they need to avoid relapse over the longer
term.^283 Forms of pharmaceutical therapy other
than NRT, such as antidepressants, also can
enhance the benefits of psychosocial treatment
for smoking cessation.^284
Addiction Involving Alcohol. In one study,
patients with addiction involving alcohol who
received daily doses of naltrexone were less
likely than those taking placebos to relapse if
they also participated in psychosocial therapies,
including cognitive behavioral therapy (CBT)
(38 percent vs. 60 percent) or motivational-
enhancement therapy (MET) (44 percent vs. 56
percent) over the course of 12 weeks.* 286
Patients in another study† who received CBT for
a three-month period were likelier to achieve
abstinence by the end of the 12-week program if
they also received daily doses of acamprosate
(38 percent vs. 14 percent).^287 Another study
found that six months after treatment
completion, disulfiram patients in a community
reinforcement approach (CRA) program spent
significantly less time drinking than patients
who used only disulfiram (abstinent 28.3 days
vs. 8.0 days that month).^288
- CBT patients who took naltrexone spent
significantly more of their time in treatment abstinent
from alcohol than any of the other study groups.
† The study groups were not randomized but matched
based on gender, age, previous treatment episodes,
detoxification history and average alcohol intake.
Addiction Involving Other Drugs. With
regard to treatment for addiction involving
opioids, incorporating family therapy into a
treatment regimen that includes naltrexone
therapy enhances treatment outcomes with
regard to medication compliance; abstinence
from opioids and other drugs during treatment
and during a year of follow-up; and measures of
drug-related, legal and family problems at one-
year follow-up.^289 A meta-analysis of 30 studies
conducted in outpatient methadone treatment
settings found that the inclusion of contingency
management (CM) is related to fewer positive
urine tests submitted by patients with addiction
involving opioids.^290 CM also has been found to
augment naltrexone treatment for addiction
involving opioids by increasing patients’
compliance with their treatment regimen.
Naltrexone patients who received contingency
management in the form of vouchers in
exchange for clean urinalyses, on average,
stayed in treatment longer (7.4 weeks vs. 5.6
weeks), submitted more opioid-free urine
samples (18.9 vs. 13.5) and were abstinent
continuously over longer periods of time (49.1
days vs. 37.7 days) than patients who received
naltrexone without a CM component.^291
Another study found that patients on methadone
maintenance treatment who received weekly
community reinforcement approach (CRA)
sessions demonstrated significantly greater
reductions in drug problem severity‡ than
patients who received standard methadone
maintenance services.^292Other research finds that cognitive behavioral
therapy (CBT) patients who received daily
doses§ of modafinil versus a placebo provided
significantly more clean urine tests (42.3 percent
vs. 24.0 percent) and were likelier to achieve
abstinence from cocaine over at least a three-
week period (33 percent vs. 13 percent).^293Addiction Involving Poly-Substances.
Research on the best methods of treating
individuals with addiction involving multiple
substances is limited. One study found that
methadone maintenance patients with addiction‡ As measured by the Addiction Severity Index.
§ 400 mgs.A Spectrum of Smoking Cessation
TreatmentsSmokers of less than five cigarettes per day
will have a good chance of success in quitting
by choosing a quit date, getting rid of tobacco
and using freely-available counseling ⁄support
services. Smokers of 6–14 cigarettes per day
probably are moderately dependent and will
benefit from an approved smoking cessation
aid (nicotine patch, gum, lozenge, inhaler or
nasal spray, bupropion, varenicline). Smokers
of 15 or more cigarettes per day probably are
highly dependent and will benefit from more
intensive counseling and possibly combination
pharmaceutical therapy.^285