Disulfiram therapy in patients with hepatitis C: a 12-month, controlled, follow-up study.

OBJECTIVE: Although abstinence slows liver injury in alcoholic Hepatitis C (HCV) infected patients, few clinicians prescribe disulfiram because of concern over its hepatotoxic effect. Finding no controlled studies on this effect, we investigated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) patterns in seropositive (HCV[+]) and seronegative (HCV[-]) patients who received supervised disulfiram over 12 months. METHOD: We recorded retrospective aminotransferase measurements from medical records of 26 HCV(+) and 20 HCV(-) cases receiving 1500 mg disulfiram weekly in divided doses. Within groups, paired mean AST and ALT levels at 3, 6, 9 and 12 months were compared with baseline; between groups, nonpaired mean comparisons were used. RESULTS: There were no statistically or clinically significant elevations for the HCV(+) group at any time point. Between-group means were identical at all time points. CONCLUSIONS: Although sample size and retrospective design invite replication, the data suggest that disulfiram may be useful for HCV(+) alcohol-dependent patients in slowing hepatic injury by eliminating alcohol use and thereby removing the purported alcohol-HCV hepatotoxic synergy. It may also help to establish the abstinence criteria necessary to qualify for antiviral treatment. If disulfiram is used in HCV treatment, AST and ALT must be monitored closely.

Compliance to supervised disulfiram therapy: a comparison of voluntary and court-ordered patients.

We hypothesized that court mandate would significantly enhance compliance with supervised disulfiram therapy. We conducted a twelve-week prospective study of outpatient compliance with court-ordered, monitored disulfiram treatment as compared to voluntary, monitored treatment. The court ordered group (n=19) was significantly more compliant than the voluntary group (n=22). Legally mandated subjects attended an average of 87% (+/-21%) of scheduled visits, versus 42% (+/-35%) for the group without court order. Court mandate roughly doubles the compliance rate of monitored disulfiram therapy, effectively enhancing clinic attendance during the first twelve weeks of treatment.

A survey of addiction training programming in psychiatry residencies.

The authors surveyed 50 psychiatry residency training programs to examine the current status of addiction training and the impact of the new Residency Review Committee addiction training criteria for general psychiatry residencies. Only 5 programs did not already meet the new 1-month full-time equivalent addiction training requirement, and those programs anticipated only modest changes. The modal full-time equivalent addiction experience was actually 2 months, with great diversity in timing and settings. Respondents, however, often felt that their programs relied on one key addiction supervisor and that affiliated PGY-5 addiction residents usually had only limited roles in teaching and supervising the general psychiatry residents.