March 14, 2002
Alcoholism treatment: National study with Seattle site opens enrollment for second group of participants
The UW’s Alcohol and Drug Abuse Institute and the VA Puget Sound Health Care System’s Addictions Treatment Center jointly manage the Seattle site for the COMBINE study (Combining Medications and Behavioral Interventions). Seattle is one of 11 sites taking part in this national study, which is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Over the past year, the Seattle site has enrolled about 65 participants, including many on the original waiting list. Now enrollment has been opened again for alcohol-dependent people who want to be part of the study. About 60 more participants will be enrolled this year. The researchers are particularly interested in signing up more ethnic minority volunteers, who are under-represented in the existing group. More than 8 million Americans are thought to meet the clinical criteria for alcoholism, a condition characterized by an abnormal appetite for alcohol that leads to significant impairment, alcohol tolerance, impaired control over alcohol consumption, physical dependence and often severe craving after abstinence. Alcoholism has long been recognized as a difficult condition to treat effectively; as many as 50 percent of people who receive treatment relapse at least once and only a fraction achieve long-term sobriety. NIAAA estimates that more than half of Americans have some direct family experience with alcohol problems. The current study is the first of its kind to evaluate behavioral treatments combined with two different medications that have shown promise. The medications are naltrexone, approved by the Food and Drug Administration in 1994 for treatment of alcohol dependence, and acamprosate, in use in Europe for about 15 years and currently under review by the FDA. Naltrexone, an opioid antagonist, interferes with neurotransmitter systems in the brain that produce pleasure, and previous studies have found that patients taking the drug are less likely to relapse into heavy drinking if they sample alcohol. Acamprosate is believed to work with the systems involved in early alcohol withdrawl, reducing the physical discomfort and cravings usually associated with stopping drinking. Dr. Dennis Donovan, director of the UW Alcohol and Drug Abuse Institute and professor of psychiatry and behavioral sciences, noted that use of the medications will be combined with two behavioral therapies. “This is not medication out of context,” he noted. “We think these treatments will be more effective when combined with ongoing face-to-face counseling.” Because the problem of relapse is so central to the effectiveness of alcohol treatment, Donovan said this is an appropriate focus of effort. “What we would like to do here is learn how to keep lapses, such as having a single drink, from turning into full-blown relapses. We hope that medication and coping skills will make a difference,” he said. Michelle Hansten, project coordinator in Seattle, said that people who are accepted into the study will have about four months of treatment and at least three post-treatment research follow-ups over the next year. Not all participants will receive the medications; some will get a placebo (sugar pill) along with one or both of the behavioral therapies, and a small percentage will take no pills but receive behavioral therapy only. Volunteers are first screened with telephone interviews. If they qualify and remain interested, they will go to the Seattle VA medical center for a day-long evaluation. After that, they would have an appointment each week for about four months. There is no cost to the participant for the treatment and individuals do not need to be veterans to join the study. To participate or learn more about the study, call 206-277-5086 or toll-free 1-866-8COMBINE.
