Schallenberg Max, Pilhatsch Maximilian, Petzold Johannes, Vogel-Blaschka Diana, Zimmermann Ulrich S, Spreer Maik
Department of Psychiatry and Psychotherapy, Carl Gustav Carus Faculty of Medicine, Carl Gustav Carus University Hospital Dresden, Dresden University of Technology, Dresden, Germany.
Department of Psychiatry and Psychotherapy, Elblandklinikum Radebeul, Radebeul, Germany.
Addict Sci Clin Pract. 2024 Dec 2;19(1):90. doi: 10.1186/s13722-024-00522-1.
Alcohol use disorder (AUD) poses severe health risks, yet many affected individuals opt out of complete abstinence. Therefore, harm reduction strategies have become more prominent in treatment guidelines for AUD. Our two case reports illustrate how disulfiram, initially intended to enforce abstinence, was repurposed to support reduced drinking.
A 41-year-old patient with a history of severe AUD successfully reduced his alcohol consumption to a low-risk level by leveraging the effects of the disulfiram-alcohol aversive reaction. Another patient, a 63-year-old woman with long histories of AUD and major depressive disorder, experienced fewer depressive episodes and hospitalizations with disulfiram therapy despite periodically intentional discontinuation of medication.
Individualized treatment strategies are critical in optimizing outcomes for patients with AUD. Continuous disulfiram therapy, despite its limitations in directly reducing alcohol intake, might offer a new avenue for harm reduction in exceptional cases even if alcohol consumption continues. The cases suggest that maintaining therapy, aiming at reduced drinking, can enhance the therapeutic alliance and help manage comorbid conditions. Regular medical monitoring is essential for safety and efficacy, warranting further study of possible long-term consequences and psychotropic effects of elevated acetaldehyde levels related to the disulfiram-alcohol interaction.
酒精使用障碍（AUD）会带来严重的健康风险，但许多受影响的个体并未选择完全戒酒。因此，减少伤害策略在AUD治疗指南中变得更加突出。我们的两例病例报告说明了最初旨在强制戒酒的双硫仑是如何被重新用于支持减少饮酒的。
一名有严重AUD病史的41岁患者通过利用双硫仑-酒精厌恶反应的作用，成功将其酒精摄入量降低到低风险水平。另一名患者是一名63岁的女性，有长期的AUD和重度抑郁症病史，尽管她定期故意停药，但在接受双硫仑治疗期间，抑郁发作和住院次数减少。
个体化治疗策略对于优化AUD患者的治疗效果至关重要。尽管双硫仑疗法在直接减少酒精摄入量方面存在局限性，但在特殊情况下，即使饮酒仍在继续，持续的双硫仑治疗可能为减少伤害提供一条新途径。这些病例表明，以减少饮酒为目标维持治疗可以加强治疗联盟，并有助于控制合并症。定期医疗监测对于安全性和有效性至关重要，有必要进一步研究与双硫仑-酒精相互作用相关的乙醛水平升高可能产生的长期后果和精神药物作用。
