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Combining Pharmacological Antagonists and Behavioural Psychotherapy in Treating Addictions

Why it is Effective but Unpopular

Published online by Cambridge University Press:  02 January 2018

Colin Brewer*
Affiliation:
The Stapleford Centre, 25a Eccleston Street, Belgravia, London SW1W 9NP

Abstract

Supervised administration of disulfiram is one of the very few treatments that can significantly reduce alcohol consumption, yet it is rarely used, despite being simple and cheap. Disulfiram is not ‘aversion therapy‘, but a technique for facilitating exposure and response prevention, and it fits comfortably into a behavioural, social-learning model of addiction (or dependence) and its treatment. The availability of other effective antagonists, notably to opiates, suggests that an approach that is demonstrably effective in alcohol dependence may be helpful in treating other addictions. The reasons for the unpopularity of this approach appear to be largely ideological.

Type
Papers
Copyright
Copyright © The Royal College of Psychiatrists 

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References

Alcoholics Anonymous (1975) Living Sober, p. 60. London: Jupiter.Google Scholar
Azrin, N. H. (1976) Improvements in the community reinforcement approach to alcoholism. Behaviour Research and Therapy, 14, 339–48.Google Scholar
Azrin, N. H., Sissons, R. W., Meyer, S. R., et al (1982) Alcoholism treatment by disulfiram and community reinforcement therapy. Journal of Behaviour Therapy and Experimental Psychiatry, 13, 105112.Google Scholar
Babow, I. (1975) The treatment monopoly in alcoholism and drug dependence: a sociological critique. Journal of Drug Issues, 5, 120128.Google Scholar
Bandura, A., Blanchard, E. B. & Ritter, B. (1969) Relative efficacy of desensitisation and modelling approaches for inducing behavioural, affective and attitudinal changes. Journal of Personality and Social Psychology, 13, 173199.CrossRefGoogle ScholarPubMed
Bourne, P. G., Alford, J. A. & Bowcock, J. Z. (1966) Treatment of skid row alcoholics with disulfiram. Quarterly Journal of Studies on Alcohol, 27, 4248.Google Scholar
Brahen, L. S., Henderson, R. K., Capone, T., et al (1984) Naltrexone treatment in a jail work-release programme. Journal of Clinical Psychiatry, 45, 4952.Google Scholar
Branchey, L., Davis, W., Lee, K., et al (1987) Psychiatric complications of disulfiram treatment. American Journal of Psychiatry, 144, 13101312.Google Scholar
Brewer, C. (1984) How effective is the standard dose of disulfiram? A review of the disulfiram–alcohol reaction in practice. British Journal of Psychiatry, 144, 200202.CrossRefGoogle Scholar
Brewer, C. (1986) Patterns of compliance and evasion in treatment programmes which include supervised disulfiram. Alcohol and Alcoholism, 21, 385388.Google ScholarPubMed
Brewer, C. (1987) Fact, fiction, finance and effectiveness in alcoholism treatment. British Journal of Clinical Practice, 41 (suppl. 51), 3944.Google Scholar
Brewer, C. (1988a) Doctors heal the parts ordinary health-professionals cannot reach. Journal of the Royal Society of Health, 108, 1519.CrossRefGoogle ScholarPubMed
Brewer, C. (1988b) The management of opiate abuse: learning from other addictions. Journal of Drug Issues, 18, 679697.CrossRefGoogle Scholar
Brewer, C., Rezae, H. & Bailey, C. (1988) Opioid withdrawal and naltrexone induction in 48–72 hours with minimal drop-out using a modification of the naltrexone–clonidine technique. British Journal of Psychiatry, 153, 340343.Google Scholar
Brickman, B. (1988) Psychoanalysis and substance abuse: toward a more effective approach. Journal of the American Academy of Psychoanalysis, 16, 359379.CrossRefGoogle Scholar
Charney, D. S., Heninger, G. R. & Kleber, H. D. (1986) The combined use of clonidine and naltrexone as a rapid, safe and effective treatment of abrupt withdrawal from methadone. American Journal of Psychiatry, 143, 831837.Google Scholar
Cook, C. (1988) The Minnesota model in the management of drug and alcohol dependency: miracle or myth? Part I. The philosophy and the programme. British Journal of Addiction, 83, 625634.Google Scholar
Dackis, C. A., Gold, M. S., Sweeney, D. R., et al (1987) Single dose bromocriptine reverses cocaine craving. Psychiatry Research, 20, 261264.CrossRefGoogle ScholarPubMed
Duckert, F. & Johnsen, J. (1987) Behavioural use of disulfiram in the treatment of problem drinking. International Journal of the Addictions, 22, 445454.Google Scholar
Gelder, M. G., Marks, I. M. & Wolff, H. H. (1967) Desensitisation and psychotherapy in the treatment of phobic states: a controlled clinical enquiry. British Journal of Psychiatry, 113, 5373.Google Scholar
Giannini, A. J. & Billett, W. (1987) Bromocriptine–desipramine protocol in treatment of cocaine addiction. Journal of Clinical Pharmacology, 27, 549554.Google Scholar
Haynes, S. N. (1973) Contingency management in a municipally administered Antabuse program for alcoholics. Journal of Behaviour Therapy and Experimental Psychiatry, 4, 3132.Google Scholar
Heather, N. (1990) Treatment of alcohol problems: with special reference to the behavioural approach. Pharmacology and Therapeutics (in press).Google Scholar
