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Long-Term γ-Hydroxybutyric Acid (GHB) and Disulfiram Combination Therapy in GHB Treatment-Resistant Chronic Alcoholics
Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, Via Roma, 67 56100 Pisa, Italy
AU-CNS, “From Science to Public Policy” Association, Pietrasanta, Lucca, 55045, Italy
Social-Health Direction, Health District 8 (ASL 8) Cagliari, 09100 Italy
G. De Lisio Institute of Behavioral Sciences, Pisa, 56100, Italy
* Author to whom correspondence should be addressed.
Received: 28 May 2011; in revised form: 15 June 2011 / Accepted: 29 June 2011 / Published: 6 July 2011
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.
Keywords: GHB-disulfiram combination; alcohol dependence; long-term treatment
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Maremmani, A.G.I.; Pani, P.P.; Rovai, L.; Pacini, M.; Dell’Osso, L.; Maremmani, I. Long-Term γ-Hydroxybutyric Acid (GHB) and Disulfiram Combination Therapy in GHB Treatment-Resistant Chronic Alcoholics. Int. J. Environ. Res. Public Health 2011, 8, 2816-2827.
Maremmani AGI, Pani PP, Rovai L, Pacini M, Dell’Osso L, Maremmani I. Long-Term γ-Hydroxybutyric Acid (GHB) and Disulfiram Combination Therapy in GHB Treatment-Resistant Chronic Alcoholics. International Journal of Environmental Research and Public Health. 2011; 8(7):2816-2827.
Maremmani, Angelo Giovanni Icro; Pani, Pier Paolo; Rovai, Luca; Pacini, Matteo; Dell’Osso, Liliana; Maremmani, Icro. 2011. "Long-Term γ-Hydroxybutyric Acid (GHB) and Disulfiram Combination Therapy in GHB Treatment-Resistant Chronic Alcoholics." Int. J. Environ. Res. Public Health 8, no. 7: 2816-2827.