Simioni Nicolas, Labreuche Julien, Behal Hélène, Cottencin Olivier, Rolland Benjamin
From the *Département de Psychiatrie et d'Addictologie, CHU Lille, Lille; †Etablissement Public de Santé Mentale, Val de Lys-Artois, Centre de Soins d'Accompagnement et de Prévention en Addictologie, Béthune, France; ‡The Phenix Foundation, Geneva, Switzerland; and §Santé publique: épidémiologie et qualité des soins, EA 2694, CHU Lille, ∥SCALab-PsyCHIC Team, CNRS UMR 9193, and ¶Département de Pharmacologie, INSERM U1171, University of Lille, Lille, France.
J Clin Psychopharmacol. 2017 Dec;37(6):722-728. doi: 10.1097/JCP.0000000000000786.
The aim of this study was to evaluate whether a prolonged detoxification treatment could decrease the relapse rate at 3 months after alcohol cessation in alcohol-dependent individuals through decreasing the levels of postdetoxification craving and anxiety.
Twenty-six adult patients with alcohol dependence (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) who began an outpatient alcohol cessation program with an initial drinking goal of abstinence were enrolled in a 3-month, parallel, randomized (1:1 ratio), controlled, open-label, pilot trial. Participants were randomized to receive a detoxification treatment of diazepam with a duration of 30 (n = 12) or 10 days (n = 14). All participants received BRENDA-based psychotherapy during follow-up.
No significant between-group difference in relapse to any drinking was found at 3 months (P = 0.20). However, relapse to any heavy drinking at 3 months and regular drinking or heavy drinking during follow-up were significantly lower in the 30-day diazepam group (P = 0.009, P = 0.049, and P = 0.004, respectively). These differences were corroborated by significant differences in the alcohol-specific biological marker carbohydrate deficient transferrin at 3 months. Participants in the 30-day diazepam group also displayed significantly lower scores for alcohol craving (P = 0.007), self-reported anxiety (P = 0.024), and clinician-assessed anxiety (P = 0.002) throughout the follow-up. No serious adverse event was reported during the study.
This study provides an evidence-based rationale for a double-blind, randomized, placebo-controlled trial to confirm the efficacy of such a procedure on short-term and mid-/long-term drinking outcomes after alcohol cessation in alcohol-dependent individuals.
本研究旨在评估延长的脱毒治疗是否可以通过降低脱毒后渴望和焦虑水平,来降低酒精依赖个体戒酒3个月后的复发率。
26名成年酒精依赖患者(《精神疾病诊断与统计手册》第四版,修订版)开始了门诊戒酒计划,初始饮酒目标为戒酒,他们被纳入一项为期3个月的平行、随机(1:1比例)、对照、开放标签的试点试验。参与者被随机分配接受为期30天(n = 12)或10天(n = 14)的地西泮脱毒治疗。所有参与者在随访期间接受基于BRENDA的心理治疗。
3个月时,两组间任何饮酒复发情况均无显著差异(P = 0.20)。然而,30天地西泮组在3个月时任何重度饮酒复发以及随访期间的规律饮酒或重度饮酒情况显著更低(分别为P = 0.009、P = 0.049和P = 0.004)。3个月时酒精特异性生物标志物碳水化合物缺乏转铁蛋白的显著差异证实了这些差异。30天地西泮组的参与者在整个随访期间的酒精渴望评分(P = 0.007)、自我报告的焦虑评分(P = 0.024)和临床医生评估的焦虑评分(P = 0.002)也显著更低。研究期间未报告严重不良事件。
本研究为双盲、随机、安慰剂对照试验提供了循证依据,以确认该程序对酒精依赖个体戒酒后短期和中长期饮酒结果的疗效。