ABSTRACT

During the last years, developments in relapse prevention in alcoholism were presented mainly in the field of pharmacological treatment. A meta-analysis of 18 placebo-controlled, randomized clinical trials was performed; this analysis included 2658 patients with a minimum duration of 3 months on drugs tested for their effectiveness in decreasing alcohol consumption or preventing relapse in alcohol-dependent patients (acamprosate, atenolol, bromocriptine, buspirone, citalopram, fenfluramine,

γ

-hydroxybutyrate (GHB), nalmefene, naltrexone, and tiapride). Effect sizes ranged between r = –0.09 and 0.65, corresponding to drug-placebo response rate differences of about 10% in favor of placebo and 65% in favor of drugs. Studies including non-detoxified patients showed higher effect sizes than studies with detoxified patients. Higher efficacy was found with controlled drinking as response criterion and for quantitative measures (e.g., drinking days) compared to abstinence and qualitative measures (relapse), respectively. The number of patients treated with the individual substances differs; therefore, comparison of substances concerning efficacy must be interpreted with caution. The largest data pool came from studies with acamprosate (1785 of 2658 patients). Compounds, in general, revealed to be superior to placebo in the relapse prevention in alcohol dependence, which means that they are effective. The available data are not sufficient to permit definitive conclusions on differences between the substances. Study design variables may influence the results; studies on detoxified patients, for example, yield lower effect sizes than studies on nondetoxified patients.