Transcript Martin, Clapp, Bialowski, & Beresford

Enforced Cognition:
Compliance with Court-Ordered Versus Voluntary
Disulfiram Therapy
Brandon Martin, BA, Lori Clapp, RN, Diana Bialkowski, RN, Thomas Beresford, MD
Denver Veterans Affairs Medical Center (DVAMC), Denver, CO
University of Colorado Health Sciences Center, Denver, CO
Background
Background
• Chronic alcoholism has been shown to
effect cognition in the following ways:
– impairment in perceptual-motor skills
– visual-spatial functions
– learning/memory
Significant recovery of cognitive
function can occur but may be
contingent on factors such as age
and continued abstinence (Parsons,
1993)
– abstraction and problem solving
Supervised disulfiram is a proven
effective way to achieve immediate
abstinence.
• Severe cognitive deficits may result
from chronic alcoholism as well:
– Wernickle-Korsakoff syndrome
Study Inclusion
Procedure
• Potential subjects approached when
initiating disulfiram therapy
• Informed consent
• Alcohol module of DSM-IV SCID
• Demographics
• Inclusion criteria:
– meet DSM-IV criteria for current alcohol
dependence or abuse
– Sign COMIRB-approved informed consent
– Medical clearance and ability to tolerate
prescribed doses of disulfiram
• Hypothesis: Court-mandated subjects will
attend more clinic visits than voluntary
subjects.
Percent of Patients in
Treatment Per Study Week
Average Number of Visits Attended at 15
months
50
45
43
120
40
100
35
30
80
60
• Past research has not specifically nor
effectively controlled for the effect of a
court mandate when used to enhance
compliance to monitored disulfiram
therapy.
• Promoting compliance to this therapy
remains problematic.
– Central Pontine Myelinolysis
%
Background
Voluntary
Court Order
25
20
18.1
15
40
10
20
5
0
0
V o lu n ta r y
Weeks
C o u r tO rd ered
Methods
• Subjects followed for 12 weeks and
followed up at 15 months
• Research assistants collected:
– Percent of prescribed clinic visits
attended
– Breathalyzer test results
– Number of patients active in
treatment at 12 weeks
Conclusion
• A court mandate is an effective tool for enhancing
compliance to monitored disulfiram therapy during
the initial 12 weeks of treatment and carries out as
far as 15 months.
• As abstinence from alcohol may result in
improvement of alcohol-related cognitive injury,
enforced disulfiram may be an effective way to
improve cognition in some alcoholic patients.
• Whether the sustained improvement of cognitive
processes, owing to a lack of heavy alcohol use,
can result in meaningful cognitive change remains
to be investigated.
Population
• 41 patients seeking disulfiram therapy
at the Outpatient Substance Abuse
Clinic at the DVAMC
• 22 patients enrolled voluntarily with a
mean age of 46
• 19 patients were court-ordered with a
mean age of 47.5
Percent of Visits Attended At
3 Months
90
80
70
P<0.0001
60
50
Voluntary
Court O rder
40
30
20
10
0
% C linic Visits Attended
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