Nutella, thanks for posting the link to the Alho et al paper. He has done a lot of AL research. I had read this study before and I would like to point out a couple of things about the design and results to put this into perspective.
1. During the 12 week continuous medication phase subjects were told to take their medication with breakfast. These subjects were averaging 41 US units per week pre-study so I'm guessing not around the clock drinkers. If most of these people were evening drinkers their nal may not have been as effective in the evening. Weekly AL consumption at the end of continuous drug for NTX was 13 US units (not too bad and below moderate drinking limits in US)
2. During the 13-52 week targeted period subjects were instructed to take nal 1-2 hours before a high risk situation where they thought they might drink. However the authors noted,
Quote:
The intake of the study medication during the targeted phase was relatively low, 87.0% (DIS 92.1%; NTX 81.4%; ACA 87.5%) of subjects taking the study medication at least once a week. Moreover, since the exact average daily/weekly pill count is not known because the count was determined from the patient diary only, the comparison between the study groups in this phase is not well justified and limits the conclusions.
If subjects were not taking much nal in weeks 13-52 then not much extinction was occurring. Even so the 13-52 week average units consumed was 16 US units. This is just above moderate consumption. Many of us would be happy with those numbers
3. Subjects were not provided with nal in the follow up for free. So if not many people were taking nal when it was free I would think even less were taking it when they were being charged for it.
4. When you look at table 3 of AL/week you would expect Disulf. to have the biggest reduction in the daily medication condition because it makes you sick. When you get to the targeted meds. the Disulf. AL consumption doubles because people are not taking their med.s very well in this study. The NAL targeted AL consumption goes down in the daily intake (1-12 weeks) then slightly up in the follow up period (13-52 weeks). The DIS group are drinking roughly half of what the NTX group during the targeted period but my big problem is medication compliance is not good. After all if subjects were really taking DIS why would their AL consumption double. Also if subjects were really taking NAL they would have seen a continued decline in units as extinction took place.
I see studies used in my own profession all the time to prove or disapprove one treatment technique over another and I've learned to read studies in my own area with a very critical eye. As Mark Twain made famous, "There are lies, damn lies and statistics." This study now becomes part of the evidence in evidence based addiction treatment but the conclusions are not quite right. I see the cure working for me in my reduced numbers and feel it working in my improved quality of life and reduced interest in AL. That is enough for me.
The authors did this 2.5 year study and this is their conclusion
Quote:
The main conclusions of the present study are that ACA, NTX and DIS combined with brief manual-based intervention extended in time significantly reduce heavy drinking, reduce craving for alcohol, and increase the QL. DIS was superior to the other medications and no SDEs were observed after 6 months of usage.
I read this study and here is my conclusion. If you want to go from drinking 41 beers a week to 13 a week then take nal every day for 3 months. It doesn't matter when you take it. After that if you take the nal every once in a while before you drink you can expect to drink about 16 drinks per week or a 61% reduction in drinking. There is no telling what the numbers would look like if subjects had 100% compliance like many of us here seeing success. And that my friends is why you should believe half of what you read and none of what you hear. Do your own due diligence in everything.
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