Disulfiram treatment of alcoholism. A Veterans Administration Cooperative Study. JAMA

JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 10/1986; 256(11):1449-55. DOI: 10.1001/jama.1986.03380110055026
Source: PubMed


We conducted a controlled, blinded, multicenter study of disulfiram treatment of alcoholism in 605 men randomly assigned to 250 mg of disulfiram (202 men); 1 mg of disulfiram (204 men), a control for the threat of the disulfiram-ethanol reaction; or no disulfiram (199 men), a control for the counseling that all received. Bimonthly treatment assessments were done for one year. Relative/friend interviews and blood and urine ethanol analyses were used to corroborate patients' reports. There were no significant differences among the groups in total abstinence, time to first drink, employment, or social stability. Among the patients who drank and had a complete set of assessment interviews, those in the 250-mg disulfiram group reported significantly fewer drinking days (49.0 +/- 8.4) than those in the 1-mg (75.4 +/- 11.9) or the no-disulfiram (86.5 +/- 13.6) groups. There was a significant relationship between adherence to drug regimen and complete abstinence in all groups. We conclude that disulfiram may help reduce drinking frequency after relapse, but does not enhance counseling in aiding alcoholic patients to sustain continuous abstinence or delay the resumption of drinking.

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    • "Disulfiram is a drug discovered in the 1920s . It is marketed under the trade names Antabuse and Antabus . It is predominately used in the treatment of chronic alcoholism by producing an acute sensitivity to alcohol ( Fuller et al . , 1986 ) . Disulfiram prevents the processing of alcohol by inhibiting acetaldehyde dehydrogenase , leaving an unpleasant effect after alcohol consumption ( Wright and Moore , 1990 ) . Disulfiram also is being evaluated in the treatment of cocaine - addicted patients . Disulfiram also inhibits the breakdown of dopamine and the excess dopamine "
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    Advances in Biological Regulation 05/2014; 56. DOI:10.1016/j.jbior.2014.05.003
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    • "The control arms were analyzed separately, however, when comparing disulfiram efficacy across the various control conditions. The fifth and sixth studies compared disulfiram to placebo and no disulfiram [27], [39]. In these two studies, the control arms were combined in order to calculate the overall efficacy effect-size. "
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    ABSTRACT: Despite its success with compliant or supervised patients, disulfiram has been a controversial medication in the treatment of alcoholism. Often, study designs did not recognize a pivotal factor in disulfiram research, the importance of an open-label design. Our objectives are: (1) to analyze the efficacy and safety of disulfiram in RCTs in supporting abstinence and (2) to compare blind versus open-label studies, hypothesizing that blinded studies would show no difference between disulfiram and control groups because the threat would be evenly spread across all groups. We searched PubMed, EMBASE and the Cochrane Central Register for RCTs on disulfiram use with alcoholics in comparison to any alcoholic control group. The primary outcome was defined by the authors of each trial. Additional analyses included: blind vs. open-label, with or without supervision, cocaine study or not, and type of control. Overall, the 22 included studies showed a higher success rate of disulfiram compared to controls Hedges'g = .58 (95%CI = .35-.82). When comparing blind and open-label RCTs, only open-label trials showed a significant superiority over controls g = .70 (95%CI = .46-.93). RCTs with blind designs showed no efficacy of disulfiram compared to controls. Disulfiram was also more effective than the control condition when compared to naltrexone g = .77, 95%CI = .52-1.02, to acamprosate g = .76, 95%CI = .04-1.48, and to the no disulfiram groups g = .43, 95%CI = .17-.69. LIMITS INCLUDE: (1) a population of 89% male subjects and (2) a high but unavoidable heterogeneity of the studies with a substantial I-square in most subgroups of studies. Blinded studies were incapable of distinguishing a difference between treatment groups and thus are incompatible with disulfiram research. Based on results with open-label studies, disulfiram is a safe and efficacious treatment compared to other abstinence supportive pharmacological treatments or to no disulfiram in supervised studies for problems of alcohol abuse or dependence.
    PLoS ONE 02/2014; 9(2):e87366. DOI:10.1371/journal.pone.0087366 · 3.23 Impact Factor
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    • "Patients must set a goal of abstinence when initiating disulfiram therapy, and providers should encourage patients to establish the resources and self-motivation to maintain abstinence once the drug is discontinued. Noncompliance is one of the biggest challenges in the use of disulfiram, illustrated by the 20% compliance measure in the largest controlled trial to date, administered among male US veterans.26 A very recent, single-blind trial in Japanese males with AUD demonstrated improved rates of abstinence only among subjects with an inactive ALDH2 allele.27 "
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    01/2014; 5:1-12. DOI:10.2147/SAR.S37907
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