Disulfiram Community Treatment Program

Disulfiram plus support services provided to reduce problem drinking and arrest rates

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The Community Treatment Program offered 1 year of supervised administration of disulfiram plus offers of counseling, assistance with employment and welfare (as needed), and home visits to patients and “helping persons” who had been identified to assist in the treatment regimens. The goal was to reduce arrests and problematic drinking. Eligible participants who had at least 10 arrests for intoxication in the past 18 months were recruited from jails and underwent detoxification at a hospital for 5 days prior to the initiation of disulfiram administration. While there was a non-random comparison group consisting of adults matched on age, arrest records, and time of arrest, this was not incorporated into statistical analysis other than general comparison of arrest rates. Follow-up assessments were collected 6 months following the intervention.

Outcomes

Estimates of changes or differences in alcohol-related problems and the stability of those changes or differences. 

Low Level of Change

Reduction in arrests for intoxication higher than in no-treatment comparison group. 

This intervention reported a 78% decrease in arrests (compared to a 16% decrease in arrests for the comparison group), with 31% of the intervention group not having been arrested. The second outcome was staff members’ subjective judgement of decreases in problematic alcohol use.

Costs

Two domains estimating start-up and ongoing expenses. 

Even assuming access to existing medical infrastructure, costs for medical and other services would be high. 

The intervention would require high costs to initiate and maintain due to the length of the program, level of interaction with staff members, hospital detoxification, Disulfiram administration, travel expenses, and counseling and case management services.

Cultural Engagement

Two indicators of cultural and Tribal/community contributions. 

No Tribal and minimal cultural inclusion. 

The intervention incorporated Navajo language interpreters and local community members as “helpers” to support the treatment regimen. However, there is no further mention of Tribal or cultural engagement in the development or administration of the intervention.

Clinic and home visits for Navajo adults, mostly males, on or near a rural reservation. 

Navajo adults (18-55 years) with alcohol-related arrests were recruited from jails. A total of 115 Navajo adults (4 women, 111 men) participated in the study in a community immediately adjacent to a reservation. A comparison group of 60 adults with a similar pattern of arrests was matched on age and time of arrest. The comparison group may have included individuals who had refused the intervention.

Staffing Needs

Credentials and/or background of personnel who delivered the intervention. 

Not Specified

Intensive involvement of medical staff in addition to other non-medically trained staff. 

Medical professionals oversaw hospital detoxification. Staff nurses and community members assisted with Disulfiram administration. Other team members included psychologists and staff members who offered counseling and other support services.

Research Design

Methods employed to gather research data. 

Pre-/post-intervention data

Developmental stage of research

Stage of development of the evidence supporting this intervention. 

Early Stage

Small study with substantial limitations in design, outcome measures and statistical analysis. 

This study had a small sample size with limitations including a lack of statistical testing, cultural engagement, and objective outcome measures. There was no description of the dosing of Disulfiram or ancillary services in this study or use of the “comparison” group other than to contrast arrest rates. Arrest rates could have been biased, reflecting policing practices rather than individual change. There was a low rate for post-treatment completion follow-up assessments (n = 54). Subjective judgments of overall improvement precluding the ability to draw conclusions.

Potential

Narrative offered by expert reviewers providing overall comments or evaluations about the intervention. 

Need to clarify the impact of medication vs. supportive components of intervention prior to widespread implementation. 

The results of this study should be interpreted with caution. It is unclear to what degree the outcomes could be attributed to the Disulfiram vs. the supportive ancillary services, and/or both. Additionally, outcomes were tenuous due to the lack of statistical testing and use of potentially biased and subjective measures which may not accurately predict intervention effectiveness (i.e., arrest data and problematic drinking). The costs to support the program would be high and difficult for a community with limited resources.

References

Primary 

Ferguson FN. A treatment program for Navaho alcoholics: Results after four years. Q J Stud Alcohol . 1970;31(4):898-919. https://www.jsad.com/doi/abs/10.15288/qjsa.1970.31.898 . https://doi.org/10.15288/qjsa.1970.31.898 .

Recommended Reading 

Ferguson FN. Navaho drinking: Some tentative hypotheses. Hum Organ . 1968;27(2):159-167. http://www.jstor.org/stable/44124489 . https://doi.org/10.17730/humo.27.2.v60370332122gx27 .

See references for all interventions 

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