Effect of the threat of a disulfiram–ethanol reaction on cue reactivity in alcoholics
Drug and Alcohol Dependence
Effect of the threat of a disulfiram–ethanol reaction on cue reactivity in alcoholics☆☆☆
Marilyn D. Skinnerabcd
, Mathieu Coudertbe, Ivan Berlinbe, Elodie Passeribg, Laurent Michelabcd, Henri-Jean Aubinbcdf
Received 23 January 2010; received in revised form 28 June 2010; accepted 28 June 2010.
Rationale
Little is known about the effect of disulfiram on subjective and autonomic nervous system cue reactivity in the laboratory. The dissuasive psychological effect manifested as a threat would seem to prevail over the pharmacological effect.
Objectives
The primary objective was to determine whether there was a difference in cue reactivity responses during a threat condition compared to a neutral condition during alcohol cue exposure.
Methods
In a crossover randomized study, participants received threat and neutral messages during two cue exposure sessions. The threat condition consisted of leading the patients to believe they had ingested 500
mg of disulfiram and the neutral condition of informing them that they had ingested a placebo, while in both condition they received the same placebo.
Results
Physiological cue reactivity was demonstrated by a decrease in diastolic blood pressure during the threat compared to the neutral condition (p=0.04). Heart rate and subjective cue reactivity measures remained unchanged. There was a negative affect (assessed by the Positive and Negative Affect Scale) by condition by exposure interaction.
Conclusions
The threat of a disulfiram–ethanol reaction appears to affect cue reactivity physiologically rather than subjectively. While the data does not show changes in subjective ratings, it is possible that there are alternative beneficial effects arising from other cognitive processes that are not captivated by self-reported craving scales, reflected by decreases in negative affect and blood pressure. From this perspective, disulfiram might be recast to be more acceptable to patients.
a Centre Hospitalier Emile Roux, Centre de Traitement des Addictions, Limeil-Brévannes, France
b Assistance Publique-Hôpitaux de Paris, Paris, France
c Inserm U669, Paris, France
d Université Paris-Sud and Université Paris Descartes, UMR-S0669, Paris, France
e Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France
f Centre Hospitalier Universitaire Paul Brousse, Villejuif, France
g Hôpital Mondor, Créteil, France
Corresponding author at: Centre de Traitement des Addictions, Centre Hospitalier Emile Roux, 1 avenue de Verdun, 94456 Limeil-Brévannes, France. Tel.: +33 1 45 95 84 09; fax: +33 1 45 95 83 90.
☆ Additional materials are available with the online version of this article at doi:10.1016/j.drugalcdep.2010.06.011.
☆☆ Trial Registry Name: ClinicalTrials.gov identifier NCT00372749 on September 5, 2006.
PII: S0376-8716(10)00237-1
doi:10.1016/j.drugalcdep.2010.06.011
© 2010 Elsevier Ireland Ltd. All rights reserved.
