The Pharmaceutical Journal
Vol 276 No 7400 p559
13 May 2006

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Naltrexone effective for treating alcohol dependence

Alcohol dependence can be treated effectively with naltrexone, even without behavioural therapy, a study suggests (JAMA 2006;295:2003).

Researchers assessed the effectiveness of various combinations of placebo, naltrexone (100mg per day), acamprosate (3g per day), medical management (MM) and combined behavioural intervention (CBI). In the trial medical management was delivered by a team of 44 health care professionals, including doctors, nurses, a physician assistant and a pharmacist. The 1,383 recently alcohol-abstinent volunteers in the study were divided into nine groups: placebo and MM; naltrexone and MM; acamprosate and MM; naltrexone, acamprosate and MM; placebo, MM and CBI; naltrexone, MM and CBI; acamprosate, MM and CBI; naltrexone, acamprosate, MM and CBI; and CBI only.

All groups showed substantial reductions in levels of alcohol consumption. However, no combination was more effective than naltrexone with medical management or CBI with medical management and placebo. In addition, the researchers found that a placebo combined with meeting a health care professional was more effective than CBI alone. “Our data suggest that naltrexone can be effective within the context of medical management without specialised behavioural treatment,” the authors conclude.

Carole Hunter, lead pharmacist at Glasgow Addiction Services, told The Journal how the shared care team in Glasgow provides a combination of pharmacological interventions, including disulfiram and acamprosate, and evidence-based psychosocial interventions to treat alcohol-dependent patients. Additional therapies are always useful, she added, but their inclusion in therapy would need to be evidence-based.

Francis Keaney, consultant addiction psychiatrist at the Maudsley Hospital, London, commented: “Naltrexone is certainly used off-label by individual doctors in the UK for the treatment of alcohol dependence, as it is useful not only for people who are alcohol-free but also for people who don’t want to quit completely.”

He added: “There is no magic pill for treating alcohol dependence, but it would be good to be able to match individual patients, where possible, to the best treatment for them. Expanding the menu of treatments available may help to achieve that.”

Treatment with disulfiram is most effective when it is supervised, he explained, and the supervision of medicines for alcohol treatment has usually been done in an outpatient clinic by medical or nursing staff. “Naltrexone treatment is likely to work on similar principles,” he added, “so I would strongly recommend supervised consumption and that is something pharmacists would be well placed to carry out.”