Combining Psychosocial Treatment with Pharmacotherapy for Alcohol Dependence

Abstract

Pharmacotherapy for alcohol dependence is always delivered in a psychosocial context that may affect the outcome of the treatment. The rigorous study of different psychotherapeutic treatments for alcohol dependence has shown several distinct approaches to be effective. This article reviews the combination of alcohol dependence pharmacotherapies, including disulfiram, naltrexone, and acamprosate, with different psychosocial interventions. Many psychosocial interventions for alcohol dependence, including Alcoholics Anonymous, can be integrated successfully with pharmacotherapy. Psychosocial interventions, ranging from brief medical management to more intensive manualized psychotherapies, have all been shown to produce positive outcomes in certain studies, depending on the specific medication and the study context. Particularly successful combinations may include the use of behavioral marital therapy plus a disulfiram contract for patients taking that medication, and the combination of naltrexone or acamprosate with cognitive-behavioral therapy or psychosocial support. Ongoing research examining the optimal combinations of medications with different psychosocial treatments for alcohol dependence may further inform the field.

Tolerance to Disulfiram Induced by Chronic Alcohol Intake in the Rat

“…Its therapeutic effect is most evident when compliance with drug intake is supervised by a third person (Chick et al, 1992;De Sousa and de Sousa, 2005;Fuller and Gordis, 2004;Laaksonen et al, 2007;Weiss and Kueppenbender, 2006). While the use of supervised disulfiram is increasing, only 10% of patients treated by specialist physicians in the U.S. are prescribed disulfiram (Mark et al, 2003).…”

Management of Alcohol Dependence in Patients with Liver Disease

“…[39] All 3 interventions produced equally significant and sustained improvements in drinking outcomes, and there was little evidence that matching specific types of patients to a particular treatment improved the outcome. [40] The TSF therapy [37] is directed to achieve and maintain alcohol abstinence encouraging motivation to stop drinking. Treatment modalities are flexible and individualized on patient’s needs.…”

“…The philosophical foundation of the A.A. is the 12-step program, only one of which (Step 1) actually mentions alcohol; the other steps focus more on personal growth. [40] When compared with those who do not go to A.A., the individuals who participate in AA meetings typically have better drinking outcomes [44] and have been shown to have fewer health-related expenditures. [45] However, clinical trials aimed to objectively demonstrate the efficacy of such approach are lacking.…”

Medication Assisted Treatment in the Treatment of Drug Abuse and Dependence in HIV/AIDS Infected Drug Users

“…Alcohol dependence compromises the effectiveness of HIV treatment by influencing access and adherence to antiretroviral therapy. A comprehensive approach to the treatment of alcohol dependence integrates psychosocial treatment with pharmacologic treatments [46]. Treatment paradigms for alcohol dependence that utilize pharmacotherapy focus clinical outcomes on reducing problematic drinking and relapse prevention.…”