Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: There are both theoretical and empirical reasons for combining medication and behavioral treatment for addictive problems. Each of these components attends to different symptoms and together they provide the opportunity to improve success rates. The purpose of the COMBINE Study was to examine the efficacy of combining various pharmacotherapy and behavioral interventions. The COMBINE Study specifically evaluated the efficacy of two promising medications, alone and in combination (naltrexone and acamprosate) in conjunction with two behavioral treatments of different intensities and orientations (Combined Behavioral Intervention (CBI) and Medical Management (MM)).

Methods: The study consisted of 11 clinical sites nationwide and over 1380 alcohol dependent patients. Patients were randomly assigned to different combinations of medications and behavioral treatments and seen over 16-week period and follow-up for 1 year.

Results: Pharmacotherapy can manage the negative effects of withdrawal, reduce cravings or urges to drink or use drugs and interfere with the reinforcing effects of the drugs while behavioral treatment can help rebuild or strengthen family or interpersonal ties, establish a productive, therapeutic relationship and improve coping resources. Thus, combining medication and behavioral treatment can help improve the effectiveness of addiction treatment. Because there is no combination of medication or psychotherapy that “does it all”, there is ample opportunity to study different combinations of medications and psychotherapies for the treatment of addictive problems. Of major interest is to identify what behavioral treatment modalities and pharmacological agents should be combined to improve outcomes with various subsets of addictive clients. COMBINE Study was designed to answer this important question. The results of the COMBINE Study are currently under embargo but will be available for presentation by early May 2006.

Implication for practice: Findings from the COMBINE study will improve treatment options that are pertinent to the capacities and needs of addictive clients. Findings will potentially be applicable to health care settings where large numbers of individuals with addiction problems go untreated. Data will also educate social workers on the importance of pharmacotherapy in the delivery of social interventions with these vulnerable clients.