Table 2.
Added value of pharmacotherapy to psychotherapy in the treatment of alcohol-dependent patients (dose of naltrexone (NTX) was 50 mg/day, unless otherwise stated)
| No. | Monotherapy (psychotherapy) | Combined therapy (psychotherapy + pharmacotherapy) | Specifications of psychotherapy | Results | Reference |
|---|---|---|---|---|---|
| 1 | Placebo + CBT (n = 63) | NTX + CBT (n = 68) | CBT: 12 weekly manual-guided sessions | NTX + CBT more effective than CBT to decrease rate to first relapse: Kaplan–Meier log-rank analysis, 3.90; df = 1; P = 0.048) (12% difference in final relapse rate) | (Anton et al., 1999) (Anton et al., 2001) |
| 2 | Placebo (25 μg/kg midazolam) + MET (n = 23) | Ketamine (0.71 mg/kg) + MET (n = 17) | MET: five weeks. Twice weekly spaced by 3–4 days; on 3 consecutive days in week. 2 | NTX + MET across the 21 days follow-up more effective than MET + active control on alcohol abstinent days: F = 8.21, df = 1, 797, P = 0.004 | (Dakwar et al., 2020) |
| 3 | CBT (n = 43) | NTX (50 mg/d) + CBT (n = 43) | 8 one-hour sessions over the 12 weeks. | NTX + CBT more effective than CBT: longer abstinence (P = 0.002) and more abstinent (P = 0.051) | (Feeney et al., 2004) |
| 4 | CBT (n = 59) | All groups: n = 59. CBT + acamprosate (1332–1998 mg/d); CBT + NTX (50 mg/d); CBT + combined (NTX + acamprosate in dose as above) | CBT: one hour weekly for the first four weeks. Followed by fortnightly for the subsequent eight weeks. | NTX + acamprosate + CBT more effective than CBT alone with a mean difference of 19.7, P = 0.034. Cumulative abstinence duration (days): acamprosate + CBT: 45.1; NTX + CBT: 50.0; NTX + acamprosate + CBT: 53.6 and CBT: 33.9 | (Feeney et al., 2006) |
| 5 | Placebo + CBT (n = 35) | Nalmefene (NAL; 20 or 80 mg/d for 12 weeks) + CTB (n = 70) | CBT: 45 min sessions, weekly for 12 weeks. | Nalmefene + CBT more effective than CBT to prevent relapse to heavy drinking: OR = 2.4; 95% CI: 10.5–5.59, P < 0.02 | (Mason et al., 1999) |
| 6 | Placebo + support (n = 99) | NTX (50 mg/d) + support (n = 93) | Support: weekly group support for relapse prevention and individual counselling | NTX + CBT more effective than support to prevent relapse: 18.8 vs. 7.9% (χ2 = 5.89, df = 2, P = 0.050) | (Guardia et al., 2002) |
| 7 | Placebo + CBT (n = 40) | All groups (n = 40) received CBT. Acamprosate (1998 mg/d), NTX (50 mg/d) or both | CBT: 90-min group sessions, weekly for 12 weeks. | NTX + CBT or acamprosate + CBT or NTX + acamprosate + CBT more effective than CBT to reduce relapse rate than individual support (P = 0.02) | (Kiefer et al., 2003) |
| 8 | Placebo + group support (n = 56) | NTX (50 mg/d) + Group support (n = 55) | 12 weekly 1.5 hour group sessions of psychological education and social support | NTX + CBT more effective to reduce relapse: 50 vs. 79% (P = 0.001), but no effect on the number of drinking days per week | (Morris et al., 2001) |
| 9 | Placebo + group counselling (n = 54) | NTX (50 mg/d) + group counselling (n = 45) | Group counselling related to alcohol dependence (2x weekly for 11 month) | NTX + CBT more effective than group counselling to prevent relapse: 23 vs. 54%, P < 0.01) | (Volpicelli et al., 1992) |
| 10 | Placebo + individual counselling (n = 48) | NTX (50 mg/d) + individual counselling for 12 weeks. (n = 49) | Individual relapse prevention counselling (first month: 2x weekly, then once weekly for 12 weeks. | NTX + individual counselling more effective than individual counselling to reduce drinking days (2.8 vs. 11.0, P = 0.01) and to prevent relapse (14 vs. 52%, P = 0.002) | (Volpicelli et al., 1997) |
