Feeney Gerald F X, Young Ross Mc D, Connor Jason P, Tucker Jane, McPherson Annie
Department of Psychiatry, University of Queensland, Brisbane, Australia.
Aust N Z J Psychiatry. 2002 Oct;36(5):622-8. doi: 10.1046/j.1440-1614.2002.01019.x.
The relapse prevention medication acamprosate has been recently introduced to the Australian Pharmaceutical Benefits Scheme (PBS) for the treatment of alcohol dependence. Overseas clinical trials have demonstrated the efficacy of using acamprosate as an adjunct to existing psychotherapeutic approaches. Research has not examined treatment outcomes using a standardized clinical approach. The objective of this study is to investigate the impact of adding acamprosate to an established abstinence-based outpatient alcohol rehabilitation programme in an Australian population.
Fifty patients participated in an established 12-week, outpatient, "contract" based Cognitive Behavioural Therapy (CBT) alcohol abstinence programme and received acamprosate (CBT + acamprosate). Patients weighing > or = 60 kg were prescribed acamprosate calcium 333 mg tablets, two tablets three times daily (1998 mg/day) and those weighing < 60 kg received four tablets (1332 mg/day) daily. Outcomes were compared with 50 historical, matched controls, all of whom participated in the same program without a relapse prevention medication (CBT alone). All patients met DSM-IV criteria for alcohol dependence and the majority were socially disadvantaged.
Programme attendance across the eight treatment sessions was similar in both the CBT + acamprosate and the CBT alone conditions (P = 0.268). Relapse to alcohol use occurred sooner and more frequently in the CBT alone group (P = < 0.0005). Rehabilitation programme completion at 12 weeks was 42% (CBT + acamprosate) compared with 32% for (CBT alone) (P = < 0.204). Alcohol abstinence at 12 weeks was 38% (CBT + acamprosate) compared with 14% (CBT alone) (P = < 0.006).
Even within an alcohol dependent population characterized by poor prognostic indices, the addition of acamprosate to an established CBT outpatient programme significantly improved abstinence rates over a 12-week period. The use of acamprosate as an adjunctive treatment for alcohol dependence should be encouraged in Australia.
预防复发药物阿坎酸最近已被纳入澳大利亚药品福利计划（PBS），用于治疗酒精依赖。海外临床试验已证明阿坎酸作为现有心理治疗方法辅助药物的疗效。研究尚未使用标准化临床方法检验治疗结果。本研究的目的是调查在澳大利亚人群中，将阿坎酸添加到既定的基于戒酒的门诊酒精康复计划中的影响。
50名患者参加了既定的为期12周的门诊“契约”式认知行为疗法（CBT）戒酒计划，并接受了阿坎酸治疗（CBT+阿坎酸）。体重≥60kg的患者服用333mg阿坎酸钙片，每日三次，每次两片（1998mg/天）；体重<60kg的患者每日服用四片（1332mg/天）。将结果与50名历史匹配对照进行比较，所有对照均参加了相同的计划，但未使用预防复发药物（仅CBT）。所有患者均符合DSM-IV酒精依赖标准，且大多数处于社会弱势地位。
CBT+阿坎酸组和仅CBT组在八个治疗疗程中的计划参与率相似（P=0.268）。仅CBT组更早且更频繁地出现饮酒复发（P<0.0005）。12周时康复计划完成率在CBT+阿坎酸组为42%，而仅CBT组为32%（P<0.204）。12周时戒酒率在CBT+阿坎酸组为38%，而仅CBT组为14%（P<0.006）。
即使在预后指标较差的酒精依赖人群中，在既定的CBT门诊计划中添加阿坎酸在12周内也显著提高了戒酒率。在澳大利亚，应鼓励将阿坎酸用作酒精依赖的辅助治疗。
