S Rudden | PubMed Health

PubMed1997

A double-blind, placebo-controlled pilot study of carbamazepine for the treatment of alcohol dependence.

Carbamazepine, chemically related to the tricyclic antidepressants, has multiple clinical actions. It is a potent anticonvulsant, mild sedative, and mood stabilizer. It is nonaddictive and has little toxicity when clinical and laboratory monitoring is performed. It has proven efficacy in the treatment of acute alcohol withdrawal. Kindling and protracted withdrawal are the theoretical rationale for the mechanism of its action in the treatment of alcohol dependence. This 12-month double-blind placebo-controlled pilot study of 29 subjects evaluated the efficacy of carbamazepine for the treatment of alcohol dependence. Subjects were randomly assigned to either placebo or carbamazepine. A baseline assessment and bimonthly follow-up for 12 months assessed demographic variables, mood and functioning, treatment compliance, drinking behaviors, biological markers of drinking, and medication toxicity. Despite the small sample size, compliance difficulties after 4 months and a sizable drop-out rate, there were treatment effects favoring carbamazepine. Univariate analyses showed a decrease in drinks per drinking day and maximum number of heavy drinking days in a row at 2 and 4 months of follow-up. Survival analysis revealed a significant delay in time to first episode of heavy drinking, and close to a trend level of significance for time to first drink. There were significant time, but not time by treatment group, effects on multiple measures of mood. These pilot results are encouraging and support carbamazepine as a possible pharmacologic tool in the treatment of alcohol dependence.

Adult↗

PubMed1984

Adherence in a behavioral alcohol treatment program.

This report examines the correlates of early treatment termination by patients being treated for alcohol abuse or dependence. All of the study subjects were participants in a controlled experimental investigation of the differences in clinical outcome and treatment cost of extended inpatient and partial hospital treatment. A large number of clinical variables demonstrated no difference between groups, except for the greater likelihood of a DSM III Axis I diagnosis of alcohol abuse or dependence in the treatment completers. In contrast, three of four system variables differentiated completers from noncompleters. Patients treated by hospital-employed psychiatrists, in contrast to private psychiatrists, were more likely to complete the program; 4 sequential months in the middle phase of the study were associated with noncompletion of treatment; and patients who were detoxified on the preferentially designated unit were more likely to receive some specialized alcohol treatment. The authors interpret these data to indicate that treatment adherence is influenced by factors affecting the cohesiveness of the treatment delivery system. The failure of patient characteristic variables to predict treatment adherence may well be a result of their comparative insignificance in relation to system variables.

Adult↗