Drug and Alcohol Findings home page in a new window EFFECTIVENESS BANK BULLETIN 10 June 2012

The entries below are our accounts of documents collected by Drug and Alcohol Findings as relevant to improving outcomes from drug or alcohol interventions in the UK. The original documents were not published by Findings; click on the Titles to obtain copies. Free reprints may also be available from the authors. If displayed, click prepared e-mail to adapt the pre-prepared e-mail message or compose your own message. The Summary is intended to convey the findings and views expressed in the document. Below may be a commentary from Drug and Alcohol Findings.


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Disulfiram (Antabuse) – unfashionable but effective alcohol treatment

Approved by the USA as an alcohol treatment in 1951, disulfiram has suffered from a reputation as a dangerous medication only suitable for highly motivated and strictly supervised drinkers who totally avoid alcohol, and therefore too the aversive physical reactions the drug causes after drinking. But experience has shown that at currently recommended doses it is acceptably safe and, in the right circumstances, a drug chosen and taken by many severely dependent drinkers seeking to sustain abstinence. Stimulated by the first systematic synthesis of research (first entry below), this bulletin focuses on new and seminal disulfiram research from the UK and overseas available in the Effectiveness Bank. This work both shows that it can be an effective aid for many drinkers, and also exemplifies its key weakness - that without the right support and motivation, most patients simply stop taking or never take the tablets.

Threat of aversive disulfiram reaction does deter drinking ...

Disulfiram as post-detoxification norm rather than niche option ...

Danish patients just stop taking the tablets ...

Major UK trial finds supervised disulfiram cuts drinking ...

Landmark US study suggests compliance is the key to disulfiram treatment (PDF download) ...


The efficacy of disulfiram for the treatment of alcohol use disorder.

Jørgensen C.H., Pedersen B., Tønnesen H.
Alcoholism: Clinical and Experimental Research: 2011, 35(10), p 1–10.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Jørgensen at Lottehjort@hotmail.com. You could also try this alternative source.

Given effective supervision from family or clinicians to help ensure patients keep taking the tablets, this first systematic synthesis of research finds that on average the drug disulfiram, which produces an unpleasant physical reaction to drinking, does act as an aid to abstinence in the treatment of alcohol dependence.

Summary By blocking the breakdown of alcohol in the body, disulfiram produces unpleasant reactions in response to even low levels of drinking, so acts as an aversive deterrent. It inhibits the liver enzyme aldehyde dehydrogenase, preventing acetaldehyde being converted to acetate. After drinking alcohol, acetaldehyde accumulates, causing flushing, throbbing headache, nausea, vomiting, and chest pain. Disulfiram is therefore indicated for patients who wish to remain abstinent. Generally administration of disulfiram is supervised and, like other medications, combined with behavioural therapy.

This review aimed to analyse trials to date which randomly allocated adults or older teenagers to different doses of disulfiram, or to disulfiram versus other (including a placebo) or no treatments. It was restricted to trials which reflected drinking outcomes for all the patients, regardless of whether they dropped out of treatment and/or the study. [Editor's note: an important safeguard against bias due to the more promising patients remaining in treatment.]

Published between 1979 and 2010, 11 trials totalling 1527 patients fulfilled these criteria, four from India, five Europe, and two the USA. Patients were mainly alcohol-dependent men, though four trials targeted non-dependent hazardous drinkers. In eight studies patients were required to have a close associate who could supervise them to make sure they took the medication. In all but one study, medication was supplemented by counselling or other psychosocial therapies. Typically patients complied well with the treatment and took their medication as required.

Main findings

The proportion of patients who sustained abstinence was the most common measure of success. On this yardstick, in six of the 10 relevant studies disulfiram produced significantly better outcomes than placebo, none, or other treatments. Though not the case in the remaining four studies, in no case did other treatments significantly better disulfiram. Moreover, five of the seven studies to assess this found that on disulfiram patients on average lasted significantly longer before drinking or relapsing, though four of the five were from India and shared similar procedures and patients.

