anton said. “Many medications are being studied (here at MUSC and elsewhere) for alcohol dependence currently, and newer ones are expected to give more hope for treatment or cure in the future.” In the meantime, patients have a choice, naltrexone or specialized counseling.       Friday, May 5, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island papers at 849-1778, ext. 201.