Alcoholics who were motivated were able to dramatically cut back on drinking over four months no matter what type of treatment they stuck with, including taking dummy pills, a rigorous short-term study found.
The findings suggest a variety of options can help if drinkers are determined to quit and if they regularly meet with a doctor or nurse for guidance, researchers said. They said the study also indicates drinkers can make strides without going to a costly alcohol treatment center.
That could vastly expand access to care for a problem that affects some 8 million Americans -- most of whom never seek help.
The 1,383 alcoholics studied were assigned to get 16 weeks of treatment -- either counseling, medication or fake pills -- most with the help of a doctor or nurse. All badly wanted to quit, a factor that led some outside experts to question whether the results apply to the real world.
And one critic said getting alcoholics to drink less over just four months doesn't prove they've kicked the habit.
But the researchers argued that cutting back is an important step and said the results should help convince skeptics that alcoholism isn't hopeless.
The study "really does open up the possibility of people having more choice and it could significantly expand access," said Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, which funded the research. The findings appear in Wednesday's Journal of the American Medical Association.
The most effective treatments were naltrexone, a drug that reduces alcohol craving, and specialized counseling. When each was combined with medical management, abstinence days increased from about 25 percent to about 80 percent. Combining fake pills was almost as effective.
Unexpectedly, a newer alcoholism drug called Campral, used more often in Europe than in the United States, was no more effective than dummy pills. The researchers aren't sure why and said more study is needed.
A 58-year-old Charleston, S.C., artist said taking a placebo every day helped her "stay focused on what the goal was, to get rid of this habit."
Sylvia, who asked that her last name not be used, said counseling with doctors and nurses also helped, teaching her common-sense tips, such as keeping alcohol out of the house and finding healthy substitutes -- for her, tea.
That kind of advice is similar to that given newly diagnosed diabetics, the researchers said, and involved nine 20-minute sessions with a doctor or nurse.
"I've had some backslides," Sylvia said, but added, "the longer you stay sober, the easier it gets."
Among the participants, lapses occurred during a yearlong follow-up but overall, they continued to drink far less than the daily nine- to 10-drink average at the start.
Several study authors have industry ties, including lead author Dr. Raymond Anton, a Medical University of South Carolina researcher who has consulted for the makers of a long-acting form of naltrexone and for the U.S. distributor of Campral.
Dr. Stuart Gitlow, an addiction specialist at Mount Sinai School of Medicine in New York, said the study used "worthless" short-term measures to define success.
Alcoholism is a lifetime disease, said Gitlow, who was not involved in the research. "Either you drink or you don't. Alcoholism is like pregnancy: you are or you're not. No middle ground."
Dr. Lynne Kirk, president of the American College of Physicians, called the research potentially promising for primary-care doctors faced with alcoholic patients. But she said real-world treatment might be more challenging because those in the study were clearly "ready to abstain from alcohol. That's a big step in and of itself."