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.
"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. "
[Show abstract][Hide abstract] 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
"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. "
[Show abstract][Hide abstract] 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.
"Because 50–90% of patients who abuse cocaine also abuse alcohol (Weiss et al, 1988; Grant and Harford, 1990; Closser and Kosten, 1992; Khalsa et al, 1992), the belief was that discouraging alcohol consumption in cocaine-and alcoholdependent individuals might lower cocaine use. Indeed, disulfiram was found to reduce alcohol and cocaine intake in this patient population (Carroll et al, 1993, 1998, 2000). Surprisingly, further studies revealed that disulfiram is at least as effective at treating cocaine addicts who do not consume alcohol, and may even be more effective (George et al, 2000; Petrakis et al, 2000; Carroll et al, 2004). "
[Show abstract][Hide abstract] ABSTRACT: The antialcoholism medication disulfiram (Antabuse) inhibits aldehyde dehydrogenase (ALDH), which results in the accumulation of acetaldehyde upon ethanol ingestion and produces the aversive 'Antabuse reaction' that deters alcohol consumption. Disulfiram has also been shown to deter cocaine use, even in the absence of an interaction with alcohol, indicating the existence of an ALDH-independent therapeutic mechanism. We hypothesized that disulfiram's inhibition of dopamine β-hydroxylase (DBH), the catecholamine biosynthetic enzyme that converts dopamine (DA) to norepinephrine (NE) in noradrenergic neurons, underlies the drug's ability to treat cocaine dependence. We tested the effects of disulfiram on cocaine and food self-administration behavior and drug-primed reinstatement of cocaine seeking in rats. We then compared the effects of disulfiram with those of the selective DBH inhibitor, nepicastat. Disulfiram, at a dose (100 mg/kg, i.p.) that reduced brain NE by ∼40%, did not alter the response for food or cocaine on a fixed ratio 1 schedule, whereas it completely blocked cocaine-primed (10 mg/kg, i.p.) reinstatement of drug seeking following extinction. A lower dose of disulfiram (10 mg/kg) that did not reduce NE had no effect on cocaine-primed reinstatement. Nepicastat recapitulated the behavioral effects of disulfiram (100 mg/kg) at a dose (50 mg/kg, i.p.) that produced a similar reduction in brain NE. Food-primed reinstatement of food seeking was not impaired by DBH inhibition. Our results suggest that disulfiram's efficacy in the treatment of cocaine addiction is associated with the inhibition of DBH and interference with the ability of environmental stimuli to trigger relapse.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 11/2010; 35(12):2440-9. DOI:10.1038/npp.2010.127 · 7.05 Impact Factor
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