Perhaps one of the greatest disconnects between research and practice involves the use of medications to treat alcohol-related disorders. For example, clinical trials suggest that naltrexone helps reduce the frequency of drinking and the severity of relapse among alcohol-dependent patients (2).

Although there are occasional reports of no effects (3), large-scale analyses of clinical trials have continued to support an improvement in treatment outcomes with the use of this medication (4,5).

Training materials on the use of medications in alcoholism treatment also are available. A Center for Substance Abuse Treatment (CSAT) Treatment Improvement Protocol was developed to provide detailed clinical guidance on how to use naltrexone in alcoholism treatment (2), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) published as part of its COMBINE Monograph Series the Medical Management Treatment Manual, which details the rationale and use of both naltrexone and acamprosate (6).

Despite the availability of training materials for professionals and consistent reports of significant reductions in alcohol use, medications such as naltrexone are not commonly prescribed. Members of the American Academy of Addiction Psychiatry and the American Society of Addiction Medicine prescribed naltrexone to only about 1 in 7 (13 percent) of their patients (7,8). A survey of counselors and physicians specializing in addiction medicine (9) found that few counselors (5 percent) recommended naltrexone to most of their patients, and more than half (54 percent) never suggested that patients try it. A higher percentage of physicians prescribed naltrexone for patients. Eight of 10 physicians (80 percent) reported current or prior use of naltrexone with patients, but only 11 percent prescribed it “often,” and only 4 percent prescribed it for “almost all patients” with alcoholism or alcohol abuse problems.

If naltrexone is effective, why isn’t it used? Organizational support was the strongest predictor of whether counselors recommended naltrexone. Patient access to insurance benefits also influenced the use of medications. Counselors treating patients who had Medicaid coverage were more likely to promote the use of naltrexone, which was on the Medicaid formulary in the study States (9). Counselors whose patients paid for their own treatment or whose treatment was funded through State and Federal funds were less likely to recommend naltrexone to patients. Among physicians, those involved in research and those in organizations that promoted naltrexone use were more likely to prescribe the medication. Physicians in recovery themselves were the least likely to prescribe naltrexone (9).

The medication naltrexone and up to 20 sessions of alcohol counseling by a behavioral specialist are equally effective treatments for alcohol dependence when delivered with structured medical management, according to results from "Combining Medications and Behavioral Interventions for Alcoholism" (The COMBINE Study). Results from the National Institutes of Health-supported study show that patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management (MM), an intervention consisting of nine brief, structured outpatient sessions provided by a health care professional. Contrary to expectations, the researchers found no effect on drinking of the medication acamprosate and no additive benefit from adding acamprosate to naltrexone. Effect of Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence appears in the current issue of the Journal of the American Medical Association,Volume 295, Number 17, pages 2003-2017.

Additionally it is non-addictive (unlike Suboxone for Opiates) and has virtually no side effects.