Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics

被引:150
作者
Kranzler, HR
Burleson, JA
Brown, J
Babor, TF
机构
[1] Alcohol Research Center, Department of Psychiatry, University of Connecticut Health Center, Farmington, CT
[2] Department of Psychiatry, MC-2103, University of Connecticut Health Center, Farmington
关键词
alcoholism; alcohol dependence; alcoholic subtypes; pharmacotherapy; fluoxetine;
D O I
10.1111/j.1530-0277.1996.tb01696.x
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
Objective: The aim of this study was to test the hypothesis that, because of abnormalities in serotonergic neurotransmission that may underlie craving and impulsive behavior, fluoxetine treatment differentially affects drinking among type B alcoholics, who are characterized by high levels of both premorbid vulnerability and alcohol-related problems. Methods: Using a k-means clustering procedure, alcohol-dependent subjects from a placebo-controlled trial of fluoxetine were grouped into low-risk/severity (type A: n = 60) and high-risk/severity (type B: n = 35) groups. Multivariate analysis of covariance (with pretreatment measures as covariates) evaluated the effects of Alcoholic Subtype, Medication Group, Treatment Completion, and their interactions on measures of drinking, both during the 12-week treatment period and a 6-month follow-up period. Results: Although there were no main effects of Alcoholic Subtype or Medication Group, subjects who completed the treatment trial showed significantly better drinking-related outcomes. There was also an interaction of Alcoholic Subtype by Medication Group during treatment. Among type B subjects, fluoxetine treatment resulted in poorer drinking-related outcomes than placebo treatment. Among type A subjects, there was no effect of Medication Group. This interactive effect did not persist during the 6-month follow-up period. Conclusions: Alcoholic subtypes identified by cluster analysis seem to be differentially responsive to the effects of fluoxetine treatment on drinking-related outcomes. Serotonergic abnormalities previously identified among a subgroup of alcoholics who are also characterized by impulsivity and severity of alcohol dependence may help to explain the differential medication effect. Based on these findings, it is recommended that, in the absence of a comorbid mood or anxiety disorder, fluoxetine not be used to maintain abstinence or reduce drinking in high-risk/severity alcoholics.
引用
收藏
页码:1534 / 1541
页数:8
相关论文
共 55 条
[1]  
ANNIS HM, 1989, HDB ALCOHOLISM TREAT
[2]  
[Anonymous], 1983, State-trait anxiety inventory for adults [Inventory]
[3]  
[Anonymous], 1987, DIAGNOSTIC STAT MANU, V4th
[4]  
[Anonymous], 1980, EVALUATING ALCOHOL D
[5]  
BABOR T, 1994, TYPES ALCOHOLICS EVI, V708
[6]  
Babor T. F., 1988, ALCOHOLISM ORIGINS O, P245
[7]  
BABOR TF, 1992, ARCH GEN PSYCHIAT, V49, P599
[8]   Reliability of the ethanol dependence syndrome scale [J].
Babor, TF .
PSYCHOLOGY OF ADDICTIVE BEHAVIORS, 1996, 10 (02) :97-103
[9]   SUBTYPES OF COCAINE ABUSERS - SUPPORT FOR A TYPE A-TYPE B DISTINCTION [J].
BALL, SA ;
CARROLL, KM ;
BABOR, TF ;
ROUNSAVILLE, BJ .
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY, 1995, 63 (01) :115-124
[10]  
BECK AT, 1961, ARCH GEN PSYCHIAT, V5, P462