One-year follow-up of disulfiram and psychotherapy for cocaine-alcohol users: Sustained effects of treatment
Department of Psychiatry, Yale University School of Medicine, USA. Addiction
(Impact Factor: 4.74).
10/2000; 95(9):1335-49. DOI: 10.1046/j.1360-0443.2000.95913355.x
To evaluate outcomes 1 year after cessation of treatment for cocaine- and alcohol-dependent individuals.
Randomized controlled trial.
Urban substance abuse treatment center.
Ninety-six of 122 subjects randomized to treatment.
One of five treatments delivered over 12 weeks. Cognitive-behavioral treatment (CBT) plus disulfiram; Twelve-Step facilitation (TSF) plus disulfiram; clinical management (CM) plus disulfiram; CBT without disulfiram; TSF without disulfiram.
Percentage of days of cocaine and alcohol use during follow-up, verified by urine toxicology screens and breathalyzer tests.
First, as a group, participants reported significant decreases in frequency of cocaine, but not alcohol, use after the end of treatment. Secondly, the main effects of disulfiram on cocaine and alcohol use were sustained during follow-up. Finally, initiation of abstinence for even brief periods of time within treatment was associated with significantly better outcome during follow-up.
These findings support the efficacy of disulfiram with this challenging population and suggest that comparatively brief treatments that facilitate the initiation of abstinence may have long-term benefits.
Available from: Brian Kiluk
- "Data for this study were gathered from five independent randomized controlled trials evaluating behavioral (e.g., cognitive behavioral therapy [CBT], twelve-step facilitation [TSF], interpersonal therapy [IPT], contingency management [CM]) and pharmacologic (e.g., disulfiram) treatments for cocaine dependence in different populations (e.g., outpatient, methadone maintenance). The five studies were: Study # 1—12-week trial evaluating five treatment arms (CBT plus disulfiram; TSF plus disulfiram; CBT alone; TSF alone; disulfiram plus clinical management) for ambulatory cocaine-dependent individuals with comorbid alcohol abuse or dependence (Carroll, Nich, Ball, McCance-Katz, & Rounsaville, 1998; Carroll et al., 2000); Study # 2—12-week trial evaluating four treatment arms (CBT plus disulfiram; CBT plus placebo; IPT plus disulfiram; IPT plus placebo) in a general outpatient sample of cocainedependent individuals (Carroll et al., 2004); "
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Cocaine users often present to treatment with a multitude of problems typically considered addiction related; however, there is little evidence that reductions in cocaine use are followed by reductions in these problems. This study evaluated the relationship between rates of cocaine use during treatment and the level of non-cocaine life problems experienced during a 12-month period following treatment in a pooled sample of 434 cocaine-dependent individuals participating in 1 of 5 randomized controlled trials.
Structural equation modeling and latent growth curve modeling were used to evaluate the relationship between frequency of cocaine use within treatment (8 or 12 weeks) and a latent construct of global problems indicated by the days of problems reported on the Addiction Severity Index across follow-up time points (1, 3, 6, and 12 months after treatment).
Both a continuous latent cocaine use outcome measure (percent days abstinent, percent positive urines, and maximum days of consecutive abstinence) and a dichotomous measure of cocaine use (≥21 consecutive days of abstinence) during the treatment period were associated with frequency of cocaine use and global problems during follow-up. Overall, results indicated that greater cocaine abstinence during the treatment period was associated with higher rates of abstinence and fewer global problems experienced following treatment.
This is one of the first studies to support a model that suggests addiction-related problems decrease in accordance with achieving abstinence from cocaine, thereby providing evidence that within-treatment cocaine abstinence has benefits that extend beyond the frequency of drug use.
Journal of Consulting and Clinical Psychology 03/2014; 82(4). DOI:10.1037/a0036245 · 4.85 Impact Factor
Available from: David J Nutt
- "Disulfiram at daily doses of 250–500 mg appears to improve treatment retention and duration of abstinence from both alcohol and cocaine (Carroll et al., 1998) (Ib) with a sustained response at 12 months for cocaine, but not alcohol (Carroll et al., 2000) (Ib). The effect of disulfiram on reducing cocaine is independent of its effect on alcohol consumption, although those that did best stopped or reduced their drinking. "
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ABSTRACT: The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
Journal of Psychopharmacology 05/2012; 26(7):899-952. DOI:10.1177/0269881112444324 · 3.59 Impact Factor
Available from: annalsgastro.gr
- "barkeepers). It is recommended to combine Disulfiram [12, 13] with the anti-craving substance Acamprosate , which should be prescribed for a period of 18 months or longer, usually starting at the onset of withdrawal treatment. However, the prolonged use of Disulfiram should be avoided in alcoholics with liver disease, since liver function may worsen during therapy. "
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ABSTRACT: In the past three decades, researchers have been attempting to replace the obsolete concept of homogeneity of alcohol dependence, by classifying these patients into specific heterogeneous subtypes. Based on 30 years of experience and research, the Lesch Typology has proved to be very useful in clinical daily routine. The aim of the Lesch Typology is to provide targeted subtype-specific treatments to patients, thereby increasing their probability of long-term abstinence and hence improving their prognosis.
The Lesch Typology is based on data from a longitudinal prospective study (with follow ups even 19 years later) on alcohol dependent patients (n=436). By observing the long term development of these patients, four distinct courses could be identified. In the meantime, a computerized version of the Lesch Typology had been created and translated into many languages, and is currently being employed in numerous psychiatric institutions while assisting clinicians in quickly determining a patient’s subtype (www.lat-online.at).
Based on the patients’ drinking patterns and origin of substance craving, hence according to the Lesch Typology, four subtypes of alcohol dependent patients can be distinguished: 1. the “allergy model” (craving caused by alcohol); 2. the “conflict resolution and anxiety model” (craving caused by stress); 3. the “depressive model” (craving caused by mood); and 4. the “conditioning model” (craving caused by compulsion).
Pharmacological treatments are not always the most effective way of preventing relapses in alcohol dependent patients. Many times, a combination with psychosocial as well as psychotherapeutic approaches is necessary and essential for helping patients to stay sober. Depending on the patient’s Lesch Type, certain therapeutic approaches are more appropriate and subsequently lead to better results and higher chances of lasting abstinence.
Annals of Gastroenterology 03/2011; 24(2):89-97.
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