Across the seven studies in which tablet-taking was supervised, disulfiram significantly improved the overall abstinence rate, but the variation in the results of these studies was so large that that it was inappropriate to amalgamate them as if they were testing the same treatment in similar circumstances.

Most of the six studies comparing disulfiram with other medications Naltrexone, acamprosate, topiramate, or g-hydroxybutyrate. intended to reduce drinking found disulfiram had a greater effect on abstinence and/or days until lapse or relapse, though again, four of these studies were from India and shared similar procedures and patients.

Medication was not supervised in all three studies where the comparator was an inactive placebo. One small Austrian study of 26 teenage patients (of whom only half could be followed up for three months) found a higher abstinence rate among disulfiram patients. The remaining two US studies found no such effect. In all three, many patients did not take their medication or complete treatment. Nevertheless, amalgamated results from these three studies cumulate to a significant improvement in abstinence.

The two (both Danish) studies which compared disulfiram with no treatment at all – not even a placebo – were inconclusive about its efficacy among the usual run of patients. One found a positive impact on abstinence, but the patients were all in the month leading up to major surgery and risked complications aggravated by drinking. Another found no such effect among patients discharged from hospital after having to be admitted for the treatment of alcohol withdrawal symptoms. [Editor's note: In both studies it seems medication was taken under medical supervision twice a week but patients had to choose to attend the clinic rather than being supervised by family at home.]

The authors' conclusions

Primarily among alcohol-dependent men whose consumption of the drug was supervised, disulfiram increased the proportion abstinent and the number of days before drinking. Among patients who took their medication more or less as required, it also led to fewer days of drinking. It is unclear whether beyond this type of caseload, non-treatment seeking patients and those drinking at hazardous but non-dependent levels also benefit from disulfiram, and whether the impacts extend beyond a year, the longest follow-up period in the studies.


Findings logo commentary Though overall encouraging, these findings fall short of a convincing endorsement in the circumstances of a trial in which patients are randomly allocated to disulfiram rather than it being a positive choice, especially in societies where effective family supervision of severely dependent drinkers is less available. Additional evidence from non-randomised studies does however support the drug's efficacy among patients who choose (perhaps under pressure) to take the drug, and choose to be supervised to make sure they do.

Particularly when disulfiram was compared to other treatments, the findings should be interpreted in the light of the abstinence outcomes which (instead of the intended outcome of drinking at or below safe levels) the review was forced to adopt. Disulfiram targets absolute non-drinking, while other medications such as naltrexone are strongest at preventing heavy drinking. For example, the verdict that disulfiram is superior to other medications rests largely on the Indian trials. Of these, the comparison with acamprosate found no difference in the typical intensity of drinking on drinking days and no significant difference in the number of days on which patients drank. The corresponding comparison with naltrexone was decisive in its finding that fewer patients relapsed at some time to heavy drinking on disulfiram, but less so Though these differences were statistically significant. in respect of typical drinking intensity (a difference of one UK unit or 8g alcohol) or the number of days patients altogether avoided drinking over the follow-up year (306 on disulfiram v. 243 naltrexone). In India, virtually complete compliance with medication and with the studies suggests that the family influences (wives and parents supervised consumption) and motivations of these typically employed married men detoxified at a private hospital were greater than some UK treatment populations. Nevertheless, for their longer term sobriety, it was perhaps worrying that in both studies, on average disulfiram patients ended with more intense craving for drink than patients on other medications.

Another questionable implication of the review is that disulfiram has been shown to be more effective than a placebo. Across three studies it found a significant advantage in terms of abstinence which was overwhelmingly due to the large numbers in a 1986 US trial. But the review amalgamated findings from patients prescribed an active dose of disulfiram with those prescribed an inactive dose intended as a placebo, but which patients could honestly be told was a drug which caused adverse effects on drinking. Though not a statistically significant difference, it so happened that it was in this group that the greatest proportion sustained abstinence. To attribute this to an effect of disulfiram, as the review implicitly does, is an unusual interpretation. It is better seen as a classic placebo effect, reflecting the patients' expectations rather than the reality of the drug's impact.

