Findings bulletins: naltrexone Vs acamprosate, treatment pathways, IBA history, drugs & doctors

Recent bulletins from the drug and alcohol bank:

Naltrexone and acamprosate best suited to different alcohol treatment goals

Naltrexone and acamprosate both modestly curtail drinking among alcohol-dependent patients, but which is best in which circumstances and for which treatment goals? To find out, this review compared the medications’ performance when separately benchmarked against a placebo, bringing to bear much more data than is available from the few trials which directly compared the two.

Alcohol treatment pathways can be confusing and unpredictable, say patients

Low levels of engagement and retention in alcohol treatment services hinder the effective provision of treatment for dependent drinkers. Interviews with 20 patients in community alcohol services in London reveal that treatment pathways can be confusing and unpredictable, and should better reflect the capacity and capabilities of people with alcohol dependence.

Pioneering trial of brief interventions in primary care

Uncovered in our search for seminal studies for the Alcohol Treatment Matrix, this 1987 evaluation of a brief controlled drinking intervention in Scottish general practice. Hampered by problems with implementation in real-world conditions, it showed no advantage for patients over basic advice (or no intervention at all), prefiguring later findings from larger trials.

As part of the Alcohol matrix:

Doctors & drugs; medical treatment of alcohol dependence

First cell of row three enters the domain of doctors and drugs. Medications most clearly distinguish an intervention as medical, but for this ‘disease’, drugs are generally minor aids to the patient’s impetus to overcome their drink problem and the processes in their life which help realise this ambition. Ends by asking:
How far should we go to get patients to take the pills?
Was NICE right to relegate disulfiram to a second-line option?
Is the placebo effect the main active ingredient?

The practitioner in medical treatments

The previous bite looked mainly at the medications clinicians prescribe. Now we look at the clinicians themselves, and find that for this ‘disease’, bedside manner is not just a conduit for treatment; to a substantial extent, it is the treatment. Seminal UK and US studies suggest that patients “sensitized to rejection” assess their clinicians as much as the reverse, asking above all if they are liked and accepted. Signs of rejection or coldness lead to rejection back and failure to engage with treatment.The bite ends by asking:
To what degree is a clinician’s commitment to working with drinkers determined by management and workplace culture?
What are the attributes of effective clinicians? Maintaining acceptance and optimism in the face of difficulties seems critical.