Chronic Alpha Chloralose Use Disorder: A Case Report of a Seventeen Year Course and Review of the Literature

Author

F. Chair, Z. Bencherfa

Abstract

 Background. Alphachloralose is a chlorinated derivative of glucose used as a rodenticide, whose acute toxicity is well documented but whose addictive potential remains very poorly studied. Only one case of a use disorder related to this substance has been published to date.

Case presentation. We report the case of a 34-year-old woman who developed an alphachloralose use disorder of seventeen years’ duration, which began with a suicide attempt at the age of 17. Use became daily, motivated by the search for sedative and anxiolytic effects, with intense craving, unsuccessful attempts to stop, continued use during two pregnancies and early relapse during a hospitalisation for withdrawal.

Discussion. The clinical course meets the DSM-5-TR criteria for a severe use disorder. Khantzian’s self-medication model and the neurobiological framework of Koob and Volkow help to clarify this trajectory, in a context of vulnerability related to adverse childhood experiences.

Conclusion. This case suggests that repeated exposure to alphachloralose may, in vulnerable individuals, progress towards a severe use disorder, justifying systematic psychiatric assessment beyond the toxicological management of acute poisoning alone.

Keywords

Alphachloralose; substance use disorder; self-medication; rodenticide; addiction; DSM-5-TR; case report

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References

American College of Obstetricians and Gynecologists. (2017). Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. Obstetrics & Gynecology, 130(2), e81-e94.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: American Psychiatric Association.

Baker, T. B., Piper, M. E., McCarthy, D. E., et al. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111(1), 33-51.

Balis, G. U., & Monroe, R. R. (1964). The pharmacology of chloralose: A review. Psychopharmacologia, 6, 1-30.

Dube, S. R., Felitti, V. J., Dong, M., et al. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use. Pediatrics, 111(3), 564-572.

Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.

Garrett, K. M., & Gan, J. (1998). Enhancement of gamma-aminobutyric acidA receptor activity by alpha-chloralose. Journal of Pharmacology and Experimental Therapeutics, 285(2), 680-686.

Hasin, D. S., O’Brien, C. P., Auriacombe, M., et al. (2013). DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851.

Hughes, K., Bellis, M. A., Hardcastle, K. A., et al. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356-e366.

Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142(11), 1259-1264.

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231-244.

Koob, G. F., & Le Moal, M. (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24(2), 97-129.

Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.

Manel, J., Villa, A. F., et al. (2021). Exposure to alphachloralose-based rodenticides: A retrospective study of cases reported to French Poison Control Centres. Clinical Toxicology, 59(11), 980-988.

Manzo, L., Locatelli, C., Candura, S. M., et al. (1979). Electrocerebral changes in acute alpha-chloralose poisoning. Journal of Toxicology: Clinical Toxicology, 14, 373-381.

Metz, V., Stickel, A., Hofer, S., et al. (2020). Substance use in pregnancy: A systematic review and meta-analysis of postnatal relapse risk. The Lancet Psychiatry, 7(11), 950-962.

Newton-Howes, G., Foulds, J., Guy, N., et al. (2017). Personality disorder and alcohol and drug use disorders: A systematic review and meta-analysis. British Journal of Psychiatry, 211(1), 22-30.

Olsen, R. W. (2018). GABA-A receptor: Positive and negative allosteric modulators. Neuropharmacology, 136(Pt B), 10-22.

Samali, E. M., El Koundi, A., Meskine, A., et al. (2025). Alphachloralose intoxication: A retrospective study on epidemiology, clinical presentation, and management in an adult emergency department in Morocco. African Journal of Emergency Medicine, 15(3), 100887.

Thomas, H. M., Simpson, D., & Prescott, L. F. (1988a). The toxic effects of alpha-chloralose. Human Toxicology, 7(3), 285-287.

Thomas, H., Simpson, D., & Prescott, L. (1988b). Clinical features and management of acute alpha-chloralose poisoning. The Lancet, 1(8591), 940-941.

Volkow, N. D., & Boyle, M. (2023). Neuroscience of addiction: Relevance to prevention and treatment. World Psychiatry, 22(1), 10-25.

Zemmama, H., Rharrabti, S., El Ayoubi Idrissi, K., et al. (2015). D’une intoxication à l’alphachloralose à l’addiction [From alphachloralose poisoning to addiction]. La Presse Médicale, 44(10), 1082-1084.

 

 

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