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Research Summary

Social Reinforcement and Stepped Counseling Combined with Medication May Improve Abstinence in Patients with Alcohol Dependence

To try to improve on treatment as usual (TAU) (detoxification followed by individual counseling treatment with medication), researchers at 2 Portuguese alcohol treatment centers compared TAU with sequential combined treatment (SCT) in a randomized trial of 209 patients with alcohol dependence. In SCT, social reinforcement is used to promote abstinence by making an adult close to the patient co-responsible for his or her treatment. The SCT arm included individual and family counseling in combination with medication (usually disulfiram) taken under supervision by the co-responsible adult.

  • Among the 64% of subjects who completed 6-month follow-up, 78% in the SCT group were abstinent compared with 59% in TAU group (p<0.01).
  • Mean time to first relapse was 150 days in the SCT group compared with 123 days in the TAU group (p<0.01).
  • Including subjects lost to follow-up, who were considered as having relapsed, the maximum duration of continuous abstinence was 130 days in the SCT group compared with 111 days in the TAU group (p<0.05).


This study shows promising results for a treatment modality that intervenes at a system and individual level, but they should be interpreted with caution. Subjects were highly selected in that they had agreed to take disulfiram if prescribed prior to randomization. In addition, loss to follow-up was high, and therapists were selected according to the model (SCT or TAU) they were already delivering in their clinical practices.

Nicolas Bertholet, MD, MSc


Neto D, Lambaz R, Aguiar P, et al. Effectiveness of sequential combined treatment in comparison with treatment as usual in preventing relapse in alcohol dependence.Alcohol Alcohol. 2008;43(6):661–668.