Wednesday, May 18, 2011

Supervised Antabuse Program (S.A.P.)      

Peter Coleman, M.D.

Over the last few years we have been having very good success with our Naltrexone implants for alcoholics.  Many of our patients report that their alcohol cravings simply go away.  I wrote in this newsletter a couple of months ago that there is medical evidence that one of the ways Naltrexone implants work is by interrupting some of the brain pathways.  The Naltrexone seems to actually break some of the circuits that connect seeing an alcohol trigger and having a strong impulse to use the alcohol.
But, we are always doing what we can to improve all of our patient’s success.  So, this month we have introduced a new program to help alcoholics achieve long lasting sobriety.
Antabuse (Disulfiram) is a medicine that patients take on a daily basis and it makes them feel absolutely awful if they drink any alcohol.  It has been available as a prescription for over 40 years and has been found to be helpful in some situations.  Over the years, I have prescribed Antabuse for patients and have found it quite useful, especially for patients who have been relapsing frequently or who have very high alcohol cravings.  However, I have found that Antabuse has usually not been helpful for more than a few months.  Once patients are feeling better they often decide they no longer need the Antabuse and so they stop taking it.  They usually relapse shortly after that.

 That is why we are very excited to be introducing our Supervised Antabuse program (SAP).  The basic idea is that patients will agree to have someone watch them take their Antabuse for 12 months or longer.  They can choose to come to our office every day and our staff will watch them take the Antabuse or, more usually, we can enroll a reliable person they know as our medical assistant – a Temporary Medical Assistant.  The Temporary Medical Assistant will confirm that the patient has taken their Antabuse every day and report back to our office for our medical records.  We will provide some coaching and medical follow up during the program.

Over the last few years, there has been more and more evidence that Supervised Antabuse is the most powerful medical intervention that can be used to help patients.  At a recent conference, I attended in Greece there were a number of presentations on just how powerful the results can be.  Henning Krampe reported results of their work in Germany.  Over a 10 year period, their group had abstinence rates of around 50%.  These are very impressive results considering they were working with the most severe alcoholics.  Many of their subjects had suffered with D.T.'s and other complications of end-stage alcoholism.  Many were homeless, had very few resources and had failed multiple previous treatments.  The German program provided care to the patients for 10 years.  Considering this is over a ten year period, these are amazing results!  In India, Dr Avinash de Souza has achieved results that are even more impressive.  He has studied Supervised Antabuse Treatment and consistently had 12 month abstinence rates of around ninety percent.

The bottom line is that if patients are taking their Antabuse they will not drink, so the key to achieving sobriety using Antabuse is to make sure the patient does take it.  We can make this much more likely by working together as a team - with the patient, a Temporary Medical Assistant, and our office.

We are not thinking that this program takes anything away from the rest of a patient’s recovery program.  Patients need to be fully responsible for their own recovery.  Supervised Antabuse, like Naltrexone Implants, only provides a crutch to help the patient stay sober long enough to make the changes necessary for long-term sobriety.  We still recommend 12 step or other support groups, regular therapy or coaching and comprehensive medical care.  Some patients will benefit from Naltrexone Implants or Vivitrol.  Some patients will benefit from antidepressants or other medicines to help with insomnia, anxiety, Bipolar illness, etc.

I am excited that this program may be able to help a number of patients who are currently not doing well.  If you would like more information, please email me or call me at anytime!

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