title: Long-term γ-hydroxybutyric acid (GHB) and disulfiram combination therapy in GHB treatment-resistant chronic alcoholics.
abstract: Leading Italian studies support the use of γ-hydroxybutyric acid (GHB), not only in the treatment of the alcohol withdrawal syndrome, but also in maintaining alcohol abstinence. GHB gives a better result than naltrexone and disulfiram in maintaining abstinence, and it has a better effect on craving than placebo or disulfiram. The problem is that about 30-40% of alcoholics are non-responders to GHB therapy. In our clinical practice, we speculate that by combining disulfiram with GHB treatment we may be able to achieve a kind of 'antagonist' effect by using the 'psychological threat' of disulfiram (adversative effect) while taking advantage of the anticraving effect of GHB, despite the limitation of its 'non-blockade' effect on alcohol. In this context, to improve the outcome in GHB long-term treated alcoholics, we added disulfiram to GHB in the management of GHB treatment-resistant alcoholics. In this study we compared retention in treatment of 52 patients who were treated with the GHB-disulfiram combination for up to six months, with retention for the same subjects considering their most recent unsuccessful outpatient long-term treatment with GHB only. An additional comparison was carried out on the days of complete abstention from alcohol. Thirty four patients (65.4%) successfully completed the protocol and were considered to be responders; 18 (34.6%) left the programme, and were considered to be non-responders. Considering the days of complete abstinence from alcohol, 36 patients stayed in treatment longer with the GHB-Disulfiram combination, 12 stayed for a shorter time and four for the same time. The results of this study seem to indicate a higher efficacy of the GHB-disulfiram association compared with GHB alone. Randomized controlled trials are now needed to verify this hypothesis.
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, Via Roma, 67 56100 Pisa, Italy. angelogimaremmani@gmail.com
authors.forename: Angelo Giovanni Icro
authors.initials: AG
authors.lastname: Maremmani
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Pani
authors.forename: Luca
authors.initials: L
authors.lastname: Rovai
authors.forename: Matteo
authors.initials: M
authors.lastname: Pacini
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
authors.forename: Icro
authors.initials: I
authors.lastname: Maremmani
mesh_terms: D000328:Adult; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D057229:Alcoholics; D000437:Alcoholism / Q000188:drug therapy*; D004221:Disulfiram / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000379:methods*; D000431:Ethanol / Q000009:adverse effects; D005260:Female; D006801:Humans; D006885:Hydroxybutyrates / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000427:Alcohol Deterrents; D006885:Hydroxybutyrates; C111420:4-hydroxybutyric acid; D000431:Ethanol; D004221:Disulfiram