Abstract
Leading Italian studies support the use of γ-hydroxybutyric acid (GHB), not only in the treatment of the alcohol withdrawal syndrome, but also in maintaining alcohol abstinence. GHB gives a better result than naltrexone and disulfiram in maintaining abstinence, and it has a better effect on craving than placebo or disulfiram. The problem is that about 30–40% of alcoholics are non-responders to GHB therapy. In our clinical practice, we speculate that by combining disulfiram with GHB treatment we may be able to achieve a kind of ‘antagonist’ effect by using the ‘psychological threat’ of disulfiram (adversative effect) while taking advantage of the anticraving effect of GHB, despite the limitation of its ‘non-blockade’ effect on alcohol. In this context, to improve the outcome in GHB long-term treated alcoholics, we added disulfiram to GHB in the management of GHB treatment-resistant alcoholics. In this study we compared retention in treatment of 52 patients who were treated with the GHB-disulfiram combination for up to six months, with retention for the same subjects considering their most recent unsuccessful outpatient long-term treatment with GHB only. An additional comparison was carried out on the days of complete abstention from alcohol. Thirty four patients (65.4%) successfully completed the protocol and were considered to be responders; 18 (34.6%) left the programme, and were considered to be non-responders. Considering the days of complete abstinence from alcohol, 36 patients stayed in treatment longer with the GHB-Disulfiram combination, 12 stayed for a shorter time and four for the same time. The results of this study seem to indicate a higher efficacy of the GHB-disulfiram association compared with GHB alone. Randomized controlled trials are now needed to verify this hypothesis.
Highlights
Alcohol abuse and alcoholism are a world-wide problem, from a medical and a social viewpoint.In the past the therapy for alcoholics was mainly based on the psychosocial approach, but the combined use of pharmacotherapy and psychosocial interventions has raised the percentage rate of success in maintaining alcoholic patients in remission [1,2]
There are only three medications that have been approved by the U.S Food and Drug Administration (FDA) for use in treating alcohol abuse and alcoholism: disulfiram [3] naltrexone [4,5,6] and acamprosate [7,8]
We studied endpoint clinical differences between responders and non-responder patients treated with the GHB-disulfiram combination
Summary
Alcohol abuse and alcoholism are a world-wide problem, from a medical and a social viewpoint. The reduction, whether temporary or continuing, in the craving experienced by these patients was insufficient to control their dependence on alcohol This could be related to the short half-life of GHB [19], so that it could be useful to divide up GHB administration into six doses per day [15,20]. Disulfiram may be an effective and well-tolerated pharmacological treatment, within the framework of a well-integrated pharmacological, psychosocial and behavioural treatment programme [31] It has won attention as an agent adjunctive to other pharmacological medications, that reduce alcohol craving [22]. To do that we compared the retention in treatment of patients treated with the GHB-disulfiram combination, for up to six months, to retention for the same subjects considering their most recent unsuccessful outpatient long-term treatment with GHB only. An additional comparison was carried out by comparing the days of complete abstention from alcohol in those two cases
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