Results from the first major randomised trial of disulfiram were taken to mean that the medication will only work among the sometimes minority of patients prepared to keep taking it – the most 'compliant' patients and research subjects. This was also read as one of the messages of a UK trial, which found the drug effective at least in the first months of treatment when its daily consumption was supervised mainly at home by the patient's female partner, and both knew the consequences of drinking while taking it. Over the six months they were followed up, disulfiram patients reduced their drinking days and amounts drunk by significantly more than patients prescribed a vitamin, though by the end the extra reduction had evened out, as had the time they had lasted without drinking.

In this which is still the major British study, the impact of the treatment appeared to have waned by the end of the six-month follow-up period. Whether impacts are indeed short-lived was the prime concern of a commentary on the featured study. Its main source was a German study of the intensive treatment of severe alcoholics using disulfiram and a similarly aversive medication for two years, which resulted in high rates of long-term abstinence, outlasting the treatment period by seven years. In this study, joined by under half the patients who were asked and were eligible, administration was supervised by clinic staff, and few patients dropped out of treatment, perhaps spurred on by what were usually serious medical consequences of highly excessive drinking.

Disulfiram is one of the three main medications licensed in the UK for the treatment of alcohol dependence and endorsed in national guidance for Scotland and England and Wales. The other medications are acamprosate and naltrexone (licensed in 2011), for which the guidance envisages a more routine and/or first-line post-detoxification role than for disulfiram. The latter comes with the caution that total abstinence is required to avoid unpleasant and potentially dangerous reactions, and that the positive evidence derives only from situations where consumption has been supervised. Compared to the main alternative medications, the experts behind the English/Welsh guidance found the evidence for disulfiram "much weaker and the potential for harm was greater [so] did not consider disulfiram as a suitable first-line pharmacological treatment for relapse prevention in individuals with alcohol dependence". It has its greatest role they thought among patients who are relatively older, socially stable, impulsive, Presumably because taken in the morning the drug deters patients from acting on a later impulse to drink. highly motivated, and enjoy strong home-based or clinical support, especially in the form of someone to supervise consumption.

However, given strong clinical support from a specialist multidisciplinary team, it seems that disulfiram can successfully be prescribed to most patients who qualify for outpatient detoxification. As well as or instead of supervision, an associate can take on a less onerous monitoring role, feeding back to the doctor whether the patient is taking the tablets while the doctor does the persuading, opening up effective treatment to a wider range of patients and medical settings. Arguably GPs with their family and local ties are in a better position to engineer these regimens than specialist centres. Allied with intensive support, disulfiram has also successfully been used as a fallback option for patients who have not done well in less radical and risky therapies such as acamprosate.

Statistics for England in 2011 show that doctors in general have forefronted acamprosate, prescribed 107,389 times compared to 60,375 for disulfiram, figures dominated by GP prescribing. However, in hospitals disulfiram is prescribed slightly more often. In these settings patients are likely to be so severely dependent that at least initial abstinence is the preferred objective, and there is the support for patients and the expertise to handle the risks of prescribing disulfiram.

Thanks for their comments on this entry in draft to Colin Brewer. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 21 June 2012

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Top 10 most closely related documents on this site. For more try a subject or free text search

STUDY 2005 'Real-world' studies show that medications do suppress heavy drinking

STUDY 2012 Audit of alcohol detoxification at Leeds Addiction Unit

REVIEW 2011 Medical treatment of alcohol dependence: a systematic review

STUDY 1992 Disulfiram treatment of alcoholism

REVIEW 2009 The state of pharmacotherapy for the treatment of alcohol dependence

STUDY 2010 Disulfiram in severe alcoholism – an open controlled study

REVIEW 2011 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

REVIEW 2002 Convincing evidence that acamprosate and naltrexone help prevent alcohol relapse

REVIEW 2012 Acamprosate for alcohol dependence: a sex-specific meta-analysis based on individual patient data

STUDY 2010 Naltrexone and combined behavioral intervention effects on trajectories of drinking in the COMBINE study





Audit of alcohol detoxification at Leeds Addiction Unit.

Rana A., Luthra V., Wazir M.N.K. et al.
Drugs and Alcohol Today: 2012, 12(1), p. 45–50.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Raistrick at d.raistrick@nhs.net.

