Combining Pharmacological and Behavioural Therapies for Alcohol Dependence: Current Evidence and Future Directions: A Narrative Review

Alcohol dependence is a complex and relapsing disorder with significant global health and socioeconomic impacts. Despite the availability of effective treatments, relapse rates remain high, highlighting the need for more comprehensive and individualised approaches. This narrative review evaluates current evidence supporting the combined use of pharmacological and behavioural therapies for alcohol dependence and explores emerging strategies and future directions for integrated treatment models. A narrative review of published literature, including randomised controlled trials, meta-analyses, and clinical guidelines from 2000 to 2025, was conducted to assess the efficacy, mechanisms, and implementation challenges of combination therapies. Key pharmacological agents such as naltrexone, acamprosate, disulfiram, topiramate, baclofen, and gabapentin, along with behavioural interventions including cognitive behavioural therapy, motivational interviewing, contingency management, 12-step facilitation, and mindfulness-based relapse prevention, have demonstrated improved outcomes when used in combination. Evidence indicates that integrated treatment approaches offer superior outcomes compared to monotherapies by targeting both neurobiological mechanisms and psychosocial determinants of alcohol use. Studies such as the COMBINE trial demonstrate enhanced abstinence rates, reduced relapse, and improved adherence with combined interventions. However, challenges persist related to treatment accessibility, patient heterogeneity, and system-level integration. Combining pharmacological and behavioural therapies represents a promising paradigm in the management of alcohol dependence. Future research should focus on personalisation of care, technological support tools, and integrated delivery models to optimise treatment outcomes.