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Alcohol Detoxification
Highlights of 36th Annual ASAM
Symposium #11
Implementing Pharmacotherapy for Alcohol Use Disorders
Organizer: Mark L. Willenbring, MD (NIAAA)
Speakers: David R. Gastfriend, MD; Barbara Mason, PhD; Helen Pettinati, PhD; and Robert Swift, MD
This symposium focused on the application of available evidence concerning pharmacotherapy of alcohol use
disorders in clinical settings.
The second speaker, Dr. Pettinati, spoke on the effective use of disulfiram ( Antabuse ). The drug, which
has been used for the treatment of alcoholism since 1948, is currently being investigated as a treatment
for cocaine dependence, because of anecdotal reports that those taking disulfiram who also used cocaine
had less craving for cocaine and therefore lower levels of use. When this was studied, it was found that
disulfiram works even in non-alcohol-using cocaine users. The severity of the alcohol-disulfiram reaction
is related to the dose of disulfiram and the amount of alcohol ingested. This reaction also varies
from person to person, depending on the allelic form of aldehyde dehydrogenase, the enzyme that is
blocked by disulfiram. The pivotal study of disulfiram was in 605 alcohol-dependent VA patients
in 1986.[2] This study showed that the results were mostly related to the level of compliance in
taking the medication. In other words, nonadherence to taking the drug is the most common reason
for nonresponse to pharmacotherapy. Therefore, increasing compliance by monitoring medication
administration or through the threat of serious consequences (eg, loss of medical license, etc.)
increased the benefit of pharmacotherapy. The combination of disulfiram and naltrexone may be
useful in treating patients with co-occurring cocaine and alcohol addictions.
Source: Medscape Psychiatry & Mental Health. 2005;10(1) ©2005 Medscape
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