Alcohol-deterrent drugs help long-term abstinence

Studies investigating the long-term outcomes of alcoholism treatment are rare and inconsistent.

A nine-year study in the January issue of Alcoholism: Clinical & Experimental Research investigates the occurrence of abstinence, lapse, and relapse among chronic alcoholics while exploring the role that "alcohol deterrents" (ADs) - specifically, disulfiram and calcium carbimide - may play. Results indicate that ADs can help achieve an abstinence rate of more than 50 percent.

"Although up to 30 percent of patients may claim to be abstinent two to three years after treatment," said Hannelore Ehrenreich, head of the division of clinical neuroscience at the Max-Planck-Institute of Experimental Medicine in Germany and corresponding author for the study, "objective laboratory data indicate that only six to 20 percent of patients are abstinent two years after therapy.

These results reflect therapists' clinical experience that alcoholism is a chronic and relapsing disease ? similar to other chronic conditions such as hypertension or diabetes, and should be accepted as a disorder that requires long-term or life-long treatment. This study is the first report on supervised, long-term administration of ADs, with a focus on the psychological rather than the pharmacological action of ADs."

Alcohol deterrents seem to be more widely accepted and used in Europe than they are in North America, said Colin Brewer, research director of the Stapleford Centre in London. "I have co-authored a study showing that the three 'Anglo-Saxon' countries examined - the U.K, U.S. and New Zealand - had the lowest use," he said. "Furthermore, a recent U.S. study showed that addiction specialists prescribed disulfiram or naltrexone for fewer than 15 percent of their alcoholic patients. Conversely, disulfiram use is certainly common in Spain, Portugal, Germany, Austria and Scandinavia."

Researchers analyzed data gathered from 1993 to 2002, when 180 chronic alcoholics were consecutively admitted to a two-year comprehensive integrated treatment program called the Outpatient Longterm Intensive Therapy for Alcoholics (OLITA). Carefully prepared and supervised intake of disulfiram or calcium carbimide is a major component of the program. Given that an earlier study showed that 30 OLITA patients achieved higher abstinence rates than case controls in other programs, the authors wanted to extend their investigation to all 180 patients for seven years following treatment, with a specific focus on the role of disulfiram or calcium carbimide in relapse prevention and maintenance of long-term abstinence.

"We found an abstinence rate of more than 50 percent among the patients studied," said Ehrenreich. "Long-term use of ADs appeared to be well-tolerated. Abstinence rates were better in patients who stayed on alcohol deterrents for more than 20 months as compared to patients who terminated intake at 13 to 20 months."

Ehrenreich said that the data imply a psychological rather than a pharmacological action of ADs. "First, the longer the intake, the more likely is a patient to stay continuously abstinent even after termination of ADs," she said. "Second, the dose of ADs is as irrelevant as the experience of a subsequent reaction for ADs to be effective. Third, sham-ADs are as efficient as disulfiram or calcium carbimide, provided that the use is repeatedly explained and continuously guided and encouraged."