In a specialist hospital unit in Leeds, virtually all the alcohol dependent outpatients completed detoxification and all but a few went on to try to sustain their drinking reductions using the aversive medication disulfiram, indicative of what can be achieved in these settings.

Summary This brief report documents two annual audits of the outpatient alcohol detoxification and allied aftercare services of the Leeds Addiction Unit in northern England, based partly on a three-month follow-up of patients. The unit's psychiatrists, psychologists and community psychiatric nurses are all trained in motivational dialogue and have regular, observed supervision. They are a specialist and experienced team with the skills to take on severely dependent and complex cases. Timely follow-up by the assigned key worker at home or unit and the medically supervised administration of disulfiram By blocking the breakdown of alcohol in the body, disulfiram produces unpleasant reactions in response to even low levels of drinking, so acts as an aversive deterrent. Specifically it inhibits the action of the liver enzyme aldehyde dehydrogenase, preventing the conversion of acetaldehyde to acetate. As a result, after drinking alcohol, acetaldehyde accumulates, causing flushing, throbbing headache, nausea, vomiting, and chest pain. Disulfiram is therefore usually indicated for patients who wish to remain abstinent. Today the administration of disulfiram is generally supervised and combined with behavioural therapy. – which produces unpleasant reactions in response to even low levels of drinking – monitored every four to eight weeks by doctors, were key elements of the treatment. Typically social and behavioural network therapy Integrates cognitive-behavioural, community reinforcement and other elements with the aim of building social networks supportive of positive change in the patient's drinking. If possible the patient's associates are directly involved in the process. is also used to help maintain abstinence.

Decisions to offer outpatient detoxification are taken on the basis of health complications, severity of dependence, previous history of medical detoxification, safety considerations (like arrangements to visit day units for physical and mental health monitoring), availability of social support, and access to emergency services.

The featured study documents audits intended to check the effectiveness and safety of this service from the pre-detoxification period through to three months after detoxification. All 50 community detoxifications in March 2009 were included in a first audit, all 59 from March 2010 in a re-audit. Notes routinely made during the process were inspected, and respectively 48 and 53 of the patients re-contacted and assessed three months after completion of detoxification. Two thirds were men and they averaged just over 35 years of age. Most were already known to the service.

Main findings

The first audit revealed that the pre-detoxification assessment was often incomplete or incompletely documented in respect of providing a detoxification preparation worksheet (noted in 58% of cases), giving blood screen results (73%) and discussing with the patient their readiness to alter their drinking in terms of their stages of change (38%). All three rates had improved a year later to to 70%, 100% and 62% respectively.

In the two years 96% and 98% of detoxifications were successfully completed without any adverse events. Three months after being detoxified, in the first audit 11 patients (23%) had dropped out of treatment compared to eight (15%) in the re-audit. The majority, 73% and 83% respectively, were still in contact with their therapists. After detoxification, disulfiram continued to be prescribed to 66% of patients in the initial audit and 89% in the re-audit, when acamprosate was also prescribed after detoxification to 52% of patients. Roughly half the followed up patients in initial audit were on regular disulfiram, whereas in re-audit this was the case for almost everybody.

In the first audit 15 (31%) patients had remained completely abstinent during the three-month follow-up and another five (10%) were drinking within safe limits, improving a year later to 16 patients (36%) and 10 (22%). In the two years, 46% and 42% had relapsed.

The authors' conclusions

Virtually all detoxifications were successfully and safely completed. Social and behavioural network relapse prevention therapy seemed to contribute significantly to maintenance of abstinence or safe drinking after detoxification, and disulfiram taken under medical supervision played a pivotal role. During the next three months, 53% of patients in the initial audit and 58% in the re-audit maintained in treatment were either completely abstinent or (though the therapeutic stress was on abstinence) managed to confine their drinking to normal limits.

Findings from the first audit suggested that follow-up contacts after detoxification and continuing disulfiram prescribing were delivering good results, leading the unit to incorporate follow-up appointments in to treatment planning before detoxification and to offer these more often. Clients maintained their relationships with their dedicated key workers before, during and after detoxification, and received regular advice on initiating or continuing with disulfiram. These changes led to clear improvements in the second audit in terms of better abstinence rates and reduced drop-out.


