There are a number of effective treatments available for people impacted by alcohol use disorder (alcoholism/alcohol abuse). However, not all people who enroll in a treatment program will successfully complete that program and ultimately eliminate or reduce their alcohol intake. In a study slated for publication in 2014 in the journal Addiction, a group of U.S. researchers used data from a project called the COMBINE Study to explore some of the reasons people in alcohol treatment stop taking their prescribed medications and prematurely withdraw from program participation. These researchers concluded that withdrawal from treatment is typically a gradual process, not an abrupt one
Alcohol treatment programs commonly rely on the use of medication and/or some form of behavioral psychotherapy. A medication option called disulfiram (Antabuse) produces a treatment benefit by physically discouraging alcohol consumption. Another medication called naltrexone (ReVia) produces its benefits by reducing the brain’s susceptibility to the pleasurable effects of drinking. A third medication approved for use in alcohol treatment, acamprosate (Campral), helps reduce the severity of the withdrawal symptoms that, in their sheer unpleasantness, frequently have the effect of encouraging continued drinking in physically dependent alcohol consumers. Some programs use a fourth medication called topiramate (Topamax), which apparently helps readjust the chemical brain imbalances found in habitual heavy drinkers.
Forms of behavioral psychotherapy used to help people in alcohol treatment include cognitive behavioral therapy (CBT) and contingency management. CBT produces its benefits by helping people in treatment recognize the harmful actions and attitudes that contribute to a pattern of excessive drinking, as well as by encouraging the establishment of new actions and attitudes that diminish the likelihood of excessive drinking. Contingency management is designed to increase active program participation by providing prizes or other incentives for people who consistently meet program goals and expectations.
The COMBINE Study
The COMBINE Study was conducted in the first decade of the 2000s by the National Institute on Alcohol Abuse and Alcoholism. Its specific intent was a large-scale assessment of the usefulness of acamprosate and naltrexone in alcohol treatment, both in isolation and in combination with behavioral therapy, 12-step programs and interview sessions designed to encourage enrollment in a treatment program. A total of 1,383 people with alcoholism took part in the study at 11 treatment locations. At the time, this was the largest number of alcoholism-affected Americans ever involved in an evaluation of the effectiveness of the methods used to address serious alcohol problems.
Why Do People Discontinue Treatment?
In the study scheduled for publication in Addiction, researchers from institutions including Yale University, the University of Pennsylvania and the National Institute on Alcohol Abuse and Alcoholism used information from the COMBINE Study and a related follow-up project to assess the reasons some people enrolled in alcohol treatment prematurely stop taking their prescribed medications. Data was gathered from 1,226 COMBINE participants. Of these individuals, 667 prematurely discontinued their medication, while 559 did not. The researchers were able to create complete profiles for 450 of the participants who stopped using their medications. They analyzed factors that included alcohol intake in the time frame prior to the suspension of medication use, alcohol intake in the time frame following the suspension of medication use, the number of days during which the study participants avoided drinking and the number of days during which the participants consumed alcohol in heavy amounts.
The researchers concluded that many of the participants who ultimately stopped taking their alcohol treatment medications started increasing their alcohol intake weeks earlier. These same individuals also frequently increased their intake levels even further after halting their medication use. Some people had specific reasons for discontinuing their prescribed medication (e.g., a bad medication reaction), while others did not. In addition, some individuals quit using their medications early on in the treatment process, while others quit their medications only in the latter stages of treatment.
Overall, the study’s authors concluded that most people in alcohol treatment who stop taking their prescribed medications don’t base their actions on hasty decisions. Instead, they typically consider their actions well in advance. The decision to halt medication use prematurely with or without the knowledge of a prescribing doctor is apparently linked to two key factors: unusually excessive alcohol consumption and unusually frequent alcohol consumption (in comparison to other program participants).