JAMA just published a meta analysis of medications used to treat alcoholism. Here are their findings:
To prevent 1 person from returning to any drinking, the NNTs were 12 (95% CI, 8 to 26; 16 trials, n = 4847) and 20 (95% CI, 11 to 500; 16 trials, n = 2347) for acamprosate and oral naltrexone (50 mg/d), respectively. For return to heavy drinking, acamprosate was not associated with improvement, whereas oral naltrexone (50 mg/d) was associated with improvement with an NNT of 12 (95% CI, 8 to 26; 19 trials, n = 2875). For injectable naltrexone, our meta-analyses found no statistically significant association with return to any drinking or return to heavy drinking but found an association with reduction in heavy drinking days (WMD −4.6%; 95% CI, −8.5% to −0.56%; 2 trials, n = 926). Evidence from well-controlled trials of disulfiram does not adequately support an association with preventing return to any drinking or improvement in other alcohol consumption outcomes (Table 1). The largest disulfiram trial (n = 605) reported fewer drinking days for participants who returned to drinking and had a complete set of assessments.32 Results of sensitivity analyses that included studies rated as high or unclear risk of bias were similar to the results of our main analyses (eFigures 1 and 2 in the Supplement).
So . . .
- 1 patient out of 12 who received acamprosate maintained abstinence over a 12 week period, and
- 1 patient out of 20 who received naltrexone maintained abstinence over a 12 week period, and
- 1 patient out of 12 who received naltrexone did not return to heavy drinking over a 12 week period.
You’d think that success rates of 5% to 8.3% (over the relatively short period of 12 weeks) would be pretty disappointing, right? If you agree, you and I appear to be in a tiny minority.
In the last 24 hours, Time, the NY Times, NPR, Huffington Post, CNN, Fox News, and many others are posting articles under headlines touting their effectiveness, their underuse and the “Best Meds for Alcohol Dependence Revealed”.
These stories seem to be incongruent with the findings. Why? Is it that there’s very little hope for recovery from alcoholism? Is it cultural deference to doctors and medical researchers?
I don’t get it.
Why are they not writing stories about an underutilized treatment model that has outcomes that are 10 to 16 times better than these outcomes?