Does Disulfiram Help to Prevent Relapse in Alcohol Abuse?

Brewer, Colin; Meyers, Robert J.; Johnsen, Jon

doi:10.2165/00023210-200014050-00001

Cited by 67 publications

(61 citation statements)

References 44 publications

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“…Clinical trials of disulfi ram therapy have shown mixed results, in part because of the challenges in achieving high levels of patient adherence. There is some evidence that strategies of patient monitoring, such as direct observation of dosing, may improve clinical outcomes (Brewer et al, 2000;Chick et al, 1992;Fuller and Gordis, 2004;Suh et al, 2006).…”

Section: Disulfi Ram and Tablet Naltrexonementioning

confidence: 99%

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

Abraham¹,

Knudsen²,

Roman³

2011

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: The objectives of this study were to (a) identify the patterns of disulfi ram (Antabuse) and tablet naltrexone (Revia) adoption over a 48-month period in a nationally representative sample of privately funded programs that deliver substance use disorder treatment; (b) examine predictors of sustainability, later adoption, discontinuation, and nonadoption of disulfi ram and tablet naltrexone; and (c) measure reasons for medication discontinuation. Method: Two waves of data were collected via face-to-face structured interviews with 223 program administrators. Results: These data demonstrated that adoption of medications for alcohol use disorders (AUDs) was a dynamic process. Although nonadoption was the most common pattern, approximately 20% of programs sustained use of the AUD medications and 30% experienced organizational change in adoption over the study period. Bivariate multinomial logistic regression models revealed that organizational characteristics were associated with sustainability including location in a hospital setting, program size, accreditation, revenues from private insurance, referrals from the criminal justice system, number of medical staff, and use of selective serotonin reuptake inhibitors at baseline. Two patterns of discontinuation were found: Programs either discontinued use of all substance use disorder medications or replaced disulfi ram/tablet naltrexone with a newer AUD medication. Conclusions: These fi ndings suggest that adoption of AUD medications may be positively affected by pressure from accreditation bodies, partnering with primary care physicians, medication-specifi c training for medical staff, greater availability of resources to cover the costs associated with prescribing AUD medications, and amending criminal justice contracts to include support for AUD medication use. (J. Stud. Alcohol Drugs, 72, 669-677, 2011)

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Section: Disulfi Ram and Tablet Naltrexonementioning

confidence: 99%

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

Abraham¹,

Knudsen²,

Roman³

2011

J. Stud. Alcohol Drugs

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“…In recent studies it has shown promise in treating individuals with co-occurring cocaine and alcohol dependence (Carroll et al, 2000;Carroll et al, 1998;Kosten et al, 2002). As with naltrexone, the effectiveness of disulfiram is contingent on patients' compliance with the prescribed dose and schedule (Brewer et al, 2000;Kranzler, 2000;Litten and Allen, 1999). …”

Section: Introductionmentioning

confidence: 99%

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

Knudsen

Ducharme

Roman

2007

Drug and Alcohol Dependence

124

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Despite growing interest in closing the "research to practice gap," there are few data on the availability of medications in American substance abuse treatment settings. Recent research suggests that organizational characteristics may be associated with medication availability. It is unclear if the availability of medications can be conceptualized in terms of "technology clusters," where the availability of a medication is positively associated with the likelihood that other medications are also offered. Using data from 403 privately funded and 363 publicly funded specialty substance abuse treatment centers in the US, this research models the availability of agonist medications, naltrexone, disulfiram, and SSRIs. Bivariate logistic regression models indicated considerable variation in adoption across publicly funded non-profit, government-owned, privately funded non-profit, and forprofit treatment centers. Some of these differences were attenuated by organizational characteristics, such as accreditation, the presence of staff physicians, and the availability of detoxification services. There was some evidence that naltrexone, disulfiram, and SSRIs represent a group of less intensely regulated medications that is distinct from more intensely regulated medications. These types of medications were associated with somewhat different correlates. Future research should continue to investigate the similarities and differences in the predictors of medication availability across national contexts.

