Building Better Cognitive-Behavioral Therapy: Is Broad-Spectrum Treatment More Effective Than Motivational-Enhancement Therapy for Alcohol-Dependent Patients Treated with Naltrexone *?(Report‪)‬

SIGNIFICANT STRIDES IN THE TREATMENT of alcohol dependence have been made over the last 3 decades, with advances in combined behavioral and psychopharmacological treatments dominating the literature. Recent randomized trials of learning-theory-based treatments in combination with pharmacotherapies show that naltrexone (Revia) is an effective agent for use in alcohol treatment, in that it consistently increases time to first relapse, and when individuals drink while on naltrexone, they report less pleasure and drink less heavily than patients on placebo (Rohsenow, 2004). In contrast, a number of open debates regarding maximally effective psychotherapies for alcohol dependence remain. Motivational interviewing is one brief intervention that has achieved prominence in the clinical and research arena, with at least four meta-analyses that examine the effectiveness of the various adaptations of motivational interviewing (Bien et al., 1993; Burke et al., 2003; Dunn et al., 2001; Noonan and Moyers, 1997). Each meta-analysis supports the assertion that adaptations of motivational interviewing have outcomes superior to no treatment or a placebo control. Burke and colleagues (2003) have shown that when compared with other active treatments, such as cognitive-behavioral therapy (CBT), the effect size for any reported differences, analyzed in the aggregate of the meta-analysis, is close to zero. Thus, adaptations of motivational interviewing are superior to no treatment and equally effective to more costly CBT treatment.