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7 results

  • Chapter 13 - Substance Use Disorders

  • Edited by David M. L. Branford, Independent Pharmacy Consultant, Satheesh K. Gangadharan, Leicestershire Partnership NHS Trust, Mary Barrett, Leicestershire Partnership NHS Trust, Regi T. Alexander, Hertfordshire Partnership University NHS Foundation Trust
  • Book:
    The Frith Prescribing Guidelines for People with Intellectual Disability
    Published online:
    07 November 2024
    Print publication:
    21 November 2024, pp 180-198

  • Summary

    According to the ICD-11 (World Health Organization, 2019), substance use disorders include disorders that result from a single occasion or repeated use of substances (both legal and illegal) that have psychoactive properties; all drugs that are taken in excess have in common direct activation of the brain reward system, which is involved in the reinforcement of behaviours and the production of memories. They produce such an intense activation of the reward system that normal activities may be neglected. Instead of achieving reward system activation through adaptive behaviours, drugs of abuse directly activate the reward pathways. The pharmacological mechanisms by which each class of drugs produces reward are different, but the drugs typically activate the system and produce feelings of pleasure, often referred to as a ‘high’ (American Psychiatric Association, 2013). This chapter will cover all substance use in people with intellectual disability, whether it is a problem, and alternative treatments.

  • Concurrent use of alcohol and cocaine: which is the best drug choice?

  • H. Becerra Darriba
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, p. S129
    • Article
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      • Open access
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  • Introduction

    Patients with comorbid cocaine and alcohol dependence have a worse prognosis with lack of adherence to follow-up and treatment, frequent psychosocial problems, and higher rates of relapse [1]. Concurrent use of both substances produces cocaethylene, which is associated with more toxicity than cocaine alone [2].

    Objectives

    To determine the efficacy of disulfiram compared to nalmefene in the treatment of comorbid cocaine and alcohol use.

    Methods

    A quasi-experimental open study was designed on 41 outpatients, with a follow-up of at least 1 year at the Mental Health Unit, aged between 18 and 65 years, diagnosed with cocaine and alcohol dependence (ICD-10). A minimum simultaneous weekly consumption of 2 grams of cocaine and 12 SD (Standard Drink) of alcohol during the month before, described by self-records was established. Treatment with oral disulfiram 250mg/day was assigned to 21 patients, and with oral nalmefene 18mg/day to 20 individuals. Observation period was for 6 months. Urinalysis and alcohol breath test were carried out twice a week. Abstinence was defined by obtaining negative results for at least 4 consecutive weeks. Statistical analysis were performed using SPSS v21.0 (significance p<0.05).

    Results

    61.9% of patients treated with disulfiram achieved a minimum of 4 consecutive weeks of abstinence from cocaine and alcohol, compared to 40% in the nalmefene group (χ²=1.188; gl=1; p=0.276). There were no significant differences.

    Conclusions

    Disulfiram or nalmefene monotherapy seems clinically ineffective or insufficient in reducing the combined use of cocaine and alcohol. Further research is needed to assess the effect of both drugs simultaneously.

    Disclosure

    No significant relationships.

  • Encephalopathy caused by disulfiram

  • R. Sant’Angelo, I. Piretti
  • Journal:
    European Psychiatry / Volume 64 / Issue S1 / April 2021
    Published online by Cambridge University Press:
    13 August 2021, p. S707
    • Article
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      • Open access
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  • Introduction

    Disulfiram is an alcohol detox drug that has been approved by the FDA for over 50 years. Among the various side effects that can cause there is encephalopathy. Its incidence is currently unknown, according to some authors it is estimated between 1 and 20%.

    Objectives

    In this article we report the case of a 48-year-old woman diagnosed with borderline personality disorder and alcohol use disorder, presenting with encephalopathy.

    Methods

    We discuss about our diagnostic and therapeutic approach.

    Results

    Fortunately, the rapid identification of this rare condition led to a favorable outcome in our patient.

    Conclusions

    Early detection of any acute change in mental state, especially in early stage of therapy, is important. Cessation of disulfiram is recommended in case of suspicion about disulfiram encephalopathy. This case underscores the importance of awareness of this serious complication during disulfiram treatment. If suspected early, appropriate diagnosis and treatment can prevent rapid progression.

