The Use of Disulfiram to Treat Alcoholism
What is Disulfiram?
Disulfiram (commonly known as Antabuse) is an FDA-approved medication that has been in use for decades to encourage continued abstinence from alcohol.1,2 Disulfiram interferes with the way the body metabolizes or breaks down alcohol. Because of this, when a person drinks while taking disulfiram, they may experience a buildup of a certain break-down product (acetaldehyde), which leads to the adverse, but therapeutic effects associated with the treatment drug.2
Flushing of the face, nausea, heart palpitations, and other uncomfortable symptoms will occur should drinking occur while on disulfiram treatment.1 As such, disulfiram promotes abstinence through the likelihood of such inevitably negative experiences and is prescribed to decrease continued drinking behavior for people in recovery from alcohol use disorders.
History of Disulfiram
Disulfiram’s alcohol-aversive effects (i.e., the disulfiram-ethanol reaction) were first observed in the 1930s, when workers exposed to tetraethylthiuram disulfide became ill after drinking alcohol.2 Seventeen years later in Copenhagen, researchers again became sick after drinking alcohol thanks to a small dose of disulfiram in their systems following a study on treating parasitic stomach infections.2 Following this, the researchers conducted a study to confirm that their sickness was caused by an interaction between disulfiram and alcohol.2
In the late ‘40s and early ‘50s, following additional studies, the FDA approved disulfiram to treat alcohol dependence in the United States.2 Antabuse tablets began being manufactured by Wyeth-Ayerst Laboratories.2 In 1949, the founding president of the American Society of Addiction Medicine—Ruth Fox, M.D.—became the first American to use disulfiram to treat alcohol dependence.2
After reducing the dosage to prevent more serious side effects, Fox treated about 2,500 patients with the drug and concluded it was effective in deterring drinking in patients with alcohol dependence.2 In the following years and in present day, it has been used at lower doses (to minimize disulfiram toxicity) in combination with a variety of additional addiction treatment measures.2
What is Aversion Therapy?
Traditionally, the goal of any type of alcohol aversion therapy has been to promote 100% abstinence through the development of conditioned aversions to alcoholic drinks.3 Historically, in developing potential treatments for alcoholism, alcohol has been paired with a variety of aversive stimuli including uncomfortable faradic stimulation (i.e., shock aversion), drug-induced respiratory arrest, and chemically-induced illness in order to decrease a person’s urge to drink.3
Over the years, disulfiram was found to be effective in treating AUDs, especially in carefully-supervised settings.2 As with other medications, its effectiveness increases when administered in conjunction with behavioral interventions (e.g., cognitive-behavioral therapy), incentives, social support, and treatment adherence within a substance abuse rehabilitation program.2 However, one study suggests that disulfiram might be more effective in promoting short-term abstinence and treatment after detoxification over promoting long-term self-restraint.2
Why Is Disulfiram Used in Addiction Treatment?
While disulfiram has been shown to be more helpful in maintaining abstinence than other medications for those with alcohol use disorder (AUD). It has shown to work best when the person is still in treatment, rather than when the individual isn’t under medical supervision.
The reaction is generally proportional to the amounts of alcohol and disulfiram ingested and reactions can be life threatening if not monitored properly.2 However, careful patient medical screening and reduced dosages have made this outcome extremely rare nowadays.2 While it may serve as a deterrent, disulfiram does not reduce an individual’s alcohol cravings. Some experts question disulfiram’s effectiveness since it can take around 30 minutes before it actually begins to work, and even then, the intensity of the reaction is unpredictable.3