[Collateral effects of disulfiram on the central nervous system in alcoholics that have become totally abstemious. Description of 8 cases]. / Effetti collaterali del disulfiram sul sistema nervoso centrale in etilisti divenuti del tutto astinenti. Descrizione di otto casi.

Disulfiram is used in alcohol rehabilitation because it inhibits aldehyde dehydrogenase and consequently causes the disulfiram-ethanol reaction (vomiting, vertigo, anxiety, cardiovascular effects) after ingestion of alcoholic beverages. However, adverse effects on the central nervous system (for the most part psychotic reactions, acute organic brain syndrome, catatonia) may appear as a direct result of the drug itself. Disulfiram and its metabolite carbon disulfide inhibit dopamine beta-hydroxylase, increasing the levels of dopamine and reducing those of norepinephrine in the central nervous system. We observed direct disulfiram-induced toxicity on the central nervous system in 8 abstinent patients in whom a disulfiram-ethanol reaction had been excluded. Risk is increased when 1) excessive amounts of the drug are ingested; 2) the patient is already suffering from a major psychiatric illness; 3) the patient has anatomical brain lesions. In all cases observed, the toxic effects appeared in the first weeks and were reversed after suspension of the drug (except in one patient who died from severe bronchopulmonary infection). We thus suggest the following protocol: 1) physical examination and interview 3-4 weeks after initiation of treatment; 2) as a general rule, in abstinent patients, the lowest possible maintenance dosage should be administered. This strategy, despite the risk of underdosage, meets the goals inherent in an integrated medical and psychosocial approach to the treatment of alcoholism with which these patients seem better able to comply.

[The hospitalized drug addict. Social assistance and therapeutic care]. / Il tossicodipendente ospedalizzato. Aspetti socio-assistenziali e terapeutici.

Ninety drug addicts observed in 1973-83 were examined in a study of the main anamnestic and behavioural parameters, the reasons for hospitalisation, the presence of withdrawal symptoms during treatment and any prospects of long-term cure. In conclusion, it is emphasised that the low frequency of real withdrawal pathology often renders "scaled" treatment with methadone superfluous. Finally it is pointed out that in itself, the hospitalisation period can do almost nothing to break the addiction spiral unless it forms part of a wider prospect of global treatment.