Drug may help to alleviate alcoholism.

Brief treatment with a drug that dampens pleasurable sensations induced by the brain's natural opiates may offer significant help to alcoholics, especially when teamed with training in ways to avoid and resist alcohol cravings. The drug, naltrexone, was approved last year by the Food and Drug Administration for use with psychological treatments for alcoholism. "We suspect that naltrexone blocks physiologically reinforcing effects of alcohol and makes alcohol less stimulating and attractive," contends Stephanie S. O'Malley, a psychologist at Yale University School of Medicine. The new investigation, described by O'Malley and her coworkers in the March Archives of General Psychiatry, expands on their initial report (SN: 11/21/92, p. 341). In the project, 97 people seeking treatment for alcohol dependence at an outpatient clinic randomly received either daily naltrexone or placebo pills, as well as weekly therapy either teaching coping skills-ways to decrease stress and avoid alcohol use-or offering general encouragement to stay sober.

Over the course of the 3-month treatment period, the two naltrexone groups displayed far greater abstinence rates than the placebo groups. Volunteers receiving naltrexone and coping therapy proved least likely to relapse after having an alcoholic drink.

Two months after treatment ended, the researchers now report, naltrexone and placebo groups showed comparable abstinence rates. But after 6 months, almost two-thirds of patients given placebos had resumed alcohol consumption to the point that they were again diagnosed with alcohol abuse or dependence, in contrast to just one-third of those given naltrexone.

After 4 months or more, volunteers given placebos and coping skills therapy cited rates of drinking similar to those of the naltrexone groups. The new study offers "an important continuation of [earlier] research," according to Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md.

A combination of naltrexone and psychological therapy, such as cognitive skills training, may represent the best available alcoholism treatment, O'Malley contends. Her group is now studying whether a year of treatment offers further benefits.