Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics
Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics
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DOI：
10.1111/j.1530-0277.1996.tb01696.x
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发表时间：
1996-12-01
影响因子：
3.2
通讯作者：
Babor, TF
中科院分区：
文献类型：
--
作者：
Kranzler, HR;Burleson, JA;Babor, TF
目的：本研究的目的是检验这一假设，即由于可能导致渴求和冲动行为的多巴胺能神经传递异常，氟西汀治疗对B型酗酒者的饮酒影响不同，这些酗酒者的特征是病前脆弱性和酒精相关问题水平较高。研究方法：使用k均值聚类程序，将来自氟西汀安慰剂对照试验的酒精依赖受试者分为低风险/严重程度（A型：n = 60）和高风险/严重程度（B型：n = 35）组。多变量协方差分析（以治疗前测量值作为协变量）评估了12周治疗期间和6个月随访期间酗酒亚型、药物组、治疗完成及其相互作用对饮酒测量值的影响。结果如下：虽然没有酒精亚型或药物组的主要影响，但完成治疗试验的受试者显示出明显更好的饮酒相关结果。在治疗期间，药物组的酒精亚型也存在相互作用。在B型受试者中，氟西汀治疗导致的饮酒相关结局比安慰剂治疗差。在A型受试者中，药物组无影响。在6个月的随访期间，这种相互作用没有持续。结论：通过聚类分析确定的酒精中毒亚型似乎对氟西汀治疗对饮酒相关结局的影响有不同的反应。先前在一个酗酒者亚组中发现的血清素能异常也以冲动性和酒精依赖的严重程度为特征，这可能有助于解释不同的药物作用。基于这些发现，建议在没有共病情绪或焦虑障碍的情况下，氟西汀不用于维持高风险/严重酗酒者的戒酒或减少饮酒。
Objective: The aim of this study was to test the hypothesis that, because of abnormalities in serotonergic neurotransmission that may underlie craving and impulsive behavior, fluoxetine treatment differentially affects drinking among type B alcoholics, who are characterized by high levels of both premorbid vulnerability and alcohol-related problems. Methods: Using a k-means clustering procedure, alcohol-dependent subjects from a placebo-controlled trial of fluoxetine were grouped into low-risk/severity (type A: n = 60) and high-risk/severity (type B: n = 35) groups. Multivariate analysis of covariance (with pretreatment measures as covariates) evaluated the effects of Alcoholic Subtype, Medication Group, Treatment Completion, and their interactions on measures of drinking, both during the 12-week treatment period and a 6-month follow-up period. Results: Although there were no main effects of Alcoholic Subtype or Medication Group, subjects who completed the treatment trial showed significantly better drinking-related outcomes. There was also an interaction of Alcoholic Subtype by Medication Group during treatment. Among type B subjects, fluoxetine treatment resulted in poorer drinking-related outcomes than placebo treatment. Among type A subjects, there was no effect of Medication Group. This interactive effect did not persist during the 6-month follow-up period. Conclusions: Alcoholic subtypes identified by cluster analysis seem to be differentially responsive to the effects of fluoxetine treatment on drinking-related outcomes. Serotonergic abnormalities previously identified among a subgroup of alcoholics who are also characterized by impulsivity and severity of alcohol dependence may help to explain the differential medication effect. Based on these findings, it is recommended that, in the absence of a comorbid mood or anxiety disorder, fluoxetine not be used to maintain abstinence or reduce drinking in high-risk/severity alcoholics.