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Building Better Cognitive-Behavioral Therapy: Is Broad-Spectrum Treatment More Effective Than Motivational-Enhancement Therapy for Alcohol-Dependent Patients Treated With Naltrexone?

Dena Davidson, Suzy Bird Gulliver, Richard Longabaugh, Philip W. Wirtz, Robert Swift

Objective: The current study investigated the treatment effectiveness, during treatment, of a second-generation cognitive-behavioral therapy for alcoholismbroad-spectrum treatment (BST)compared with motivational-enhancement therapy (MET), when both were offered in conjunction with a therapeutic dose of naltrexone (Revia). Method: One hundred forty-nine alcohol-dependent patients completed a 3-month randomized, controlled trial of BST and naltrexone versus MET and naltrexone. Results: Patients receiving BST had a significantly higher percentage of days abstinent than patients receiving MET. The superior effect of BST is particularly strong in interaction with support for drinking, suggesting that the advantage of BST is worth the additional cost for patients whose psychosocial networks are supportive of continued drinking. This effect remains significant when controlling for pretreatment percentage of days abstinent. Conclusions: In aggregate, these findings suggest that it is either the combination of naltrexone and BST or the unique properties of BST that account for BST's superiority to MET and naltrexone. The results of this initial phase of the trial suggest that a second-generation cognitive-behavioral therapy such as BST may have a meaningful clinical advantage over brief interventions such as MET, at least when combined with naltrexone. (J. Stud. Alcohol Drugs 68: 238-247, 2007)