Doggrell Sheila A
School of Science, Faculty of Education, Health and Science, Charles Darwin University, Darwin, Northern Territory 0909, Australia.
Expert Opin Pharmacother. 2006 Oct;7(15):2169-73. doi: 10.1517/14656566.7.15.2169.
Alcoholism is the third leading cause of preventable mortality and morbidity in the US. In the COMBINE (Combined Pharmacotherapies and Behavioural Interventions) study, the co-primary end points were the percentage of days abstinent and the time to first heavy drinking day after 16 weeks, and 1 year. The biggest difference observed in COMBINE was that seen between combined behavioural intervention (CBI; percentage of abstinent days = 66.6%) and CBI and medical management with placebos (79.8%). This illustrated a major effect of the medical management of nine sessions and/or the placebo pills. Acamprosate had no effect alone or in combination with naltrexone. At 16 weeks with medical management, there were 75.1% of the patients who were abstinent for placebos, and this was improved by naltrexone, CBI, and naltrexone with CBI (80.6, 78.2 and 77.1%, respectively). There was a follow up after 1 year, which showed that, with medical management, the amount of those who were abstinent for placebos was 61.4%, and this was improved by naltrexone, CBI, and naltrexone with CBI (66.2, 66.6 and 67.3%, respectively), but this improvement no longer reached statistical significance. After 1 year, there was no difference between groups in the overall frequency of hospitalisation, emergency treatment for alcohol problems, use of medication for drinking or emotional problems and detoxification. Being part of a study for alcohol dependence is known to increase the percentage of abstinent days. In COMBINE, this percentage was high in the group having medical management and placebo pills, and naltrexone or additional behavioural therapy only had modest additional effects.
酗酒是美国可预防的死亡和发病的第三大主要原因。在综合治疗（联合药物治疗与行为干预）研究中，共同主要终点是戒酒天数的百分比以及16周、1年后首次重度饮酒日的时间。综合治疗研究中观察到的最大差异在于联合行为干预（CBI；戒酒天数百分比 = 66.6%）与CBI加安慰剂药物治疗（79.8%）之间。这说明了九次疗程的药物治疗和/或安慰剂药丸的主要作用。阿坎酸单独使用或与纳曲酮联合使用均无效果。在进行药物治疗的16周时，服用安慰剂的患者中有75.1%戒酒，纳曲酮、CBI以及纳曲酮与CBI联合使用可改善这一比例（分别为80.6%、78.2%和77.1%）。1年后进行了随访，结果显示，在进行药物治疗的情况下，服用安慰剂戒酒的人数比例为61.4%，纳曲酮、CBI以及纳曲酮与CBI联合使用可改善这一比例（分别为66.2%、66.6%和67.3%），但这种改善不再具有统计学意义。1年后，各治疗组在住院总频率、酒精问题的急诊治疗、饮酒或情绪问题的药物使用以及脱毒方面没有差异。参与酒精依赖研究已知会增加戒酒天数的百分比。在综合治疗研究中，接受药物治疗和服用安慰剂药丸的组中这一百分比很高，而纳曲酮或额外的行为疗法仅有适度的额外效果。