    Disclosure

    No significant relationships.

  • Combined fluoxetine and disulfiram treatment of alcoholism with comorbid affective disorders. A naturalistic outcome study, including quality of life measurements

  • C Børup, M Undén
  • Journal:
    European Psychiatry / Volume 9 / Issue 2 / 1994
    Published online by Cambridge University Press:
    16 April 2020, pp. 83-89

  • This uncontrolled study presents 188 patients primarily diagnosed as addictive alcoholics and fulfilling the DSM III diagnostic criteria for panic disorder or major depression, 104 and 84 patients, respectively. The study focused on clinical outcome of pharmacological intervention with combined fluoxetine and disulfiram treatment. The patients were followed for (up to) 40 months. A good clinical outcome for both groups was found in 70%. In a subgroup of 37 patients ‘quality of life’ was assessed using quality of life scales. An appropriate correlation emerged between clinical judgement of outcome and the patients’ self-rating. Although the study was limited by being uncontrolled, the results have shown, that specific treatment in a group of alcoholics with comorbid psychopathology within the anxiety and depression spectrum is possible even after many years of addictive alcohol abuse. The necessity for proper psychiatric assessment is stressed.

  • Disulfiram induced peripheral neuropathy: between the devil and the deep blue sea

  • Caragh Behan, Abbie Lane, Mary Clarke
  • Journal:
    Irish Journal of Psychological Medicine / Volume 24 / Issue 3 / September 2007
    Published online by Cambridge University Press:
    13 June 2014, pp. 115-116
    Print publication:
    September 2007

  • Disulfiram is widely used for the aversive treatment of alcoholism. It is well tolerated in most patients; however 1:15,000 will develop peripheral neuropathy, which is frequently misdiagnosed as alcoholic neuropathy. Most cases present with a motor-sensory neuropathy of the lower limbs, which tends to improve when administration ceases, though some cases may be left with permanent sequelae. This adverse reaction can be avoided by using the lowest effective dose. A literature review using the Medline revealed 66 citations relating disulfiram to peripheral neuropathy, and the number of cases reported is small.

  • 5 - Community Reinforcement and Traditional Approaches: Findings of a Controlled Trial

  • Edited by Robert J. Meyers, University of New Mexico, William R. Miller, University of New Mexico
  • Book:
    A Community Reinforcement Approach to Addiction Treatment
    Published online:
    05 August 2012
    Print publication:
    16 August 2001, pp 79-103

  • Summary

    This chapter contains the primary report of findings from the comparison of the Community Reinforcement (CRA) and traditional approaches. Study participants completed a comprehensive assessment at intake that included measurement of numerous demographic characteristics, motivation for change, psychological functioning, drinking history, and current drinking practices. The taking and monitoring of disulfiram were important distinguishing aspects of the treatment groups. The a priori treatment contrasts were made at proximal and distal follow-up points using three primary dependent measures. The three outcome measures were total standard drinks consumed during the assessment period, number of drinking days per week, and estimated peak blood alcohol concentration (BAC) for the assessment period. Traditional and CRA groups also had similar outcomes among the disulfiram-ineligible clients. The chapter concludes with a confessional litany of some errors the authors made along the way, in the hope of saving colleagues from similar pitfalls.

  • Disulfiram neuro-toxicity: a review and report of a case of fluctuating neuro-encephalopathy

  • Marcus Webb
  • Journal:
    Irish Journal of Psychological Medicine / Volume 8 / Issue 1 / March 1991
    Published online by Cambridge University Press:
    13 June 2014, pp. 51-54
    Print publication:
    March 1991

  • A case of chronic disulfiram (Antabuse) toxicity is described, in the context of a literature review, apparently the first such description from Ireland. The rare combination of encephalopathy with peripheral neuropathy occurred in this case, along with other probably related features. These included a fluctuating clinical course, cerebellar ataxia, grand mal seizures, impotence and a delay in improvement on discontinuing disulfiram. It is likely that symptoms of anxiety and depression in this man were also in part induced by disulfiram toxicity, but interpretation of events is complicated by developing arteriosclerosis. The difficulties in distinguishing toxic effects of disulfiram from complications of chronic alcoholism are emphasized, with resulting delay in recognizing disulfiram toxicity.