Disulfiram Treatment for Alcohol Abuse

IF 2.6 3区 医学 Q3 BIOCHEMISTRY & MOLECULAR BIOLOGY
Colin Brewer, Emmanuel Streel
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引用次数: 0

Abstract

Dear Editor,

As the authors or co-authors of numerous contributions to the disulfiram (DSF) literature since the 1980s and the co-authors of the first textbook devoted to DSF treatment for some 40 years [1], we read Schallenberg et al.'s paper [2] with interest and some anticipatory excitement. Their positive findings are consistent with several other DSF studies in which consumption was carefully supervised. Diligent supervision is crucial for the success of DSF treatment, and it is something that we have stressed since the early 1980s [3], including the first study that examined the techniques that some patients use to evade or sabotage it [4]. We were therefore surprised that they do not directly cite these papers and earlier ones. As long ago as the 1960s, Bourne et al. published the first such study [5], which recorded surprisingly good outcomes in a group of recurrent ‘skid-row’ alcoholic offenders, not normally regarded as promising candidates for treatment. Azrin et al. published one of the first controlled studies of supervised versus unsupervised DSF in 1982 [6]. Haynes echoed Bourne et al.'s achievements with a 13-fold reduction in alcohol-related offending [7], whereas Sereny et al. found that outpatient treatment with clinic-supervised DSF was widely accepted when it was made a required condition of continuing treatment after two failures [8].

Equally surprising is their failure to reference either of the two papers which not only reviewed the effectiveness of long-term supervised DSF but also suggested the mechanisms that made supervised DSF so effective [9, 10], even when DSF was discontinued after a year or two of good progress, as in the OLITA study that they cited. They include exposure and response-prevention, a well-validated treatment for repetitive and/or phobic behaviour. It embodies and facilitates the repeated practice, learning and consolidation of new and more appropriate habits in real-life environments, as opposed to the artificial and protected environments of residential and outpatient clinics.

They also make the common mistake of describing DSF as ‘aversive’, even though in most studies, the majority of patients never risk drinking while taking it. It is therefore more correctly described as a ‘deterrent’ drug, and it deters drinking in the same way that speed cameras deter speeding without most drivers having to be fined first. A similar deterrent effect is seen in studies of ‘instant justice’ programmes for repeat driving while intoxicated (DWI) offenders, in which failure to produce a negative breathalyser test every morning and evening at their local police station results in instant, unappealable overnight imprisonment (an alcohol-sensitive electronic ankle tag is an alternative) [11]. Despite many of them clearly qualifying for a diagnosis of alcohol use disorder, ‘over 99% of tests are negative and 53% of offenders never test positive. A further 19% test positive only once and 11% do so twice’ [12]. The authors specifically state that ‘[The reduction in offending] seems to be largely a deterrent effect’.

We feel that the missing references, with their important practical and theoretical implications for DSF treatment, should not be overlooked. As it happens, Dr (now Professor) Peter Bourne is still very much alive.

双硫仑治疗酒精滥用
亲爱的编辑:作为自20世纪80年代以来对双硫仑(DSF)文献的大量贡献的作者或合著者,以及40年来第一本专门介绍DSF治疗的教科书的合著者,我们怀着兴趣和一些期待的兴奋阅读了Schallenberg等人的论文。他们的积极发现与其他几项DSF研究一致,在这些研究中,消费受到了仔细的监督。勤勉的监督对DSF治疗的成功至关重要,这是我们自20世纪80年代初以来一直强调的,包括第一次研究一些患者用来逃避或破坏它的技术。因此,我们对他们没有直接引用这些论文和更早的论文感到惊讶。早在20世纪60年代,Bourne等人就发表了第一个这样的研究b[5],该研究在一组经常性的“街头”酗酒者身上记录了令人惊讶的好结果,这些人通常不被认为是有希望的治疗对象。Azrin等人在1982年发表了有监督与无监督DSF的第一批对照研究之一。Haynes与Bourne等人的成果相呼应,酒精相关的犯罪行为减少了13倍,而Sereny等人发现,在两次失败后,将门诊治疗作为继续治疗的必要条件,在临床监督下进行DSF治疗被广泛接受。同样令人惊讶的是,他们没有引用这两篇论文中的任何一篇,这两篇论文不仅回顾了长期监督DSF的有效性,而且还提出了使监督DSF如此有效的机制[9,10],即使DSF在取得良好进展一两年后就停止了,就像他们引用的OLITA研究一样。它们包括暴露和反应预防,这是一种针对重复和/或恐惧行为的有效治疗方法。它体现并促进了在现实生活环境中反复练习、学习和巩固新的更合适的习惯,而不是在住宅和门诊诊所的人工和受保护的环境中。他们还犯了一个常见的错误,将DSF描述为“令人厌恶的”,尽管在大多数研究中,大多数患者在服用DSF时从未冒险饮酒。因此,更准确地说,它是一种“威慑”药物,它可以像测速摄像头一样阻止超速行驶,而大多数司机都不必先被罚款。类似的威慑效果也出现在针对多次醉酒驾驶(DWI)的“即时司法”项目的研究中,在这些项目中,如果不能每天早晚在当地警察局进行酒精测试呈阴性,就会被立即处以不可上诉的夜间监禁(可选择佩戴酒精敏感电子脚踝标签)。尽管他们中的许多人明显符合酒精使用障碍的诊断,但99%以上的检测结果是阴性的,53%的违法者从未检测出阳性。另有19%的人只检测出一次阳性,11%的人检测出两次阳性。作者特别指出:“(犯罪的减少)似乎在很大程度上是一种威慑效应。”我们认为缺失的参考文献及其对DSF治疗的重要实践和理论意义不应被忽视。碰巧的是,彼得·伯恩博士(现在是教授)还活得好好的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Addiction Biology
Addiction Biology 生物-生化与分子生物学
CiteScore
8.10
自引率
2.90%
发文量
118
审稿时长
6-12 weeks
期刊介绍: Addiction Biology is focused on neuroscience contributions and it aims to advance our understanding of the action of drugs of abuse and addictive processes. Papers are accepted in both animal experimentation or clinical research. The content is geared towards behavioral, molecular, genetic, biochemical, neuro-biological and pharmacology aspects of these fields. Addiction Biology includes peer-reviewed original research reports and reviews. Addiction Biology is published on behalf of the Society for the Study of Addiction to Alcohol and other Drugs (SSA). Members of the Society for the Study of Addiction receive the Journal as part of their annual membership subscription.
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