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To the Editor: In the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study, Dr Anton and colleagues¹ evaluated the effects of combining medications with behavioral interventions in treatment of alcohol dependence. While all 9 study groups showed marked reductions in drinking from baseline to end of study, treatment with acamprosate, naltrexone, or both when added to the background of medical management did not substantially improve percent days abstinent or time to first heavy drinking day (the 2 coprimary outcomes) compared with placebo and medical management, regardless of whether a combined behavioral intervention (CBI) was added.

In this multifactorial design, naltrexone statistically separated from nonnaltrexone groups on time to severe relapse but demonstrated a significant interaction with CBI for percent days abstinent. The direction of interaction indicatedthat the medication effect was weaker when CBI was added, an unexpected finding. Furthermore, the magnitude of additional benefits of naltrexone over placebo with medical management . . . [Full Text of this Article]

Jeffrey M. Jonas, MD
jeffrey.jonas@frx.com
Forest Research Institute
Jersey City, NJ

Sylvie Chabac, MD, MBA
Merck Santé
Lyon, France

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