The medications were naltrexone (ReVia) and acamprosate (Campral). One opportunity to study the placebo effect in alcohol dependence was the multisite National Institute on Alcohol Abuse and Alcoholism (NIAAA) COMBINE (Combining Medications and Behavioral Interventions) study ( Anton et al., 2006), in which we tested combinations of medications and behavioral treatments for alcohol-dependent participants. When such individuals receive placebo, behavioral therapy may be less effective than it would have been if delivered alone. Although the placebo effect is generally considered positive, the opposite effect could exist for patients receiving placebo medication in conjunction with behavioral therapy one could hypothesize that some patients receiving medication may put less effort into their behavioral therapy because they expect the medication to change their drinking behavior. Understanding the placebo effect is particularly relevant in alcohol-dependent patients receiving concomitant behavioral therapy. The nature of the placebo effect in alcohol dependence has previously been unknown. Thus, the placebo effect appears to be disease specific, not a uniform finding. Placebo had a positive effect in studies with continuous outcomes but only in studies using subjective, not objective, outcomes.

They found no effect for placebo in the 32 studies with binary outcomes. Hróbjartsson and Gøtzsche (2001) reviewed 114 studies of various disorders in which placebo was compared with no treatment. The power and universality of the “placebo effect” has been challenged, however. A positive response to placebo is common for example, studies of major depressive disorder have reported a placebo response rate as high as 65% ( Quitkin, 1999). The purpose of placebo is to ensure that the superiority of an active treatment to that of no treatment can be attributed to the medication itself rather than the nonspecific effects of pill taking and medical attention. T he use of placebos in medication studies is common ( Temple and Ellenberg, 2000), although controversial ( Rothman and Michels, 1994).

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