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Alcohol addiction update 2008

Clinical bottom line

Information on interventions for alcohol addictions is sparse. Without any drug intervention, about 1 user in 5 will be abstinent between 3 and 24 months.


Data

Three systematic reviews and meta-analyses of alcohol cessation studies (one Cochrane review) had information on over 4,400 participants with cessation rates between three and 12 or 24 months. Two had over 300 participants in the comparison, and one (looking at opioid antagonists) had 208 participants in longer term studies. All used only properly randomised trials, used various means to assess abstinence, and used placebo, usually with some form of psychosocial intervention.

A summary of the reviews is available as a downloadable PDF (28kb).

Results

Table 1 shows the main results in terms percentage of abstinent patients with intervention and placebo, the relative benefit, and the NNT for one participant to be abstinent at six months who would not have been if treated with placebo. The order is by numbers of participants in the reviews. No intervention had an NNT better than 10 with at least 200 patients.

Table 1: Results of alcohol cessation reviews, ordered by number of participants


Percent abstinent with
Intervention
Number of patients
Active
Placebo
Relative benefit
(95%CI)
NNT
(95% CI)
Acamprosate
3324
23
15
1.6 (1.4 to 1.8)
12 (9 to 17)
Naltrexone
1077
35
30
1.2 (1.0 to 1.4)
not calculated
Opioid antagonists
208
52
37
1.4 (1.0 to 2.0)
6 (3 to 43)

Figure 1 shows the same information graphically, ordered by the proportion of patients abstinent at six months or longer with treatment.

Figure 1: Percentage of patients abstinent from alcohol at 3-24 months, ordered by success rate with treatment (numbers in parenthesis are numbers in the comparison)

The response with placebo in the two larger reviews was 15% and 30%, with an overall average cessation rate of 18% in 2,082 participants on placebo.

Comment

The evidence concerning interventions for alcohol is limited. The most recent systematic review was published in 2004. A Cochrane protocol for an acamprosate review was published in 2003, but work has only just begun. Extensive searching revealed other reviews on alcohol cessation interventions, but none recent, or with the outcome of cessation.