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Treating Alcoholism: No Magic Bullet

The FDA approved naltrexone for treatment of alcohol dependence based on proven efficacy in randomized trials. Nevertheless, questions remain about the importance of clinical setting, patient characteristics, and concomitant therapies in determining naltrexone's effectiveness. Researchers from the U.S. Department of Veterans Affairs studied naltrexone (given daily for 3 or 12 months) in a large, multicenter, placebo-controlled trial that included 627 veterans with alcohol dependence. All subjects received counseling based on the tenets of Alcoholics Anonymous, initially weekly and then monthly.

At 13 weeks, there was no significant difference in return to heavy drinking. At 1 year, there were no significant differences in percentage of drinking days or number of drinks per drinking day. In the 2 naltrexone groups, medication adherence (percentage of days that the medication bottle was opened) was 72% at 13 weeks and 43% to 44% at 1 year. Medication adherence, attendance at counseling, and AA participation were associated with improved outcomes, regardless of treatment assignment.

Comment: Editorialists point out that, in this study, naltrexone was ineffective in a population that comprised mainly men who had long-standing alcoholism and relatively little social support and who received minimal counseling; these patient characteristics contrast with those in prior studies that demonstrated naltrexone's efficacy. Can naltrexone cure alcoholism? Clearly, the answer is "no, not alone," and we shouldn't expect that any one drug could cure a complex, chronic medical illness. Nonetheless, the current results do not negate previous findings of modest efficacy when the drug is used with appropriate counseling in less severely affected patients.

— Richard Saitz, MD, MPH

Published in Journal Watch General Medicine January 4, 2002

Citation(s):

Krystal JH et al. Naltrexone in the treatment of alcohol dependence. N Engl J Med 2001 Dec 13; 345:1734-9.

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Fuller RK and Gordis E. Naltrexone treatment for alcohol dependence. N Engl J Med 2001 Dec 13; 345:1770-1.

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• Medline abstract (Free)