Access to treatment for alcohol dependence (AD) in rural and remote areas is limited. This study evaluated the effectiveness of two pharmacotherapies for AD – naltrexone alone, and in combination with sertraline – among Alaska Natives (ANs) and other Alaskans living in rural settings. Findings indicate that naltrexone is just as effective on its own as it is in combination with sertraline.
Results will be published in the July issue of Alcoholism: Clinical & Experimental Research and are currently available at OnlineEarly.
“In 1994, naltrexone was the first medication to be approved by the Food and Drug Administration for the treatment of AD,” said Stephanie S. O’Malley, professor of psychiatry at Yale University School of Medicine and first author of the study. “Since then, numerous studies have shown its effectiveness. However, almost all of these studies were completed in urban settings in academically oriented clinics, and few if any Alaska Natives or American Indians were enrolled in these studies. In addition, it became clear that not all individuals benefit from naltrexone. For this reason, researchers have been investigating if different medications can be combined with naltrexone to increase its effectiveness.”
Given that previous research had suggested that sertraline could potentially reduce the likelihood of drinking in response to stress, and that naltrexone was known to reduce the amount consumed if someone lapsed, the study authors thought a combination of the two might increase abstinence rates more than using naltrexone alone.
Participants in this randomized, controlled study comprised 101 Alaskans with AD: 68 American Indians (AIs) and/or ANs, and 33 non-AIs/ANs. All received one of three 16-week treatments: naltrexone + sertraline placebo, naltrexone monotherapy (50 mg) + sertraline placebo, or naltrexone + sertraline (100 mg). All three treatments included nine sessions of medical management and supportive advice.
“Contrary to our hypothesis, the combination of naltrexone and sertraline was no better than naltrexone alone,” said O’Malley. “We did, however, find that naltrexone significantly improved abstinence rates compared to placebo. For example, 35 percent of those on naltrexone remained abstinent for the entire 16-week treatment whereas only 12 percent of those in the placebo group did. The number of people who experienced consequences due to drinking was also significantly less in the naltrexone group. In summary, naltrexone was shown to be an efficacious treatment for AD among geographically isolated and rural Alaskans, including those of AI/AN descent.”
O’Malley said these findings are important for all individuals with AD living in rural or remote areas.
“More than one-fifth of the U.S. population lives in rural or remote areas, and many of these areas have high rates of AD,” she said. “Our study suggests that naltrexone in combination with a primary-care model of counseling could be used to treat alcoholism in these settings. This approach could increase access to care and reduce the consequences of alcoholism in these communities.”
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, “Naltrexone Alone and with Sertraline for the Treatment of Alcohol Dependence in Alaska Native and Non-Natives Residing in Rural Settings: A Randomized Controlled Trial,” were: Robert W. Robin, Denise Romano, Jane Robinson, Boris Meandzija, and Ran Wu of Yale University School of Medicine; Aryeh L. Levenson, Iva GreyWolf, and Lawrence E. Chance of the Southeast Regional Health Consortium in Alaska; Colin A. Hodgkinson and David Goldman of the Laboratory of Neurogenetics at the National Institute on Alcohol Abuse and Alcoholism; and Verner Stillner of Bartlett Regional Hospital in Alaska. The study was funded by the National Institute on Alcohol Abuse and Alcoholism, and the National Center on Minority Health and Health Disparities.