Treatment of Alcoholic Violent Offenders: Ethics and Efficacy

Abstract

The published literature tends to find that the outcome of mandatory treatment for alcohol dependence is no worse than that for 'voluntary' treatment. Supervised disulfiram has been shown to improve outcome in Court-referred patients. When offenders take treatment offered as part of probation or a deferred sentence, they choose to do so, rather than face a penalty. It is not a 'free' choice in the usual sense, but the outcome can be beneficial to the offender as well as to society and this helps to justify its use. Coping and social skills therapy have value, as probably have antipsychotic and antidepressant drugs in some cases. Supervised disulfiram has a role supported by controlled studies.

Why is Disulfiram Superior to Acamprosate in the Routine Clinical Setting? A Retrospective Long-Term Study in 353 Alcohol-Dependent Patients

“…Planned outpatient contacts were a mandatory, binding agreement for all patients (DSF: every second working day, each session lasting about 10 min; ACP: once a week, each session about 20 min). High-frequency outpatient contacts in the DSF group were offered because DSF generally has no specifice ffect unless it is monitored and supervised by professionals or family members (Anton, 2001;Brewer, 1992;Chick, 1998;Fuller and Gordis, 2004;Hughes and Cook, 1997). As intended, the frequency of attendance turned out to be considerably higher in the DSF group DSF was administered in a mean dose of 2.1 g per week (divided evenly across the contacts) and ACP was prescribed as 2 g per day; consumption was not supervised.…”

A breath test to assess compliance with disulfiram

“…A further application of objective disulfiram compliance monitoring could be made in keeping offenders convicted of alcohol‐related crimes out of prison. Supervised disulfiram has already been recommended as an effective option in this respect [29,30]. Disulfiram treatment, as an alternative to serving a custodial sentence, could potentially reduce the serious problem of overcrowding in prisons and bring about major cost‐savings for the prison service.…”

Learning the Language of Abstinence in Addiction Treatment: Some Similarities between Relapse–Prevention with Disulfiram, Naltrexone, and Other Pharmacological Antagonists and Intensive “Immersion” Methods of Foreign Language Teaching

“…Disulfiram deters drinking by the fear of an unpleasant reaction with alcohol. Controlled studies have repeatedly and consistently shown that disulfiram, when given under supervision, can significantly reduce the risk of relapse (12)(13)(14)(15)(16)(17). By preventing alcohol use even outside the therapeutic situation and many days or weeks after the last therapeutic contact, supervised disulfiram increases the likelihood that the new, alcohol-free patterns of behavior will be remembered, used when appropriate and, by repeated practice, properly or at least adequately performed.…”