Cigarette Smoking Predicts Differential Benefit from Naltrexone for Alcohol Dependence

Biological Psychiatry, 05/02/2012

The results suggest that naltrexone might be particularly beneficial for improving alcohol use outcomes in alcohol–dependent smokers.


  • The authors examined the association between cigarette smoking and drinking outcomes in the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study, a randomized, double-blind placebo-controlled 16-week trial comparing combinations of medications (i.e., acamprosate and naltrexone) and behavioral interventions (i.e., medical management, combined behavioral therapy) in 1383 alcohol-dependent individuals.


  • Smokers (i.e., more than one half the sample) significantly differed from nonsmokers on several demographic and drinking-related variables at baseline and generally had poorer treatment outcomes than nonsmokers.
  • However, smokers who received naltrexone had better drinking outcomes than smokers who received placebo, whereas alcohol use among nonsmokers did not vary by naltrexone assignment.
  • This pattern of findings occurred independent of whether patients received combined behavioral intervention or medical management and remained after controlling for alcoholism typology and baseline demographic differences.
  • Approximately 9% of smokers quit smoking, and an additional 10% reduced their cigarette intake during treatment.
  • Reductions in smoking did not vary by treatment assignment.

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