Supervised disulfiram in relapse prevention in alcohol-dependent patients suffering from comorbid borderline personality disorder--a case series.
OBJECTIVE
Disulfiram is widely used to prevent alcoholic relapse. However, due to the intended adverse reaction with ethanol, some believe that its use is dangerous for patients with personality disorders or psychiatric comorbidities because of their increased risk of impulsivity or suicidal behaviour. We examined the safety and efficacy in relapse prevention of a series of alcoholics with borderline personality disorder (BPD).


METHODS
Case history study of patients diagnosed with BPD, prescribed disulfiram in a dose of 1.5-2.5 g/week, supervised by a physician in up to three brief contacts per week.


RESULTS
Two out of eight patients remained completely abstinent during the supervised disulfiram therapy over a mean period of 9.25 months. Adherence to treatment was 18.44 +/- 21.78 months. The first relapse occurred after 1.38 +/- 1.41 months. The cumulated time of abstinence was 16.88 +/- 20.48 months. The overall tolerability was considered to be high; dizziness and fatigue appeared in all patients at the beginning of the therapy but did not persist. No serious adverse events or ethanol-disulfiram interactions were observed. No suicidal behaviour was reported.


CONCLUSIONS
Although case observations should be interpreted with caution, supervised disulfiram seems to deserve further investigation in patients with comorbid BPD, for whom it appears to help prevent alcoholic relapse.
Mutschler
Jochen
J
1Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, University of Heidelberg, J5, 68159 Mannheim, Germany . jochen.mutschler@puk.zh.ch
Grosshans
Martin
M
Koopmann
Anne
A
Hermann
Derik
D
Diehl
Alexander
A
Mann
Karl
K
Kiefer
Falk
F
D000328:Adult; D000427:Alcohol Deterrents / Q000008:administration & dosage* / Q000009:adverse effects; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D001883:Borderline Personality Disorder / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D017831:Diagnosis, Dual (Psychiatry); D004221:Disulfiram / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy; D055502:Secondary Prevention; D016320:Substance Abuse Treatment Centers; D013695:Temperance / Q000706:statistics & numerical data; D016896:Treatment Outcome
D000427:Alcohol Deterrents; D004221:Disulfiram