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In Reply: Drs Jonas and Chabac assert that the COMBINE Study is not broadly relevant because (1) the findings were unexpected and contradict prior studies; (2) the study had a data collection rate higher than those of previous acamprosate trials; (3) the medical management intervention was intensive and not feasible; (4) the cohort was highly selected; and (5) outcomes were unusually good in the placebo group. Drs Kiefer and Mann assert that acamprosate might have been found effective if we had selected patients who were more severely dependent or in need of medical alcohol detoxification.

We disagree that neither medication showed any substantial effect relative to placebo. Main effects in a combination trial are interpretable only within the context of interactions. The observed 2-way interaction indicates that receiving either the CBI, naltrexone, or both significantly improved outcomes relative to placebo in the context of medical management. This demonstrates that medical . . . [Full Text of this Article]

Raymond F. Anton, MD
antonr@musc.edu
Medical University of South Carolina
Charleston

William R. Miller, PhD
Center on Alcoholism, Substance Abuse and Addiction
University of New Mexico
Albuquerque

Stephanie S. O’Malley, PhD
Yale University School of Medicine
New Haven, Conn

Allen Zweben, DSW
Columbia University School of Social Work
New York, NY

James D. Hosking, PhD
Collaborative Studies Coordinating Center
University of North Carolina
Chapel Hill

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