Findings logo commentary For an outpatient procedure, completion rates in the audits were remarkably high, a testament perhaps to the quality and the intensity of therapy and monitoring, including the readiness to prescribe disulfiram and to try to make sure patients took it. Though approaching half the patients relapsed in the following months, many must have remained in contact with their therapists (for example, 42% relapsed in year two but only 17% of all patients lost contact), suggesting that, as intended, the motivational style of the therapy was seen as non-judgemental support, even when things had not turned out as therapist and patient would have wanted.

Disulfiram is sometimes seen as a niche alternative only for highly motivated patients with associates close enough to effectively supervise its consumption. The featured study shows that with sufficient medical support, it can successfully be prescribed to almost all patients who qualify for outpatient detoxification. It has support from a UK randomised trial, which found the drug effective at least in the first months of treatment when its daily consumption was supervised mainly at home by the patient's female partner, and both knew the consequences of drinking while taking it. Over the six months they were followed up, disulfiram patients reduced their drinking days and amounts drunk by significantly more than patients prescribed a vitamin, though by the final four weeks the extra reduction had evened out, and by the end they had lasted without drinking no longer.

In contrast, hampered by high drop-out and failure to take the medication, the major UK randomised trial of acamprosate versus a placebo found that the drug did not improve abstinence rates or prevent relapse. Even among those who took the tablets at least for the first two weeks, there was no added benefit. Nevertheless, evidence from Europe supports the effectiveness of acamprosate for relapse amelioration/prevention following alcohol detoxification. It seems likely that poor retention among the more unstable and irregular drinkers seen at the UK clinics in the study decreased the drug's impact, as they would also have done disulfiram.

The two medications used by the featured unit are recommended in national guidance for Scotland and England and Wales. The guidance envisages a more routine and/or first-line post-detoxification role for acamprosate than for disulfiram, the latter coming with the caution that total abstinence is required to avoid unpleasant and potentially dangerous reactions, and that the positive evidence derives from situations where consumption has been supervised.

Statistics for England in 2011 show that doctors in general have also forefronted acamprosate, prescribed 107,389 times compared to 60,375 for disulfiram, figures dominated by GP prescribing. However, in hospitals such as those audited in the featured study, disulfiram is prescribed slightly more often. In these settings patients are likely to be so severely dependent that at least initial abstinence is the preferred objective and there is the expertise to handle the risks of prescribing disulfiram.

Thanks for their comments on this entry in draft to Duncan Raistrick of the Leeds Addiction Unit in England. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 11 June 2012

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Top 10 most closely related documents on this site. For more try a subject or free text search

STUDY 2010 Disulfiram in severe alcoholism – an open controlled study

STUDY 2005 'Real-world' studies show that medications do suppress heavy drinking

REVIEW 2011 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

STUDY 1992 Disulfiram treatment of alcoholism

REVIEW 2009 The state of pharmacotherapy for the treatment of alcohol dependence

REVIEW 2011 Medical treatment of alcohol dependence: a systematic review

STUDY 2015 High-dose baclofen for the treatment of alcohol dependence (BACLAD study): A randomized, placebo-controlled trial

REVIEW 2011 The efficacy of disulfiram for the treatment of alcohol use disorder

STUDY 2011 Extended telephone-based continuing care for alcohol dependence: 24-month outcomes and subgroup analyses

REVIEW 2012 Acamprosate for alcohol dependence: a sex-specific meta-analysis based on individual patient data





Disulfiram in severe alcoholism – an open controlled study.

Ulrichsen J., Nielsen M.K., Ulrichsen M.
Nordic Journal of Psychiatry: 2010, 64(6), p. 356–362.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Ulrichsen at jakobulrichsen@mac.com. You could also try this alternative source.

From Denmark a randomised trial of disulfiram in the treatment of alcohol dependence reveals the major weakness of the treatment - that among some sets of patients, few will consistently take tablets they know will cause unpleasant effects if they drink.

