Drug therapy might undermine self efficacy dependence there is a growing demand on costly acute medical and surgical services. New treat ncrieff & Drummond fear that recovery ing medication may undermine patients' self apparently expensive could efficacy and damage long-term outcome. After health service resources. A year's treatment with the end of antidepressant treatment, Frank acamprosate in the United Kingdom costs less misinformed recovered depressed patients that than I week of medical inpatient care for alcohol they had actually been taking placebo. He found detoxification. We do, of course, need stronger evidence of that they relapsed less quickly than if told they had been on active drug, inferming that their new drugs' efficacy. Also, more attention should feelings of mastery had increased. However, the be paid to the profile of patients most likely to with regard to acamprosate). WWWhen they dependence is different from that in depression. There is the over-confident drinker who compla- reviewed the existing tricyclic antidepressant cently states he has cracked his problem, but trials (1958-72) which met methodological who rapidly relapses. On the other hand, some criteria, Morris & Beck found that 32 of 93 studies have found that higher claims o Yet antidepressants continued were negative efficacy predicted good outcome, but the data is in use with benefit to thousands. The treatment for of alcohol dependence is at the beginning of rather circular: even when controlling "severity" patients who think they will do well a new era. It is nevertheless right of Moncrieff do well, and those who think they will do badly, and others, to re-assert the do badly. principles of good conduct and reporting of Empirically, the long-term studies published treatment research. on acamprosate (1 year ,12 and 6 months' after end of drug-treatment period have revealed only a very slow trend, if any, to relapse on ceasing complex behavioural problem dependence active medication. O'Malley et al.' during 6 Animal studies on drug and alcohol a pace which are ad vancing our knowledge a months off-treatment follow-up found that, makes it difficult to quote up to date reviews. while the effect of naltrexone therapy on absti The importance of the biological components only lasted up to 2 months off therapy, the identified in that research will vary from patient advantage that had been gained in terms of to patient. Drugs exist which may reduce the heavy drinking episodes and signs of abuse or intensity of alcohoVstimulus conditioned re dependence persisted ponses, by blocking neuroreceptors in one of Patients who, in taking a pharmacological aid the numerous relevant pathways. Of course, the to reduce relapse, recognize that there may be vironmental components of the depend Cn biological as well as psychological and social will be so overwhelming for some patients that contributants to their depende on alcohol, in there is no perceptible behavioural effect of the often have more rather than less my experience re-tuning of that pathway. In other patients, such respect for the need to make cognitive and be- an effect could conceivably modestly improve havioural adjustments. use the opportunity outcome. of supported abstinence t start practising these adjustments. Declaration of interepr our clinic has received payments for salaries (not my own, to assist the conducting of trials from Moncrieff & Drummond right to assert the are the manufacturers of na trexone and of acam- need to progress research in psychological and prosate, and I have received honoraria and ex- social treatments. The extra advantage of the penses via educational grants from those o date is at best modest, companies to attend scientific meetings. dications available me helping only a small proportion of patients, and all evaluations were conducted with concurrent JONATHAN CHICK psychological or social therapy. We are in an era Department of Pychiamy, at least in the United Kingdom, of increasing University of Edinburgh, identification or perhaps of preval ence of alcohol Scotland, UK