Conducted from 2001 to 2004 and involving nearly 1,400 patients, including 133 at Brown Medical School, the study will be published today in the The Journal of the American Medical Association.

01:04 AM EDT on Wednesday, May 3, 2006

BY G. WAYNE MILLER
Journal Staff Writer

PROVIDENCE -- Ordinary doctors and nurses can successfully treat alcoholism on an outpatient basis with supervision and medication -- reducing the need for costlier, more intensive programs -- a major study concludes in an article published today in The Journal of the American Medical Association.

"The huge implication is that instead of folks having to go to 'specialty people' to get treatment for their alcohol addiction they can get it right in the primary-care setting, with much less fanfare," said Richard H. Longabaugh, professor of psychiatry and human behavior at Brown Medical School.

Longabaugh, who has spent much of his career studying alcoholism, is one of several authors of the study, which involved nearly 1,400 patients at 11 academic centers across the country. In conjunction with Roger Williams Medical Center, Brown enrolled 133 patients, making it the largest group in the clinical trial, which was conducted from 2001 to 2004.

"One of the problems with alcoholism is there is a big mismatch between the number of people afflicted and the number in treatment. This extends the options. Really, people can get treatment in their doctor's office," said co-author Dr. Robert M. Swift, psychiatry professor and associate director of Brown's Center for Alcohol and Addiction Studies.

Journal photo / John Freidah

Dr. Robert Swift, of Brown University, left, co-authored a study that says doctors can successfully treat alcoholism on an outpatient basis. Study participant Walter Kent is at right.

An estimated 8 million Americans are alcoholics, but fewer than 1 million get treatment, according to the researchers. The study should encourage more primary-care providers to recognize and address the problem -- and entice more alcoholics into treatment.

"Hopefully it will bring a lot of people into help one way or another," Swift said.

Called COMBINE, for Combined Pharmacotherapies and Behavioral Interventions, the study involved the most extensive research ever into the effects of medication and what traditionally is known as counseling. Financed by the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health, the study costan estimated $25 million.

Researchers enrolled subjects in one of nine protocols, each with a different variation of drugs, placebos, behavior therapy and so-called medical management -- supervision, education and care of a patient, including monitoring of liver function and potential drug side effects.

The drug naltrexone, which reduces cravings for alcohol, was found to be unusually effective, especially in combination with medical management. But therapy and medical management without a drug was also effective -- giving alcoholics a choice.

"Treatment works," said Swift. "People got better regardless of what arm of the study they went into."

WALTER KENT, 61, of Cumberland, was one of the participants. He shared his experiences earlier this week during a lecture that Swift delivered to first-year students at Brown Medical School. (Swift could not specifically address the study, because it was still unpublished.)

"I started drinking at the age of 21," Kent said. "For the next 35 years, I continued."

By 1999, Kent, a father of five who ran a carburetor business, had bottomed out. A fall from a building had left him with head and shoulder injuries, and his alcohol consumption, already intense, worsened. Some days, he would have as many as 20 drinks. He contemplated suicide.

"You're not going to make it," Kent's wife said. "Our marriage is going to go down the tubes after 30 years -- and if not, you're going to be dead."

Despite medication, Kent's blood pressure was dangerously high -- "in the stroke zone," as he described it. His liver was severely inflamed, a precursor to often-fatal cirrhosis.

Kent had enrolled in rehabilitation programs before, but after a few weeks or months, he always returned to the bottle. This time, his wife saw an ad for a clinical trial that was being conducted at Roger Williams. Kent applied and was accepted into the COMBINE study.

Because of the blind nature of the trial, neither Kent nor the researchers knew his protocol at the time. It was what Swift yesterday described as "the whole enchilada" -- naltrexone, another drug, medical management and therapy.

Within a month, Kent's blood pressure had dropped and his liver was recovering. Because of the naltrexone, he no longer craved alcohol.

"I always said: If you can curb the urge, you can kill the problem. This was the first time in my life that I had no urge to take a drink. And I had tried, believe me."

Kent has been sober for more than four years.

"It's just totally amazing how this works and what it did for me and my family. It's overwhelming, really. If this can work for me, it can work for anybody."

ALTHOUGH many patients in the study became completely abstinent -- and, like Kent, have remained so -- some reduced their drinking but did not stop altogether. Overall, abstinent days among the nearly 1,400 subjects increased from 25 percent to almost 75 percent, while alcohol consumption dropped from an average of 66 to 13 drinks a week. The NIAAA defines heavy drinking as five or more drinks a day for men, four or more for women.

According to Swift and Longabaugh, primary-care doctors and nurses -- and even pharmacists -- can easily master the essential lessons of the COMBINE study. A summary will be included in the soon-to-be-published 2006 edition of NIAAA's Helping Patients Who Drink Too Much: A Clinician's Guide (available at http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf )

Yale, Harvard, the University of Miami, and Boston University were among the centers that joined Brown and Roger Williams in the study.

Longabaugh said the effort was unusually rewarding not only because it has immediate practical applications but also because the results were unambiguous.

"It's not just a chance finding where you get [a conclusion] in one setting and you don't get it in another setting. It's really nice to get the answers and find that we have something that's going to be useful to the population. Oftentimes we get inconclusive results and it can wear out a researcher."

gwmiller@projo.com/ (401) 277-7380