On treatment mechanisms - what can we learn from the COMBINE study?

Aim To discuss the results of combined pharmacotherapies and behavioural interventions for alcohol dependence as presented by the COMBINE study. Methods and results Although the main hypothesis in the COMBINE study was to determine if improvements in treatment outcome can be achieved by combining pharmacotherapy and behavioural interventions, the lack of support for this idea in the results of the study is merely mentioned in passing, but not really discussed. Instead, the COMBINE study group claims that the results of their study constitute support for the use of naltrexone in primary care settings. However, the empirical basis for this recommendation appears somewhat weak. Furthermore, the COMBINE study group's discussions of the results could have benefited from a discussion of the treatment mechanisms that are supposed to have generated the improvement in the participants' drinking practices: what importance should we attribute to common mechanisms that are embedded in the treatment context, and what weight should we ascribe to the pharmacological interventions and the specific behavioural intervention? Conclusions- In the context of other major studies within the alcohol field, such as Project MATCH and the UK Alcohol Treatment Trial (UKATT) study, and contemporary psychotherapy research, it seems reasonable to regard the main results from the COMBINE as supportive of a need to change the focus of future addiction treatment research.