The medication therapies that were compared to a placebo control included the mu-opiate receptor antagonist naltrexone (100 mg daily) and the putative glutamate modulator acamprosate (3 gm daily), both of which were administered at doses above the therapeutic standard to maximize efficacy in the event of missed doses. Nonmedication interventions included a standardized medical management intervention and a "combined behavioral intervention." Medication management, designed to be deliverable in primary healthcare settings, consisted of 9 sessions of a 15–20-minute manualized treatment intended to reinforce adherence to medication, abstinence from drinking, and referral to Alcoholics Anonymous. Behavioral therapy involved up to twenty 50-minute sessions, was delivered by a masterâs level specialist in substance use treatment, and contained elements of evidence-based "best practices" for the treatment of alcohol dependence, including cognitive-behavioral therapy, motivational interviewing and motivational enhancement, and 12-step facilitation. The study design examined the effects of combining pharmacotherapies and specialized behavioral therapies in a 2 (acamprosate vs. placebo) x 2 (naltrexone vs. placebo) x 2 (combined behavioral intervention vs. no combined behavioral intervention) factorial design, resulting in 8 medication treatment groups, all of which also received medication management. The ninth group, combined behavioral intervention without any pills, was added to evaluate the placebo effect of pill taking and medical management intervention combined with behavioral therapy (placebo + combined behavioral intervention vs. placebo without combined behavioral intervention vs. combined behavioral intervention alone). Thus, participants were randomly assigned to 1 of 9 study treatments: (1) acamprosate + combined behavioral intervention + medical management, (2) acamprosate + medical management, (3) naltrexone + combined behavioral intervention + medical management, (4) naltrexone + medical management, (5) acamprosate + naltrexone + combined behavioral intervention + medical management, (6) acamprosate + naltrexone + medical
management, (7) placebo + combined behavioral intervention + medical management, (8) placebo + medical management, or (9) combined behavioral intervention alone.