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Long-term Antabuse keeps most alcoholics abstinent

By Anne Harding

NEW YORK (Reuters Health) - Alcoholics may have a better chance of staying abstinent if long-term therapy includes drugs such as Antabuse, a new study shows.

Someone on one of these so-called alcohol deterrents will get sick with even a sip of alcohol, with a flushed face, rapid heartbeat, nausea, vomiting and anxiety. But the main power of these pills is their psychological effect, Dr. Hannelore Ehrenreich of the Max-Planck-Institute of Experimental Medicine in Gottingen, Germany, the study's lead author, told Reuters Health.

Ehrenreich and her colleagues found that more than half of severe alcoholics whose treatment included an alcohol deterrent were not drinking seven years after their program ended. This is far better than the track record seen with typical programs, she said, in which just 6 percent to 20 percent of participants are abstinent two years after treatment.

The program Ehrenreich and her team studied, known as Outpatient Long-term Intensive Therapy for Alcoholics (OLITA), included regular individual therapy, group sessions and other types of social support, as well as frequent urine and blood tests for drug and alcohol use. Patients also regularly took an alcohol-deterrent drug. Patients with conditions that made them ineligible for drug treatment, such as liver or heart disease, were assigned to a placebo.

At the beginning of the study, patients took the drug daily in front of a therapist. The drug gradually was given less often, but still under supervision, until the patient had been in treatment for 13 months, after which he or she could decide whether to continue taking it. Early on patients received the shorter-acting drug calcium carbimide, and were later switched to Antabuse (also known as disulfiram), which is effective for a week or longer.

Of the 180 patients who began the study, 108, or 60 percent, were abstinent seven years after the end of treatment. The longer a patient took an alcohol deterrent, the researchers found, the more likely he or she was to stay sober. And among patients who drank again, the later in treatment the lapse occurred, the more able patients were to return to abstinence afterwards.

One recent study found that only a tiny minority of addiction specialists prescribes alcohol deterrents to their alcoholic patients. This is likely because, Ehrenreich said, Antabuse got a bad reputation when it was first introduced in the mid-20th century. A person's family members would slip the drug into the alcoholic's food or drink, believing that it would treat their problem; in fact, the result was sometimes fatal. For alcohol deterrents to work, Ehrenreich said, they must be taken knowingly and willingly.

The findings underscore the fact that alcoholism is a chronic illness and must be treated like one, Ehrenreich added; short-term treatments are rarely enough to keep a person off alcohol.

"We cannot think within a few months everything is over," she said. "This person needs lifelong attention."

SOURCE: Alcoholism: Clinical and Experimental Research, January 2006.

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