***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Hypothetically , topiramate can improve drinking outcomes among alcohol-dependent individuals by reducing alcohol 's reinforcing effects through facilitation of gamma-aminobutyric acid function and inhibition of glutaminergic pathways in the corticomesolimbic system . OBJECTIVE To determine if topiramate is a safe and efficacious treatment for alcohol dependence . DESIGN , SETTING , AND PARTICIPANTS Double-blind , r and omized , placebo-controlled , 14-week trial of 371 men and women aged 18 to 65 years diagnosed with alcohol dependence , conducted between January 27 , 2004 , and August 4 , 2006 , at 17 US sites . INTERVENTIONS Up to 300 mg/d of topiramate ( n = 183 ) or placebo ( n = 188 ) , along with a weekly compliance enhancement intervention . MAIN OUTCOME MEASURES Primary efficacy variable was self-reported percentage of heavy drinking days . Secondary outcomes included other self-reported drinking measures ( percentage of days abstinent and drinks per drinking day ) along with the laboratory measure of alcohol consumption ( plasma gamma-glutamyltransferase ) . RESULTS Treating all dropouts as relapse to baseline , topiramate was more efficacious than placebo at reducing the percentage of heavy drinking days from baseline to week 14 ( mean difference , 8.44 % ; 95 % confidence interval , 3.07%-13.80 % ; P = .002 ) . Prespecified mixed-model analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days ( mean difference , 16.19 % ; 95 % confidence interval , 10.79%-21.60 % ; P < .001 ) and all other drinking outcomes ( P < .001 for all comparisons ) . Adverse events that were more common with topiramate vs placebo , respectively , included paresthesia ( 50.8 % vs 10.6 % ) , taste perversion ( 23.0 % vs 4.8 % ) , anorexia ( 19.7 % vs 6.9 % ) , and difficulty with concentration ( 14.8 % vs 3.2 % ) . CONCLUSION Topiramate is a promising treatment for alcohol dependence . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00210925 AIMS To assess the effectiveness of pharmacotherapy with acamprosate in alcohol-dependent patients treated in a naturalistic setting in primary care in France . METHODS The ARES ( Acamprosate et Repercussions Economiques et Sociales ; Acamprosate and Economic and Social Repercussions ) study was performed by 149 general practitioners interested in treating alcohol use disorders in France who included patients fulfilling DSM-IV criteria for alcohol dependence . The only exclusion criteria concerned contra-indications to acamprosate , co-medication with naltrexone and multiple substance abuse . Eligible patients were r and omized to one of two treatment arms , either st and ard care alone or st and ard care with acamprosate , using an open-label design and followed up quarterly for a period of 1 year . The primary outcome variable was the change from baseline on the Alcohol-Related Problems Question naire . Secondary efficacy variables were abstinence , Clinical Global Impression , quality of life measured with the SF-36 and incidence of adverse events . An intent-to-treat population was used for outcome analysis . RESULTS 422 patients were included , of whom 348 ( 82 % ) completed the protocol as planned . At the end of the study , patients r and omized to the acamprosate group had significantly better outcomes in terms of total ARPQ score , change from baseline ( -2.61 vs -3.44 ) and number of subjects with no alcohol-related problem . On average , patients treated with acamprosate had one less alcohol-related problem than did the controls . The number needed to treat in order to save one additional patient from alcohol-related problems compared to st and ard care was 7.14 . Statistically significant differences in favour of the acamprosate group were observed for all secondary efficacy outcome measures including quality of life . CONCLUSIONS Adjunctive therapy with acamprosate in primary care is associated with significantly better functional outcome . Pragmatic trials in alcohol dependence are both feasible and informative BACKGROUND Promising treatments for alcoholics include naltrexone ( NTX ) , cue exposure combined with urge-specific coping skills training ( CET ) , and communication skills training ( CST ) . This study investigated the effects of combining these elements as treatment adjuncts . METHODS A 2 x 2 design investigated the effects of CET combined with CST , as compared with an education and relaxation control treatment , during a 2-week partial hospital program ( n = 165 ) followed by 12 weeks of NTX ( 50 mg/day ) or placebo during aftercare ( n = 128 ) . Drinking outcomes were assessed at 3 , 6 , and 12 months after discharge from the partial hospital . Process measures included urge , self-efficacy ( confidence about staying abstinent in risky situations ) , and self-reported coping skills .  