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Two-Pronged Approach


 

An author of a recent study that found improved results for depressed alcohol-dependent patients when they were treated for both diagnoses says hospitalists are positioned to help push increased usage of the dual-medication approach.

“This could change the way people treat these patients,” says first author Helen Pettinati, PhD, professor of psychiatry and director of the Addiction Treatment & Medication Development Division at the University of Pennsylvania School of Medicine’s Treatment Research Center in Philadelphia.

The study in the American Journal of Psychiatry tracked 170 patients, with some treated with 14 weeks of sertraline (200 mg/day, n=40), naltrexone (100 mg/day, n=49), both drugs (n=42), or double placebo (n=39). All groups received weekly counseling as well. Patients treated with both medications produced a higher alcohol abstinence rate (53.7%) and demonstrated a longer delay before relapse to heavy drinking (median delay=98 days) than the naltrexone (abstinence rate: 21.3%; delay=29 days), sertraline (abstinence rate: 27.5%; delay=23 days), and placebo (abstinence rate: 23.1%; delay=26 days) groups. In addition, patients treated with both medications “reported fewer serious adverse events, and tended to not be depressed by the end of treatment,” the authors wrote.

Pettinati says it is uncommon for hospitalists and other physicians to consider treating hospitalized patients with medication for alcohol dependence. She hopes hospitalists see this study as a spotlight on that approach. In past years, Pettinati suggests, medication for alcohol dependence might have been viewed as unnecessary because patient lengths-of-stay (LOS) were longer. Today, HM leaders are pushing for ever-shorter LOS.

“Now when a person comes in,” Pettinati says, “you have to make an immediate decision what kind of medication you want to treat this person with.”

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