Researchers examine new treatments for alcoholism

In an age of changing medical technique and unorthodox treatment, Boston University researchers have joined 11 schools nationally in evaluating new strategies in the treatment of alcoholism.

The disease, which along with alcohol abuse affects nearly 14 million Americans — or 1 in every 13 adults — is the focus of a treatment research program sponsored by the National Institute of Alcohol Abuse and Alcoholism.

Last week, research as part of a program titled Combining Medications and Behavioral Interventions — abbreviated “COMBINE” — began at Boston University and is the first nationwide study to investigate the effects of combined behavioral and medicinal treatments for people afflicted with alcoholism, according to the NIAAA.

“The NIAAA is interested in examining whether medical therapy and counseling in combination is most effective,” said Dr. Joseph LoCastro, co-principal investigator of the COMBINE program at the Boston University Medical Center.

“COMBINE is based on the accumulated knowledge of two decades in which NIAAA researchers have applied rigorous clinical trial methodology to test treatments for alcoholism,” said Dr. Richard Fuller, NIAAA director of clinical and prevention research.

Two medications are undergoing tests; naltrexone, a post-alcohol consumption medication, and acamprosate, a pre-consuming drug, according to LoCastro. Naltrexone works by interfering with the brain transmissions to make alcohol seem less rewarding to addicts, he said.

However, naltrexone “is not an all-in-one cure. It is a valuable tool in a treatment program which includes therapy and support,” according to the Addiction Research Foundation website.

Acamprosate, which is now being reviewed in the United States, has been used in Europe and for the last 14 years. This medication eases the discomfort of abstaining from alcohol. According to the Food and Drug Administration, acamprosate “normalizes abnormalities” that contribute to alcohol withdrawal and its effects.

As with naltrexone, behavioral counseling will be a necessary accompaniment to the drug therapy. Moderate intensity, including learning motivational skills, and low intensity therapy, promoting sobriety and medical compliance, two counseling types are that will also be analyzed for effectiveness.

“Of persons who receive treatment, as many as 50 percent relapse at least once, and a minority achieve long term remission of the disease,” said Dr. Enoch Gordis, director of the NIAAA. “Identifying and developing effective treatments is the first priority of alcoholism research.”

COMBINE, which consists of LoCastro, co-principal investigator Dr. Domenic Ciraulo and other physicians, psychiatrists, social workers, research assistants and nurses, has already begun subject recruitment.

During this stage, the team is looking for adults who have an alcohol problem and are interested in treatment. Individuals must be willing to be sober for a minimum of 4 days and a maximum of 21 days prior to the study, and the trial treatment is free for participants.

“This is quite a cooperative effort. It is a pulling together of experts in the field,” LoCastro said.

At the conclusion of the study, approximately 125 subjects from each of 11 locations, totaling about 1,375 participants, will combine for a general data analysis.

“Hopefully,” LoCastro said, “we will have enough information to release in two years; it just depends on how many we can recruit.”