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Open AccessArticle

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.
Int. J. Environ. Res. Public Health 2011, 8(7), 2816-2827;
Received: 28 May 2011 / Revised: 15 June 2011 / Accepted: 29 June 2011 / Published: 6 July 2011
(This article belongs to the Special Issue Alcohol and Public Health)
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. View Full-Text
Keywords: GHB-disulfiram combination; alcohol dependence; long-term treatment GHB-disulfiram combination; alcohol dependence; long-term treatment
MDPI and ACS Style

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.

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