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“…It is the large evidence-base from the mid-1970s onwards showing that when its administration is supervised by health professionals, family members, colleagues or probation staff, supervised disulfiram treatment (SDT) is an effective and often highly effective component of any multimodal approach to alcoholism. (Brewer 1992;Brewer et al 2000) Unfortunately, this extensive literature is ram (TSD) se convierten en un componente efectivo, y muchas veces muy efectivo, dentro de cualquier enfoque multimodal frente al alcoholismo (Brewer 1992;Brewer et al 2000). Desgraciadamente, esta extensa literatura ha sido ampliamente ignorada o malinterpretada, incluso por los propios médicos.…”

Section: The Importance Of Supervised Consumptionmentioning

confidence: 99%

El disulfiram supervisado es más eficaz en alcoholismo que la naltrexona o el acamprosato e incluso la psicoterapia: cómo funciona y por qué es importante

Brewer¹

2005

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RESUMENAunque hayan sido rechazados o ridiculizados por muchos médicos, por revisores de publicaciones y por autores de guías de tratamientos, los ensayos controlados aleatorios individuales (RCTs) y meta-análisis muestran claramente que la introducción de un tratamiento supervisado de disulfiram (TSD) en los programas de tratamiento del alcoholismo da sistemáticamente mejores resultados que si se incluye la naltrexona (NTX) o el acamprosato (ACP).Los tamaños medios de los efectos para el NTX y para el ACP en alcoholismo son bajos -0.28 y 0.26 respectivamente, frente al 0.53 del TSD. Muchos de los estudios con NTX no incluyeron alcohólicos ambivalentes o severos (por ejemplo, infractores recurrentes alcohólicos). Aunque existen algunos estudios negativos con NTX y ACP, incluso en aquellos más fiables, todos los estudios sobre TSD en los que los pacientes recibieron realmente la medicación prevista tuvieron efectos positivos e, incluso muchas veces, muy positivos.El abuso del consumo del alcohol es prácticamente desconocido entre los japoneses que son homocigóticos para la aldeido deshidrogenasa "ineficiente" . El TSD actúa simplemente reproduciendo esta variante genética -normal, pero con una alta capacidad protectora-de una forma reversible. Este artículo revisa la literatura más reciente acerca del tema y analiza los factores ideológicos y financieros que contribuyen al escaso uso del TSD. La evidente superioridad del TSD debería convertirle en la primera opción de tratamiento para pacientes cuya situación es susceptible de empeorar rápidamente en caso de una recaída temprana. Aunque el tratamiento farmacológico es una prolongación de la relación terapéutica y no debe ser nunca un sustituto de ésta, muchos pacientes con respuesta positiva al TSD parecen necesitar muy poca intervención psicoterapéutica específica. Ello puede deberse al hecho de que el TSD actúa no sólo como un freno eficaz ante el consumo de alcohol, sino también como un potente reforzador del cambio cognitivo y de comportamiento. ABSTRACTAlthough neglected or derided by many clinicians, literature reviewers and producers of treatment guidelines, individual randomised controlled trials (RCTs) and meta-analyses show clearly that including supervised disulfiram treatment (SDT) in alcoholism treatment programmes consistently gives better outcomes than including naltrexone (NTX) or acamprosate (ACP).Average effect sizes for NTX and ACP in alcoholism are small -0.28 and 0.26 respectively, against 0.53 for SDT. Many studies of NTX did not include severe or ambivalent alcoholics (eg recurrent alcoholic offenders). While there are several negative studies of NTX and ACP, even when compliance was good, all studies of SDT in which patients actually received the planned medication had positive and often very positive results.Alcohol abuse is virtually unknown among Japanese who are homozygous for 'inefficient' aldehyde dehydrogenase. SDT simply reproduces this normal but highly protective genetic variant in a reversible manner. This paper reviews the lat...

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Does Disulfiram Help to Prevent Relapse in Alcohol Abuse?

Cited by 67 publications

References 44 publications

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

A Longitudinal Examination of Alcohol Pharmacotherapy Adoption in Substance Use Disorder Treatment Programs: Patterns of Sustainability and Discontinuation

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

El disulfiram supervisado es más eficaz en alcoholismo que la naltrexona o el acamprosato e incluso la psicoterapia: cómo funciona y por qué es importante

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