Long-Term Antabuse Treatment Shows Big Results

Antabuse, Temposil Rarely Prescribed in U.S.

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Antabuse Can Deter Drinking. © Getty Images

A nine-year study of chronic alcoholics in Europe, where alcohol-deterrent drugs such as disulfiram (Antabuse) and calcium carbimide (Temposil) are more widely used than in the United States, shows that the psychological effects of long-term treatment can produce abstinence rates of more than 50 percent.

The research lead by Hannelore Ehrenreich, head of the division of clinical neuroscience at the Max-Planck-Institute of Experimental Medicine in Germany, is the first report on supervised, long-term administration of alcohol deterrents, with a focus on the psychological rather than the pharmacological action of alcohol deterrents.

The investigators analyzed data gathered from 1993 to 2002, when 180 chronic alcoholics admitted to a two-year comprehensive integrated treatment program called the Outpatient Longterm Intensive Therapy for Alcoholics (OLITA), in which supervised intake of disulfiram or calcium carbimide is a major component of the program.

"We found an abstinence rate of more than 50 percent among the patients studied," said Ehrenreich. "Long-term use of alcohol deterrents 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 her research revealed a psychological rather than a pharmacological action of alcohol deterrents.

Play a Psychological Role

"First, the longer the intake, the more likely is a patient to stay continuously abstinent even after termination of alcohol deterrents," she said.

"Second, the dose of alcohol deterrents is as irrelevant as the experience of a subsequent reaction for alcohol deterrents to be effective. Third, sham-alcohol deterrents are as efficient as disulfiram or calcium carbimide, provided that the use is repeatedly explained and continuously guided and encouraged."

"The psychological role that alcohol deterrents may play in relapse prevention is one of the most interesting aspects of the study," added Brewer. "These results support the theory that prolonged abstinence achieved with disulfiram automatically leads to the consolidation of the habit of abstinence. Practice makes perfect.

Drugs Part of Overall Program

"The longer people abstain, the longer they will abstain. In addition, deterrent drugs clearly do deter. Supposedly deterrent drugs also deter but they only deter because there is a real pharmacological reaction. The analogy here is with speed (traffic) cameras."

"We know that inactive cameras also deter but only because drivers can't know they are inactive unless they put them to the test. In both contexts, people are reluctant to make the experiment." Although alcohol deterrents are the focus of this study," Ehrenreich said in a news release, "Other treatment components of the OLITA program are just as important, and help to explain the psychological role that alcohol deterrents play in relapse prevention.

Alcohol Relapse Is an Emergency

"These include strict abstinence orientation, high frequency short-term individual contacts, supportive, non-confronting counseling, therapist rotation, emergency service and crisis interventions, social re-integration, long-term treatment and subsequent life-long check-up visits, as well as a concept that recognizes 'alcohol relapse' as an emergency," she said.

"Related to this relapse model, we developed what we call 'aggressive aftercare,' consisting of therapeutic interventions to immediately interrupt beginning, and prevent threatening, relapses. Patients who miss a therapeutic contact are contacted through spontaneous house visits, telephone calls or mail to continue therapy or to restart abstinence."

Long-Term Treatment Program

"Our results support a major clinical implication," said Ehrenreich, "that severe alcoholism is a chronic and relapsing disease. Only long-term treatment, followed by life-long attending of check-up sessions and self-help group participation will guarantee long-term recovery.

"Supervised intake of alcohol deterrents can easily and successfully be integrated into a comprehensive and structured outpatient long-term treatment program. The strategy of deterrence works if therapists disengage from the emphasis of pharmacological effects of disulfiram and make full use of the psychological actions of this drug."

Source: This study was published in the January 2006 issue of Alcoholism: Clinical & Experimental Research.

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