{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:46:55Z","timestamp":1792118815036,"version":"4.4.0"},"reference-count":48,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2011,7,6]],"date-time":"2011-07-06T00:00:00Z","timestamp":1309910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Leading Italian studies support the use of \u03b3-hydroxybutyric acid (GHB), not only in the treatment of the alcohol withdrawal syndrome, but also in maintaining alcohol abstinence. GHB gives a better result than naltrexone and disulfiram in maintaining abstinence, and it has a better effect on craving than placebo or disulfiram. The problem is that about 30\u201340% of alcoholics are non-responders to GHB therapy. In our clinical practice, we speculate that by combining disulfiram with GHB treatment we may be able to achieve a kind of \u2018antagonist\u2019 effect by using the \u2018psychological threat\u2019 of disulfiram (adversative effect) while taking advantage of the anticraving effect of GHB, despite the limitation of its \u2018non-blockade\u2019 effect on alcohol. In this context, to improve the outcome in GHB long-term treated alcoholics, we added disulfiram to GHB in the management of GHB treatment-resistant alcoholics. In this study we compared retention in treatment of 52 patients who were treated with the GHB-disulfiram combination for up to six months, with retention for the same subjects considering their most recent unsuccessful outpatient long-term treatment with GHB only. An additional comparison was carried out on the days of complete abstention from alcohol. Thirty four patients (65.4%) successfully completed the protocol and were considered to be responders; 18 (34.6%) left the programme, and were considered to be non-responders. Considering the days of complete abstinence from alcohol, 36 patients stayed in treatment longer with the GHB-Disulfiram combination, 12 stayed for a shorter time and four for the same time. The results of this study seem to indicate a higher efficacy of the GHB-disulfiram association compared with GHB alone. Randomized controlled trials are now needed to verify this hypothesis.<\/jats:p>","DOI":"10.3390\/ijerph8072816","type":"journal-article","created":{"date-parts":[[2011,7,6]],"date-time":"2011-07-06T11:15:00Z","timestamp":1309950900000},"page":"2816-2827","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Long-Term \u03b3-Hydroxybutyric Acid (GHB) and Disulfiram Combination Therapy in GHB Treatment-Resistant Chronic Alcoholics"],"prefix":"10.3390","volume":"8","author":[{"given":"Angelo Giovanni Icro","family":"Maremmani","sequence":"first","affiliation":[{"name":"Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, Via Roma, 67 56100 Pisa, Italy"},{"name":"AU-CNS, \u201cFrom Science to Public Policy\u201d Association, Pietrasanta, Lucca, 55045, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier Paolo","family":"Pani","sequence":"additional","affiliation":[{"name":"Social-Health Direction, Health District 8 (ASL 8) Cagliari, 09100 Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Rovai","sequence":"additional","affiliation":[{"name":"Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, Via Roma, 67 56100 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pacini","sequence":"additional","affiliation":[{"name":"G. De Lisio Institute of Behavioral Sciences, Pisa, 56100, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Dell\u2019Osso","sequence":"additional","affiliation":[{"name":"Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, Via Roma, 67 56100 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Icro","family":"Maremmani","sequence":"additional","affiliation":[{"name":"Vincent P. Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Psychiatry, NPB, University of Pisa, Via Roma, 67 56100 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2011,7,6]]},"reference":[{"key":"ref_1","first-page":"89","article-title":"Pharmacological approaches to the management of alcohol addiction","volume":"6","author":"Addolorato","year":"2002","journal-title":"Eur. Rev. Med. Pharmacol. 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