Buri Caroline, Moggi Franz, Giovanoli Anna, Strik Werner
University Hospital of Psychiatry Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
Alcohol Alcohol. 2007 Jul-Aug;42(4):333-9. doi: 10.1093/alcalc/agm038. Epub 2007 May 21.
In randomized controlled trials with high internal validity, pharmacotherapy using acamprosate, naltrexone, and, to a somewhat lesser extent, disulfiram has proved effective in preventing relapse in patients with alcohol use disorders (AUD). There remains, however, a paucity of studies with sufficient external validity in which the effectiveness of pharmacotherapy in clinical practice is investigated. This study aimed to make a contribution to close this gap in research.
In this naturalistic, prospective study, a comparison on indices of substance use, psychiatric symptoms, and treatment service utilization was carried out using samples of 92 patients who received pharmacotherapy and 323 patients who did not receive pharmacotherapy following discharge from 12 residential AUD programmes (index stay).
Patients that received pharmacotherapy were more likely to use alcohol during the index stay and at the 1-year follow-up. Moreover, this patient group more readily utilized treatment services during a 2-year period prior to and a 1-year period following index stay than patients who were not given pharmacotherapy. Nevertheless, when pharmacotherapy was prescribed before first post-treatment alcohol use, it was associated with delay of alcohol use, fewer relapses, and a reduced need for inpatient treatment. In many cases, however, medication was not prescribed until alcohol use and relapse had occurred. The length of time to first alcohol use was longer, and the cumulative abstinence rate higher, for disulfiram than for acamprosate, the latter being generally prescribed for more severely alcohol-dependent patients.
There is a need for further studies to probe the reasons why medication for relapse prevention is not prescribed upon discharge from residential treatment and for less severely alcohol-dependent patients.
在具有高内部效度的随机对照试验中，使用阿坎酸、纳曲酮以及在某种程度上使用双硫仑进行药物治疗已被证明对预防酒精使用障碍（AUD）患者复发有效。然而，在临床实践中研究药物治疗有效性的具有足够外部效度的研究仍然很少。本研究旨在为填补这一研究空白做出贡献。
在这项自然主义的前瞻性研究中，对92名接受药物治疗的患者和323名在12个住院AUD项目出院后未接受药物治疗的患者（索引住院）样本，就物质使用指标、精神症状和治疗服务利用情况进行了比较。
接受药物治疗的患者在索引住院期间和1年随访时更有可能饮酒。此外，与未接受药物治疗的患者相比，该患者组在索引住院前2年和索引住院后1年期间更频繁地利用治疗服务。然而，当在首次治疗后饮酒前开出处方药物治疗时，它与饮酒延迟、复发减少以及住院治疗需求降低相关。然而，在许多情况下，直到饮酒和复发发生后才开出处方药物。双硫仑组首次饮酒的时间更长，累积戒酒率更高，而阿坎酸通常用于治疗酒精依赖更严重的患者。
需要进一步研究以探究为何在住院治疗出院时以及对酒精依赖程度较轻的患者未开出处方预防复发药物的原因。
