A new analysis has shown that combined behavioral intervention (CBI), counseling that integrates cognitive-behavioral therapy, motivational enhancement, and techniques to enhance mutual help group participation, used alone in conjunction with naltrexone, a drug approved to help treat alcoholism, can reduce drinking in alcohol-dependent individuals. In this reanalysis of data from the COMBINE Study—the largest pharmacotherapy trial for alcoholism in the United States—researchers identified clinically useful trajectories of drinking (abstainers, infrequent drinkers, frequent to infrequent drinkers, increasing to frequent drinkers, increasing-to-nearly daily drinkers, and nearly daily drinkers). In addition, researchers determined that naltrexone reduced the chance that participants would follow a nearly daily drinking trajectory, and that CBI reduced participants' chance of following an increasing to nearly daily trajectory. Combining naltrexone and CBI, however, increased the chance of membership in a trajectory with a declining frequency of any drinking over time.

Because original COMBINE analysis showed no treatment advantage for naltrexone plus CBI, the researchers believe that trajectory analysis of COMBINE data provide a more complete representation of drinking during treatment and the effects of treatments on different aspects of drinking. These results reveal that certain subgroups of individuals may benefit more from specific treatments than is apparent from summary measures of COMBINE data.