Update on Alcohol and Health：在酒精和健康更新.pptVIP

Update on Alcohol and Health Alcohol and Health: Current Evidence July-August 2006 Studies on Assessments and Interventions Combining Medication With Specialist Behavioral Intervention for Alcoholism: the COMBINE Study Anton RF, et al. JAMA. 2006;295(17):2003–2017. Objectives/Methods To study the effects of pharmacotherapy with behavioral intervention for alcohol dependence 1383 recently abstinent patients with alcoholism randomized to 1 of 9 treatments for 16 weeks: Placebo; Naltrexone (100 mg per day), acamprosate (3 g per day), or both; or Combined behavioral intervention (CBI) alone, with active pills, or with placebo Objectives/Methods (cont.) CBI: Offered by a specialist Included elements of cognitive behavioral therapy, motivational interviewing, and 12-step facilitation Up to 20 50-minute sessions “Medical management” (MM) provided to all but CBI alone group 9 counseling and education sessions (45-minute initial session and ≈20-minute follow-up sessions) Provided by a generalist healthcare professional Focused on medication side effects, adherence, and alcohol abstinence 94% follow-up at 16 weeks; 82% a year later Results Drinking outcomes improved substantially in all groups. The range of mean percent days abstinent across groups was… 23%–30% at baseline, 67%– 81% at 16 weeks, and 59%–69% a year later. Results (cont.) Results (cont.) One year after treatment… drinking outcomes did not significantly differ among groups. Conclusions/Comments This large, rigorous, and complex study showed that... naltrexone and specialist counseling have similar modest efficacy when each is offered with MM, and specialist counseling alone has less efficacy than when combined with MM. These findings support the use of naltrexone and intensive MM in primary care settings as a potential alternative to specialized treatment. Conclusions/Comments (cont.) Delivering the type of medical management provided in this study requires substantial training