Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Alcohol-deterrent drugs help patients achieve high rates of long-term abstinence


  • A nine-year study looks at the impact of “alcohol deterrents” (ADs) disulfiram and calcium carbimide.
  • Researchers found an abstinence rate of more than 50 percent among the patients studied.
  • ADs appear to play a major psychological role in relapse prevention.

Studies investigating the long-term outcomes of alcoholism treatment are rare and inconsistent. A nine-year study in the January issue of Alcoholism: Clinical & Experimental Research investigates the occurrence of abstinence, lapse, and relapse among chronic alcoholics while exploring the role that "alcohol deterrents" (ADs) – specifically, disulfiram and calcium carbimide – may play. Results indicate that ADs can help achieve an abstinence rate of more than 50 percent.

"Although up to 30 percent of patients may claim to be abstinent two to three years after treatment," said Hannelore Ehrenreich, head of the division of clinical neuroscience at the Max-Planck-Institute of Experimental Medicine in Germany and corresponding author for the study, "objective laboratory data indicate that only six to 20 percent of patients are abstinent two years after therapy. These results reflect therapists’ clinical experience that alcoholism is a chronic and relapsing disease … similar to other chronic conditions such as hypertension or diabetes, and should be accepted as a disorder that requires long-term or life-long treatment. This study is the first report on supervised, long-term administration of ADs, with a focus on the psychological rather than the pharmacological action of ADs."

Alcohol deterrents seem to be more widely accepted and used in Europe than they are in North America, said Colin Brewer, research director of the Stapleford Centre in London. "I have co-authored a study showing that the three ’Anglo-Saxon’ countries examined – the U.K, U.S. and New Zealand – had the lowest use," he said. "Furthermore, a recent U.S. study showed that addiction specialists prescribed disulfiram or naltrexone for fewer than 15 percent of their alcoholic patients. Conversely, disulfiram use is certainly common in Spain, Portugal, Germany, Austria and Scandinavia."

Researchers analyzed data gathered from 1993 to 2002, when 180 chronic alcoholics were consecutively admitted to a two-year comprehensive integrated treatment program called the Outpatient Longterm Intensive Therapy for Alcoholics (OLITA). Carefully prepared and supervised intake of disulfiram or calcium carbimide is a major component of the program. Given that an earlier study showed that 30 OLITA patients achieved higher abstinence rates than case controls in other programs, the authors wanted to extend their investigation to all 180 patients for seven years following treatment, with a specific focus on the role of disulfiram or calcium carbimide in relapse prevention and maintenance of long-term abstinence.

"We found an abstinence rate of more than 50 percent among the patients studied," said Ehrenreich. "Long-term use of ADs appeared to be well-tolerated. Abstinence rates were better in patients who stayed on alcohol deterrents for more than 20 months as compared to patients who terminated intake at 13 to 20 months."

Ehrenreich said that the data imply a psychological rather than a pharmacological action of ADs. "First, the longer the intake, the more likely is a patient to stay continuously abstinent even after termination of ADs," she said. "Second, the dose of ADs is as irrelevant as the experience of a subsequent reaction for ADs to be effective. Third, sham-ADs are as efficient as disulfiram or calcium carbimide, provided that the use is repeatedly explained and continuously guided and encouraged."

"The psychological role that ADs may play in relapse prevention is one of the most interesting aspects of the study," added Brewer. "These results support the theory that prolonged abstinence achieved with disulfiram automatically leads to the consolidation of the habit of abstinence. Practice makes perfect. The longer people abstain, the longer they will abstain. In addition, deterrent drugs clearly do deter. Supposedly deterrent drugs also deter but they only deter because there is a real pharmacological reaction. The analogy here is with speed cameras. We know that inactive cameras also deter but only because drivers can’t know they are inactive unless they put them to the test. In both contexts, people are reluctant to make the experiment."

Although ADs are the focus of this study, said Ehrenreich, other treatment components of the OLITA program are just as important, and help to explain the psychological role that ADs play in relapse prevention. "These include strict abstinence orientation, high frequency short-term individual contacts, supportive, non-confronting counselling, therapist rotation, emergency service and crisis interventions, social re-integration, long-term treatment and subsequent life-long check-up visits, as well as a concept that recognizes ’alcohol relapse’ as an emergency," she said. "Related to this relapse model, we developed what we call ’aggressive aftercare,’ consisting of therapeutic interventions to immediately interrupt beginning, and prevent threatening, relapses. Patients who miss a therapeutic contact are contacted through spontaneous house visits, telephone calls or mail to continue therapy or to restart abstinence."