Medically eligible alcohol-dependent patients were recruited . RESULTS Among those compliant with medication on at least 70 % of days , those who received NTX had significantly fewer heavy drinking days and fewer drinks on days that they drank than those receiving placebo during the medication phase but not during the subsequent 9 months . CET/CST-condition patients were significantly less likely to report a relapse day and reported fewer heavy drinking days at the 6- and 12-month follow-ups than patients in the control treatment . Interactions of medication with behavioral treatments were not significant . Process measures showed that NTX result ed in lower weekly urge ratings , and those in CET/CST used more of the prescribed coping skills after treatment , reported fewer cue-elicited urges , and reported more self-efficacy in a posttest role-play test . Drinking reductions at 3 , 6 , and 12 months correlated with more use of coping skills , lower urge , and higher self-efficacy . CONCLUSIONS The results suggest the probable value of keeping alcoholics on NTX for longer periods of time and the importance of increasing compliance with NTX . They also support the earlier promising effects of CET and CST as adjuncts to treatment programs for alcoholics by maintaining treatment gains over at least a year . The value of the urge-specific and general coping skills and of self-efficacy and urge constructs was demonstrated in their association with drinking outcomes OBJECTIVE This study tested the comparative effectiveness of modified behavioral self-control therapy ( MBSCT ) and naltrexone ( NTX ) , as well as the added benefit of combining the 2 , in problem drinking men who have sex with men ( MSM ) seeking to reduce but not quit drinking . METHOD Participants ( N = 200 ) were recruited and urn r and omized to 1 of 2 medication conditions , NTX or placebo ( PBO ) , and either MSBCT or no behavioral intervention , yielding 4 conditions : PBO , NTX , MSBCT , and NTX + MSBCT . In addition , all participants received a brief medication compliance intervention . Participants were treated for 12 weeks and assessed 1 week after treatment completion . Two primary outcomes -sum of st and ard drinks and number of heavy drinking days- and 1 secondary outcome -percentage of those drinking in a nonhazardous manner (NoH)-were selected a priori . RESULTS There was a significant main effect for MBSCT ( all ps < .01 ) but not NTX on all 3 outcomes . In addition , the combination of NTX and MBSCT was not more effective than either MSCBT or PBO . There was a significant interaction effect on NoH , such that NTX significantly increased the likelihood ( odds ratio = 3.3 ) of achieving a nonhazardous drinking outcome relative to PBO . In addition , NTX was significantly more effective than PBO on a descriptive outcome : negative consequences of drinking . CONCLUSIONS There was no advantage to adding NTX to MBSCT . In addition , MBSCT showed stronger evidence of efficacy than NTX . At the same time , NTX delivered in the context of a minimal medication compliance intervention was significantly more effective than PBO on an important clinical indicator . Results provide new information to guide the treatment of problem drinking , including in primary care setting BACKGROUND Topiramate , a sulphamate fructopyranose derivative , might antagonise alcohol 's rewarding effects associated with abuse liability by inhibiting mesocorticolimbic dopamine release via the contemporaneous facilitation of gamma-amino-butyric acid activity and inhibition of glutamate function . We aim ed to see whether topiramate was more effective than placebo as a treatment for alcohol dependence . METHODS We did a double-blind r and omised controlled 12-week clinical trial comparing oral topiramate and placebo for treatment of 150 individuals with alcohol dependence . Of these 150 individuals , 75 were assigned to receive topiramate ( escalating dose of 25 - 300 mg per day ) and 75 had placebo as an adjunct to weekly st and