Henneberger, J., Menk, E., Middaugh, R., et al (1988) Sphenopalatine ganglion blocks for the treatment of nicotine addiction. Southern Medical Journal, 81, 832836.Google Scholar
Iber, F. L., Lee, K., Lacoursiere, R., et al (1987) Liver toxicity encountered in the Veterans Administration trial of disulfiram in alcoholics. Alcoholism: Clinical and Experimental Research, 11, 301304.Google Scholar
Jensen, E. (1984) A proper use of Antabuse: the Danish model of treatment. British Journal of Clinical Practice, 38 (suppl. 36), 10.Google Scholar
Kleber, H. (1985) Naltrexone. Journal of Substance Abuse Treatment, 2, 117122.Google Scholar
Kleber, H. & Kosten, T. R. (1984) Naltrexone induction; psychologic and pharmacologic strategies. Journal of Clinical Psychiatry, 45, 2938.Google Scholar
Kosten, T. & Kleber, H. (1984) Strategies to improve compliance with narcotic antagonists. American Journal of Drug and Alcohol Abuse, 10, 249266.Google Scholar
Kwentus, J. & Major, L. (1979) Disulfiram in the treatment of alcoholism: a review. Journal of Studies on Alcohol, 40, 428439.Google Scholar
Marks, I. M. (1981) Care and Cure of Neurosis. London: John Wiley.Google Scholar
Marlatt, G. A. & George, W. H. (1984) Relapse prevention: introduction and overview of the model. British Journal of Addiction, 79, 261273.Google Scholar
Mathews, A. M., Gelder, M. G. & Johnston, D. W. (1981) Agoraphobia: Nature and Treatment. London: Tavistock.Google Scholar
Meyer, R., Mirin, S., Altman, J., et al (1976) A behavioural paradigm for the evaluation of narcotic antagonists. Archives of General Psychiatry, 33, 371377.Google Scholar
Miller, W. (1988) The effectiveness of alcoholism treatment modalities. In Causes and Consequences of Alcohol Abuse. Washington, DC: US Government Printing Office.Google Scholar
Miller, W. (1990) The effectiveness of treatment for alcohol problems: reasons for optimism. In Drug Abuse and Alcoholism: New Prospects for Recovery. London: Routledge (in press).Google Scholar
Miller, W. & Hester, R. (1986a) The effectiveness of alcoholism treatment: what research reveals. In The Addictive Behaviors: Processes of Change (eds W. R. Miller & N. Heather). New York: Plenum.Google Scholar
Miller, W. & Hester, R. (1986b) In-patient alcoholism treatments: who benefits? American Psychologist, 41, 794805.Google Scholar
O'Brien, C. (1984) Naltrexone: summary. Journal of Clinical Psychiatry, 45, 5758.Google Scholar
Ojehagen, A. & Berglund, M. (1986) To keep the alcoholic in out-patient treatment: a differentiated approach through treatment contracts. Acta Psychiatrica Scandinavica, 73, 6875.Google Scholar
Orford, J. (1985) Excessive Appetites: a Psychological View of Addictions. London: John Wiley.Google Scholar
Rachman, S. & Wilson, G. T. (1980) The Effects of Psychological Therapy. Oxford: Pergamon.Google Scholar
Resnick, R. & Resnick, E. B. (1986) Psychological issues in the treatment of cocaine abuse. NIDA Research Monograph, 67, 290294.Google Scholar
Sereny, G., Sharma, V., Holt, J., et al (1986) Mandatory supervised Antabuse therapy in an out-patient alcoholism program: a pilot study. Alcoholism: Clinical and Experimental Research, 10, 290292.Google Scholar
Sherman, A. R. (1972) Real life exposure as a primary therapeutic factor in the desensitisation treatment of fear. Journal of Abnormal Psychology, 79, 1928.Google Scholar
Stockwell, T. (1984) Sensitising drugs in behavioural perspective. In Pharmacological Treatments for Alcoholism (eds G. Edwards & J. Littleton), pp. 579603. London: Croom Helm.Google Scholar
Tennant, F. & Rawson, R. (1984) Five-year follow-up of opiate addicts with naltrexone and behaviour therapy. NIDA Research Monograph, 49, 289295.Google Scholar
Tennant, F. & Tarver, A. (1984) Withdrawal from nicotine dependence using mecamylamine: comparison of three-week and six-week dosage schedules. NIDA Research Monograph, 55, 291297.Google Scholar
Ternes, J. W., O'Brien, C., Greenstein, R., et al (1979) Unreinforced self-injections: effects on rituals and outcome in heroin addicts. NIDA Research Monograph, 27, 275281.Google Scholar
Thomson, J. A. (trans.) (1981) Nichomachean Ethics, Book 2, Sec. 2. 1104 A 33–6, p. 95. Harmondsworth: Penguin.Google Scholar
Wickler, A. (1948) Recent progress in research on the neurophysiologic basis of morphine addiction. American Journal of Psychiatry, 105, 329338.Google Scholar
Wickler, A. (1976) The theoretical basis of narcotic addiction treatment with narcotic antagonists. NIDA Research Monograph, 9, 119122.Google Scholar
Washton, A. M., Pottash, A. C. & Gold, M. S. (1984) Naltrexone in addicted business executives and physicians. Journal of Clinical Psychiatry, 45, 3941.Google ScholarPubMed
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD–9). Geneva: WHO.Google Scholar
Zitrin, C. M., Klein, D. F. & Woerner, M. G. (1978) Behaviour therapy, supportive psychotherapy, imipramine and phobias. Archives of General Psychiatry, 35, 307316.Google Scholar
Zuska, J. J. & Pursch, J. A. (1980) Long term management. In Alcoholism: A Practical Treatment Guide (eds S. E. Gitlow & H. S. Peyser), p. 138. New York: Grune and Stratum Google Scholar
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