Dr. Willenbring, there are now several medications with evidence for treating alcohol problems. It gets confusing to know which ones to use in which situations.

Medications only work modestly for the treatment of alcohol dependence. In TCPR’s last issue on substance abuse (June 2006) we reviewed the evidence on disulfiram (Antabuse), naltrexone, and acamprosate, and concluded that naltrexone works modestly, acamprosate works less well, and Antabuse has little high quality data but probably works modestly for highly motivated patients.

Project Match was a large, government-funded research project conducted in the 1990s that showed equivalent benefit of AA, cognitive behavioral therapy, and motivational enhancement therapy in alcoholism. Researchers recently reported on an effort to test brief versions of the Project Match therapies for alcohol abusing patients.

We have no effective treatment for severe amphetamine dependence. Now, a study from Finland points to an obvious candidate treatment for those meeting DSMIV criteria for intravenous amphetamine dependence. Patients were randomly assigned to Abilify (aripiprazole--15 mg/day), Concerta (methylphenidate controlled release--54 mg/day) or placebo for 20 weeks.

There are now four medications that are approved by the FDA for the treatment of alcohol dependence, so it is high time we take a fresh look at what our options are.

Motivational interviewing (MI) has taken the world of addiction therapy by storm. The essence of MI is that the therapist maintains an empathic, supportive stance with patients while gently prodding them to focus on discrepancies between how they would like their life to be and how it actually is.

Suboxone (buprenorphine/naloxone) was approved by the FDA on October 8, 2002 for the treatment of opioid addiction. Until the approval of Suboxone, we had two options for treating opioid addiction— naltrexone and methadone.

I have found Suboxone to be a tremendous breakthrough in the treatment of individuals addicted to opiates.

Dr. Chappel, you’ve been involved in addiction medicine for many years. What are some of the major advances that you’ve seen over that time?