| 11 | Placebo + intensive counselling (CBI) (n = 156) | NTX (100 mg/d) + CBI (n = 155) or acamprosate (3 g/d) + CBI (n = 151) | CBI: 20 50 min. Sessions over 16 weeks. | NTX + CBI not more effective than CBI to prolong abstinence (Cohen d: 0.07; 95% CI: −0.11-0.25 vs. Cohen d: 0.17; 95% CI: −0.02 to 0.35, respectively, P = 0.009) | (Anton et al., 2006) |
| 12 | Placebo (i.m.) + HaRT-A2 (n = 78) + behavioral treatment | HaRT-A + NTX (380 mg i.m. extended-release) (n = 74) | Five sessions at baseline (week 0) and in weeks. 1, 4, 8 and 12 | NTX + HaRT-A + behavioral treatment not more effective than HaRT-A + behavioral treatment on self-reported drinking during 24 weeks. Follow-up (quantity and frequency) | (Collins et al., 2021) |
| 13 | Placebo + CET + CST (n = 128) | NTX + CET + CST (50 mg/d; n = 165) for 12 weeks. | CET + CST: two weeks training in coping and communication skills | NTX + CET + CST at 12-month follow-up not more effective than CET + CST to reduce % heavy drinking days, nor to increase % relapse | (Monti et al., 2001) |
| 14 | Placebo + psychosocial treatment n = 87) |
NTX (50 mg/d) + psychosocial treatment (Psy-Tr; n = 84) | Weekly one-hour sessions of psychosocial alcohol treatment program | NTX + Psy-Tr not more effective than Psy-Tr to increase abstinence rate at week 12: NTX + Psy-Tr (54%) vs. Psy-Tr (51%) | (Gastpar et al., 2002) |
| 15 | Placebo + individual support (n = 20) | NTX (50 mg/d) + individual support (n = 20) | Weekly 30-min sessions individual psychotherapy for abstinence and compliance enhancement for 12 weeks. | NTX + individual support not more effective than individual support to reduce relapse rates (P = 0.67) | (Huang et al., 2005) |
| 16 | Placebo + CBT (n = 32) | NTX + CBT (n = 31) | CBT: 21 days of dependency treatment | NTX + CBT not more effective than CBT to reduce craving nor recidivism after treatment | (Knox and Donovan, 1999) |
| 17 | Placebo + CBT (n = 63) | NTX + CBT (50 mg/d; n = 61) or nefazodone + CBT (400 mg/d; n = 59) | CBT: 12 weekly sessions | NTX + CBT not more effective than CBT to prevent relapse to heavy drinking or to reduce drinking days | (Kranzler et al., 2000) |
| 18 | Placebo + CBT-based counselling (n = 32) | Baclofen (50 mg/d) for 12 weeks. n = 32 | Weekly support CBT-based counselling; motivational interviewing, education and therapy | Baclofen + CBT-based counselling not more effective than CBT-based counselling to prevent relapse to heavy drinking nor to increase abstinent days at 52 weeks. Follow-up | (Ponizovsky et al., 2015) |
| 19 | Placebo + IBT (n = 125) | Acamprosate (2 g/d) + IBT (n = 124) | 24 IBT (integrative behavior therapy) 30-min sessions for 6 month | Acamprosate + IBT not more effective than IBT: rate of abstinence at 6-month follow-up (47.6 and 48.0%, respectively) | (Wölwer et al., 2011) |
aCounselling sessions providing information about alcohol use and abuse, and the consequences of alcohol dependence; 2 HaRT-A: behavioral treatment, consisting of low-intensity not requiring abstinence; CBT: Cognitive Behavior Therapy; CBI: Combined Behavioral Intervention; IBT: integrative behavior therapy (relapse prevention, social skill trainings, and motivational and cognitive methods).