SAN JUAN, P.R. — Patients struggling with medication compliance for alcohol dependence may benefit from a clinical intervention combining medical management and brief counseling sessions, Helen M. Pettinati, Ph.D., said at the annual meeting of the American Academy of Addiction Psychiatry.
The compliance-enhancing intervention for physicians comes from an ongoing combination drug and behavioral treatment study sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), said Dr. Pettinati, a research director at the Center for Studies of Addiction, University of Pennsylvania, Philadelphia.
During a lengthy initial session, the physician educates the patient about alcohol dependence, explains medication effects and treatment success rates, and emphasizes the importance of adherence. Follow-up is a series of 15- to 30-minute sessions that include a brief check on medical functioning and whether the patient is drinking and/or medication adherent.
The NIAAA publishes a medical management manual that includes standardized dialogues for education and counseling. The manual is available for $6 at http://www.niaaa.nih.gov/publications/combine-text.htm
“If the patient has a poor response to treatment, ask first about treatment nonadherence,” Dr. Pettinati said.
“Many times in a clinical setting someone will tell me their patient does not respond to that agent, but they haven't asked the patient if they were taking the treatment,” he noted.
“There are a lot of reasons for nonadherence—only a small percentage actually forget and need help with reminders,” Dr. Pettinati said at a symposium funded by an educational grant from Alkermes Inc. Among her disclosures was receipt of grant research support from the company.
The NIAAA study assessing the medical management approach is a phase III study of naltrexone, an injectable, long-acting medication made by Alkermes.
One aim of the study was to assess whether the 30-day form of naltrexone improves compliance. The study included 624 patients with DSM-IV-defined alcohol dependence.
At a higher dose (380 mg), long-acting naltrexone reduced heavy drinking 25% more than did placebo.
The 190-mg dose had a 17% advantage over placebo. “Reductions were seen in the placebo group as well—remember, this is an injectable placebo,” Dr. Pettinati said.
People who participated in the study were compliant—the median number of injections was six. In addition, participants attended a median of 11 out of 12 psychosocial support sessions.