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STOPPING
THE SAS,
PRESCRIPTION
Réunion Ambulatoires
8.5.2006 OF DISULFIRAM
ON AN EVIDENCE BASED MEDICINE DECISION
The perception of Geneva’s addictology caregivers
Gabriel Thorens, Riaz Khan, Yasser Khazaal, Daniele Zullino
[email protected] Geneva University Hospital
Introduction
Belief in disulfiram’s utility in treating alcohol addiction
Before
Aversive treatment in addictology has failed to demonstrate
efficacy. The perception of its utility may, nevertheless, still be
strong in caregivers.
After
…the disulfiram stop policy
The only randomized trial1 comparing the
efficacy of
disulfiram against placebo
showed no
differences in recovery time
of alcohol
consumption or total
abstinence. Even if the
potentially
dangerous side effects are
rare, their
risk overcomes hypothetical
benefits2.
78%
77%
Methods
In December 2007, the Geneva
Division of
addictology decided to
stop the disulfiram
prescription.
The healthcare team’s
related
perceptions were monitored
during 3 month period using
a 31items auto questionnaire.
Results
55 participants (response rate 61.1%),
54.1%
women, mean age 43.7.
Professions: 54.8%
nurses, 30.6% MD,
9.7% social workers, 4.8%
psychologists
54.6% didn’t agree with the decision to stop disulfiram prescription
36.4% thought their patients got worse after the decision
72.2% agreed that the decision was based on evidence based
medicine
Conclusions
While most caregivers acknowledged that the decision to
stop disulfiram’s prescription was based on evidence, most
still believed in its utility for a majority of patients (even after
two years of the new policy).
Most believed that disulfiram works mainly trough
dissuasion.
The present study thus confirms the hypothesis of a
significant gap between the acknowledgement of evidencebased treatment policies by health care givers and their
perception concerning appropriate clinical methods.
69.1% thought that disulfiram works because of the context of
administration
The results highlight the importance of an comprehensive
preparation of such a fundamental policy change, with a
particular focus not only on evidence but also on personal
beliefs.
69.1% thought that Disulfiram works through the fear of its potential
effects
References
Poster available online: http://addictologie.hug-ge.ch/
1
Fuller RK and col. Disulfiram treatment of alcoholism. A Veterans Administration cooperative study. JAMA 1986 Sep 19;256(11):1449-55
2
Chick J. Safety issues concerning the use of disulfiram in treating alcohol dependence. Drug Saf. 1999 May;20(5):427-35.
WHO collaborating center
For research and education
in substance use disorders