ardised medication compliance management . Primary efficacy variables were : self-reported drinking ( drinks per day , drinks per drinking day , percentage of heavy drinking days , percentage of days abstinent ) and plasma gamma-glutamyl transferase , an objective index of alcohol consumption . The secondary efficacy variable was self-reported craving . FINDINGS At study end , participants on topiramate , compared with those on placebo , had 2.88 ( 95 % CI -4.50 to -1.27 ) fewer drinks per day ( p=0.0006 ) , 3.10 ( -4.88 to -1.31 ) fewer drinks per drinking day ( p=0.0009 ) , 27.6 % fewer heavy drinking days ( p=0.0003 ) , 26.2 % more days abstinent ( p=0.0003 ) , and a log plasma gamma-glutamyl transferase ratio of 0.07 ( -0.11 to -0.02 ) less ( p=0.0046 ) . Topiramate-induced differences in craving were also significantly greater than those of placebo , of similar magnitude to the self-reported drinking changes , and highly correlated with them . INTERPRETATION Topiramate ( up to 300 mg per day ) is more efficacious than placebo as an adjunct to st and ardised medication compliance management in treatment of alcohol dependence BACKGROUND Naltrexone and acamprosate have been shown to be effective in relapse prevention of alcoholism via different pharmacologic mechanisms . Since it remains uncertain whether both substances are equally efficient and whether a combination of both drugs potentiates the efficacy , we conducted the first published controlled study comparing and combining both compounds . METHODS After detoxification , 160 patients with alcoholism participated in a r and omized , double-blind , placebo-controlled protocol . Patients received naltrexone , acamprosate , naltrexone plus acamprosate , or placebo for 12 weeks . Patients were assessed weekly by interview , self-report , question naires , and laboratory screening .  Time to first drink , time to relapse , and the cumulative abstinence time were the primary outcome measures . RESULTS Naltrexone , acamprosate , and the combined medication were significantly more effective than placebo . Comparing the course of nonrelapse rates between naltrexone and acamprosate , the naltrexone group showed a tendency for a better outcome regarding time to first drink and time to relapse . The combined medication was most effective with significantly lower relapse rates than placebo and acamprosate but not naltrexone . CONCLUSIONS The results of this study support the efficacy of pharmacotherapeutic strategies in the relapse prevention of alcoholism . Naltrexone and acamprosate , especially in combination , considerably enhance the potential of relapse prevention The objective of this study was to compare acamprosate with placebo in the treatment of alcohol-dependent patients during a 6-month post-detoxification treatment and a 3-month medication-free follow-up . Patients ( n = 330 ) were detoxified and r and omized to treatment with acamprosate ( 1998 mg/day ) or placebo within an out-patient programme including medical counselling , psychotherapy and self-help groups . The main outcome criterion was drinking behaviour as assessed by : abstinence/relapse ratio , cumulative abstinence duration ( CAD ) and the period of continued abstinence . Anxiety , depression and craving were also monitored . Intention to treat ( ITT ) statistical principles were followed . Twenty-five per cent of patients dropped out over the first 6 months . At the end of the treatment period , the abstinence rate was 57.9 % for acamprosate and 45.2 % for placebo ( P = 0.03 ) . The CAD was 110+/-77 days for acamprosate and 89+/-77 days for placebo ( P = 0.016 ) . Patients on acamprosate had a higher continuous abstinence rate and experienced less severe relapses . No differential effect was noted for anxiety , depression or craving . Treatment remained positive , but not significant , 3 months after termination of study medication . No significant difference in adverse events was noted between treatment groups . Acamprosate treatment over 180 days was consistently more effective than placebo to maintain abstinence and to diminish relapse severity The results of placebo‐controlled trials ( RCTs 
    Output:
    
AND RELEVANCE Both acamprosate and oral naltrexone were associated with reduction in return to drinking .
When directly compared with one another , no significant differences were found between acamprosate and naltrexone for controlling alcohol consumption .