Most clinical trials of alcohol treatment medications provide patients with a standardized psychosocial treatment to enhance their retention and treatment adherence.9 There are few studies of medication that do not include concomitant counseling. Rather, studies of medications to reduce drinking or maintain abstinence have included a wide range of psychosocial treatments. Although combining psychosocial and pharmacological treatments for AUD could be more efficacious than either treatment alone, few studies have examined the effect of varying the intensity of the psychosocial treatment, so that firm recommendations on the optimal combinations are not possible. The Combine Study46 compared four months of treatment with naltrexone, acamprosate, or their combination with placebo in 1,383 patients. All groups received either medical management, a low-intensity behavioral treatment designed for use in primary-care settings, or a combined behavioral intervention, a more-intensive treatment delivered by licensed behavioral health specialists. Group assignments were randomized for both the medication (which was administered double blind) and behavioral treatments (for which raters were blinded). During the four-month treatment period, 68.2% of naltrexone-treated patients had ≥1 binge drinking day compared to 71.4% of
