Short-term efficacy of Disulfiram or Naltrexone in reducing positive urinalysis for both cocaine and cocaethylene in cocaine abusers: A pilot study
Short-term efficacy of Disulfiram or Naltrexone in reducing positive urinalysis for both cocaine and cocaethylene in cocaine abusers: A pilot study
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DOI：
10.1016/j.phrs.2006.11.005
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发表时间：
2007-02-01
影响因子：
9.3
通讯作者：
Nencini, Paolo
中科院分区：
文献类型：
--
作者：
Grassi, Maria Caterina;Cioce, Anna Maria;Nencini, Paolo
可卡因滥用者经常报告在饮酒的同时服用该药物。这种组合摄入会导致可卡乙烯的合成，这是一种活性代谢物，其作用与可卡因相似，但作用时间更长。由于可卡因的药理作用可能部分解释了可卡因滥用者将这种药物与乙醇结合使用的习惯，因此这些患者的主要治疗目标应该是使体液中可卡乙烯呈阴性。这项随机对照开放研究对 12 名同时滥用可卡因和酒精的受试者进行，评估了每日 400 毫克双硫仑 (DIS) 或每日 50 毫克纳曲酮 (NTX) 联合认知行为疗法 (CBT) 为期 12 周的药物治疗与单独 CBT 的疗效，具体表现在：(i) 坚持治疗； (ii) 对可卡因和可卡乙烯进行无药物尿液分析； (iii) 减少对酒精和可卡因的渴望。本研究中提供的数据仅限于治疗的前 4 周，当时所有入组受试者仍可供检查。事实上，在参与该研究的 12 名受试者中，只有 4 名 (33%) 完成了 12 周的治疗。其中，3 名属于 CBT 组，1 名属于 NTX/CBT 组。结果显示，接受 CBT 治疗的受试者比接受 DIS/CBT 或 NTX/CBT 治疗的受试者持续治疗的时间更长。然而，在治疗的前 4 周内，CBT 组尿液中可卡因和可卡乙烯几乎总是呈阳性。相比之下，与单独的 CBT 相比，DIS/CBT 和 NTX/CBT 治疗均与可卡因和可卡乙烯尿液分析阳性率显着降低有关。此外，在治疗的前 4 周内，接受 DIS/CBT 和 NTX/CBT 治疗的受试者在可卡因和酒精渴望方面的视觉模拟量表 (VAS) 得分均低于仅接受 CBT 的受试者。这项初步研究表明，药物治疗在维持受试者不吸毒方面的短暂功效并不能增加 CBT 让他们继续接受治疗的能力。 (c) 2006 Elsevier Ltd. 保留所有权利。
Cocaine abusers frequently report taking the drug in association with alcohol. This combined intake leads to the synthesis of cocaethylene, an active metabolite with effects similar to those of cocaine, but more prolonged. Since pharmacological effects of cocaethylene may partially account for the habit of cocaine abusers to take the drug in combination with ethanol, a main therapeutic goal in these patients should be making body fluids negative for cocaethylene. This randomized controlled open study conducted on 12 subjects co-abusers of cocaine and alcohol, evaluates the efficacy of a 12-week pharmacological treatment with Disulfiram (DIS) 400 mg daily or Naltrexone (NTX) 50 mg daily associated with Cognitive Behaviour Therapy (CBT), as compared to CBT alone, in terms of: (i) stay in treatment; (ii) drug-free urinalyses for cocaine and cocaethylene; (iii) reduction of alcohol and cocaine craving. Data presented in this study are restricted to the first 4 weeks of treatment when all the enrolled subjects were still available for examination. In fact, of the 12 subjects enrolled in the study only 4 (33%) completed the 12-week treatment. Of these, three were in the CBT group and one in the NTX/CBT group. Results show that CBT treated subjects remained in treatment longer than those assigned to either DIS/CBT or NTX/CBT therapies. However, during the first 4 weeks of treatment, CBT-group urine tested positive almost always for both cocaine and cocaethylene. In contrast, both DIS/CBT and NTX/CBT treatments were associated to a statistically significant reduction, of positive urinalysis for both cocaine and cocaethylene, with respect to CBT alone. Moreover, across the first 4 weeks of treatment DIS/CBT and NTX/CBT treated subjects maintained lower scores at Visual Analogue Scales (VAS) for both cocaine and alcohol craving than subjects receiving CBT alone. This pilot study suggests that the transient efficacy of pharmacological treatments in maintaining subjects drug free, does not add to the capability of CBT to retain them in treatment. (c) 2006 Elsevier Ltd. All rights reserved.