title: Coadministration of disulfiram and lorazepam in the treatment of alcohol dependence and co-occurring anxiety disorder: an open-label pilot study.
abstract: Anxiety is common among persons with alcohol use disorder during early abstinence from alcohol. Although benzodiazepines are effective for short-term treatment of anxiety, they are rarely used beyond acute detoxification due to concerns about misuse or interactions with alcohol.
  
  
  
  We conducted an open-label trial to explore the effects of coadministering lorazepam and disulfiram to alcohol-dependent patients with anxiety disorder symptoms. The rationale for this model is to minimize the risks of the benzodiazepine, while also potentially enhancing adherence to disulfiram.
  
  
  
  Forty-one participants with DSM-IV alcohol dependence who also met syndromal criteria for anxiety disorder with or without co-occurring major depressive syndrome initiated treatment with lorazepam (starting dose 0.5 mg three times daily) and disulfiram (starting dose 500 mg three times weekly). Participants received 16 weeks of monitored pharmacotherapy with manualized medical management.
  
  
  
  Adherence to treatment decreased steadily with time (85.4% at 4 weeks, 36.6% at 16 weeks). Participants showed significant increases in percent abstinent days during treatment and at 24 weeks follow-up. Large reductions in anxiety, depression, and craving were observed during treatment, and improvement remained significant at 24 weeks. Duration of adherence with disulfiram strongly predicted abstinence at 16 weeks. There was no evidence of misuse of lorazepam or dose escalation during the study.
  
  
  
  Lorazepam can be safely used for short-term treatment of anxiety in combination with disulfiram treatment of alcohol use disorder. However, it is not clear that making lorazepam dispensing contingent on adherence to disulfiram enhances retention in disulfiram treatment.
authors.affiliation: a Department of Psychiatry , New York University School of Medicine , New York , NY , USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bogenschutz
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , University of New Mexico Health Sciences Center , Albuquerque , NM , USA.
authors.forename: Snehal
authors.initials: S
authors.lastname: Bhatt
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , University of New Mexico Health Sciences Center , Albuquerque , NM , USA.
authors.forename: Juliane
authors.initials: J
authors.lastname: Bohan
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , University of New Mexico Health Sciences Center , Albuquerque , NM , USA.
authors.forename: Bellelizabeth
authors.initials: B
authors.lastname: Foster
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , University of New Mexico Health Sciences Center , Albuquerque , NM , USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Romo
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , University of New Mexico Health Sciences Center , Albuquerque , NM , USA.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Wilcox
authors.affiliation: c Center on Alcoholism, Substance Abuse, and Addictions , University of New Mexico , Albuquerque , NM , USA.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Tonigan
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000188:drug therapy*; D001008:Anxiety Disorders / Q000188:drug therapy*; D066249:Craving / Q000187:drug effects; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy; D004221:Disulfiram / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D010865:Pilot Projects; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D008140:Lorazepam; D004221:Disulfiram
keywords: Alcohol dependence; alcohol use disorder; anxiety; benzodiazepine; disulfiram; lorazepam