Disulfiram Maintenance in Outpatient Treatment of Alcoholism

Gerrein, John R.; Rosenberg, Chaim M.; Manohar, Velandy

doi:10.1001/archpsyc.1973.01750360034004

Cited by 93 publications

(26 citation statements)

References 6 publications

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“…For the studies indicating gender, 2058 were men and 266 were women (11.4%). The breakdown by gender was not available in a sub sample of two studies in which we analyzed only the arms of the study that were related to our research question [14], [25]. In one study, gender was not indicated [32].…”

Section: Resultsmentioning

confidence: 99%

“…Although Jorgensen et al proposed a meta-analysis on disulfiram efficacy, one non-efficacy study was included [20] and five eligible trials were absent [21], [22], [23], [24], [25]. Furthermore, the critical and determinant factor in disulfiram efficacy – that only open-label trials can show efficacy – was not explored by Jorgensen et al, and they mixed open and blind studies in their meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

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Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis

Skinner

Lahmek

Pham³

et al. 2014

PLoS ONE

274

147

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BackgroundDespite 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.Methods and FindingsWe 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.ConclusionsBlinded 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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis

Skinner

Lahmek

Pham³

et al. 2014

PLoS ONE

274

147

View full text Add to dashboard Cite

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“…6,33 One study objectively examining the effectiveness of the supervised disulfiram treatment found that twice-weekly supervised disulfiram treatment significantly enhanced the treatment session attendance and abstinence. 34 Disulfiram supervision as a part of a community reinforcement program, which included behavioral interventions for psychosocial domains (eg, employment and marital relationship), also showed significantly better results than a standard outpatient program did in reducing drinking frequency and maintaining abstinence. 35 However, many of the supervised disulfiram studies have confounding measures, such that concomitant interventions or lack of adequate controls prevent assessing direct or specific effects of supervised disulfiram.…”

Section: Adherence With Disulfiram Treatmentmentioning

confidence: 99%

The Status of Disulfiram

Suh

Pettinati

Kampman

et al. 2006

Journal of Clinical Psychopharmacology

348

117

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For more than 55 years, disulfiram has been approved by the Food and Drug Administration for the treatment of alcohol dependence. It is a unique medication that relies on "psychological threat" to avoid disulfiram-ethanol reactions. This paper reviews the history of disulfiram treatment, the current status of disulfiram treatment, the ensuing developments in disulfiram use in treating various addictions, and future directions. Clinical trials using disulfiram for the treatment of alcohol, cocaine, or co-occurring alcohol + cocaine dependence were included in this review. Disulfiram efficacy studies focusing on supervised, implant, and combination pharmacotherapies were also examined. In clinical trials, disulfiram has demonstrated inconsistent results in helping patients to abstain from alcohol, and patients poorly adhere to a disulfiram-treatment regimen. This has raised questions about disulfiram's practicality in the treatment of alcohol dependence. Recently, however, disulfiram has gained attention as a complementary agent to newer pharmacological medications, such as an opiate antagonist that specifically reduces alcohol craving. One hypothesis is that disulfiram would assist patients in gaining psychological control over drinking when given in conjunction with an opiate antagonist that would act directly on reducing alcohol craving. Preliminary evidence also suggests that disulfiram treatment could be a viable treatment for cocaine dependence because it was shown to reduce cocaine use among nonalcoholic, cocaine-dependent patients.

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“…Disulfiram is usually given in a dose range of 200 -500 mg/day. Data on efficacy reveal a mixed outcome pattern [11][12][13][14][15][16][17][18][19][20]. There are comparatively few controlled clinical trails on disulfiram (Tables 1 and 2).…”

Section: Disulfirammentioning

confidence: 99%

New pharmacological approaches for the treatment of alcoholism

Soyka¹,

Roesner

2006

Expert Opinion on Pharmacotherapy

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Pharmacological relapse prevention in alcoholism is a rather new clinical field with few drugs being available. Acamprosate, acting predominantly via glutamatergic pathways, and the opioid receptor antagonist naltrexone, were both shown to be efficient in improving rates for continuous abstinence, and not relapsing to heavy drinking in a number of clinical trials and meta-analyses. There are conflicting data on both drugs, especially for acamprosate, according to some recent US studies. However, overall, the evidence is good. Both drugs are approved in most European countries and the US. Efficacy data for disulfiram are mixed; it is a second-line medication compared with other drugs, and is probably most effective when used in a supervised setting. Recently, anticonvulsants including carbamazepine and topiramate have been discussed as possible anti-craving drugs, but there is still limited evidence for their efficacy. Although there is a significant comorbidity for alcoholism with affective disorder, anxiety and schizophrenia, relatively few controlled clinical trials have been performed in this area. Tricyclics have been found to be more effective than serotonin reuptake inhibitors in improving depressive symptoms in these patients.

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Disulfiram Maintenance in Outpatient Treatment of Alcoholism

Cited by 93 publications

References 6 publications

Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis

Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis

The Status of Disulfiram

New pharmacological approaches for the treatment of alcoholism

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