"Supervision may seem labour-intensive," observed Brewer, "but if the labour is already there, as it is in the clinic, or if one can involve family, workmates or probation services in supervision, as should be routine, it needs no extra resources. Supervised disulfiram may be particularly effective in patients who have not responded to conventional treatments. We urgently need an effective disulfiram implant, for the same reasons that naltrexone implants have been developed. There should also be more trials of probation-linked disulfiram, since alcohol-related crime is a very important issue. This study suggests that if alcoholic offenders take disulfiram regularly, even reluctantly, they will not get drunk if the dose is adequate. That should revolutionize the management of such offenders. Similar trials with naltrexone in heroin-related offenders have been very effective with no negative results."

"Our results support a major clinical implication," said Ehrenreich, "that severe alcoholism is a chronic and relapsing disease. Only long-term treatment, followed by life-long attending of check-up sessions and self-help group participation will guarantee long-term recovery. Supervised intake of ADs can easily and successfully be integrated into a comprehensive and structured outpatient long-term treatment program. The strategy of deterrence works if therapists disengage from the emphasis of pharmacological effects of disulfiram and make full use of the psychological actions of this drug."

Hannelore Ehrenreich, | EurekAlert!
Further information:

More articles from Studies and Analyses:

nachricht Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University

nachricht New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Space observation with radar to secure Germany's space infrastructure

Satellites in near-Earth orbit are at risk due to the steady increase in space debris. But their mission in the areas of telecommunications, navigation or weather forecasts is essential for society. Fraunhofer FHR therefore develops radar-based systems which allow the detection, tracking and cataloging of even the smallest particles of debris. Satellite operators who have access to our data are in a better position to plan evasive maneuvers and prevent destructive collisions. From April, 25-29 2018, Fraunhofer FHR and its partners will exhibit the complementary radar systems TIRA and GESTRA as well as the latest radar techniques for space observation across three stands at the ILA Berlin.

The "traffic situation" in space is very tense: the Earth is currently being orbited not only by countless satellites but also by a large volume of space...

Im Focus: Researchers Discover New Anti-Cancer Protein

An international team of researchers has discovered a new anti-cancer protein. The protein, called LHPP, prevents the uncontrolled proliferation of cancer cells in the liver. The researchers led by Prof. Michael N. Hall from the Biozentrum, University of Basel, report in “Nature” that LHPP can also serve as a biomarker for the diagnosis and prognosis of liver cancer.

The incidence of liver cancer, also known as hepatocellular carcinoma, is steadily increasing. In the last twenty years, the number of cases has almost doubled...

Im Focus: Researchers at Fraunhofer monitor re-entry of Chinese space station Tiangong-1

In just a few weeks from now, the Chinese space station Tiangong-1 will re-enter the Earth's atmosphere where it will to a large extent burn up. It is possible that some debris will reach the Earth's surface. Tiangong-1 is orbiting the Earth uncontrolled at a speed of approx. 29,000 km/h.Currently the prognosis relating to the time of impact currently lies within a window of several days. The scientists at Fraunhofer FHR have already been monitoring Tiangong-1 for a number of weeks with their TIRA system, one of the most powerful space observation radars in the world, with a view to supporting the German Space Situational Awareness Center and the ESA with their re-entry forecasts.

Following the loss of radio contact with Tiangong-1 in 2016 and due to the low orbital height, it is now inevitable that the Chinese space station will...

Im Focus: Alliance „OLED Licht Forum“ – Key partner for OLED lighting solutions

Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, provider of research and development services for OLED lighting solutions, announces the founding of the “OLED Licht Forum” and presents latest OLED design and lighting solutions during light+building, from March 18th – 23rd, 2018 in Frankfurt a.M./Germany, at booth no. F91 in Hall 4.0.

They are united in their passion for OLED (organic light emitting diodes) lighting with all of its unique facets and application possibilities. Thus experts in...

Im Focus: Mars' oceans formed early, possibly aided by massive volcanic eruptions

Oceans formed before Tharsis and evolved together, shaping climate history of Mars

A new scenario seeking to explain how Mars' putative oceans came and went over the last 4 billion years implies that the oceans formed several hundred million...

All Focus news of the innovation-report >>>



Industry & Economy
Event News

New solar solutions for sustainable buildings and cities

23.03.2018 | Event News

Virtual reality conference comes to Reutlingen

19.03.2018 | Event News

Ultrafast Wireless and Chip Design at the DATE Conference in Dresden

16.03.2018 | Event News

Latest News

For graphite pellets, just add elbow grease

23.03.2018 | Materials Sciences

Unique communication strategy discovered in stem cell pathway controlling plant growth

23.03.2018 | Agricultural and Forestry Science

Sharpening the X-ray view of the nanocosm

23.03.2018 | Physics and Astronomy

Science & Research
Overview of more VideoLinks >>>