Summary By blocking the breakdown of alcohol in the body, disulfiram produces unpleasant reactions in response to even low levels of drinking, so acts as an aversive deterrent. It inhibits the liver enzyme aldehyde dehydrogenase, preventing acetaldehyde being converted to acetate. After drinking alcohol, acetaldehyde accumulates, causing flushing, throbbing headache, nausea, vomiting, and chest pain. Disulfiram is therefore indicated for patients who wish to remain abstinent.

In Denmark disulfiram has been relatively well researched and is widely used in the treatment of alcohol dependence. This trial in Copenhagen recruited 39 of 242 otherwise eligible inpatients from a psychiatric emergency ward who had been admitted for detoxification and treatment of alcohol withdrawal symptoms. Of the 158 who refused the study, 63 did so because they wanted to be sure of being prescribed disulfiram. Patients in the study were typically men in late middle age who had previously been prescribed disulfiram, and were a mixture of employed and unemployed, single and cohabiting or married.

Patients were randomly allocated to post-detoxification outpatient treatment including or not including (the control A group of people, households, organisations, communities or other units who do not participate in the intervention(s) being evaluated. Instead, they receive no intervention or none relevant to the outcomes being assessed, carry on as usual, or receive an alternative intervention (for the latter the term comparison group may be preferable). Outcome measures taken from the controls form the benchmark against which changes in the intervention group(s) are compared to determine whether the intervention had an impact and whether this is statistically significant. Comparability between control and intervention groups is essential. Normally this is best achieved by randomly allocating research participants to the different groups. Alternatives include sequentially selecting participants for one then the other group(s), or deliberately selecting similar set of participants for each group. group) the administration of disulfiram supervised twice weekly at the clinic by a nurse. Both patients and medical staff knew to which treatment patients had been assigned. All had to attend the clinic twice weekly and were also offered cognitive-behavioural group therapy. Patients were deemed to have dropped out of the study if they missed either five of 52 clinic visits or five of the 16 therapy sessions. Such patients were assumed to have returned to daily drinking.

Main findings

All but two of the 19 disulfiram patients started group therapy and seven (versus 10 of 20 controls) completed it. Five disulfiram patients and four controls remained abstinent throughout the six-month treatment and follow-up period and both groups avoided drinking on average on 100 days. On average the disulfiram patients started drinking again sooner (after about 11 weeks versus nearly 14), but this difference and none of the other differences was reliable enough to be statistically significant. During the six months, five patients from the disulfiram group and seven from the control group were re-admitted to the psychiatric emergency ward for the treatment of alcohol withdrawal symptoms.

Eleven of the 19 disulfiram patients reported side-effects at half or more of their clinic visits. All complained of gastrointestinal disturbances and a few experienced other symptoms they attributed to the drug. For seven patients side effects led doses to be reduced from 800mg to 400mg or 200mg twice weekly. However, no serious adverse effects were found, including no serious instances of the alcohol–disulfiram interaction. Four of the seven patients from the disulfiram group who completed the study asked to continue the treatment.

The authors' conclusions

Six months of supervised disulfiram administration did not affect treatment outcome in this population of patients severely affected by alcohol addiction. No significant differences between disulfiram and control group were found regarding the number of patients totally abstinent, time to first drink, alcohol-free days, and treatment completion. It may still be the case that patients who are highly motivated to take it may benefit from this drug, but using disulfiram as the first line of treatment in all patients – often the case in Denmark – seems questionable.

Results may have been biased by the large number of patients (many more than who entered the study) who refused the study because they wanted to be treated with disulfiram, perhaps leaving a relatively unmotivated set of participants not ready to respond well to disulfiram. Among these patients there was even a non-significant tendency for those prescribed disulfiram to drop out and/or return more quickly to drinking.


Findings logo commentary Apart from the possible selection bias mentioned by the authors resulting perhaps in patients not motivated to take disulfiram, it should be remembered that these patients were detoxified not because they had attended the hospital to resolve their dependence on alcohol, but because this dependence had led to withdrawal symptoms which required emergency treatment. For both reasons, the 39 who made their ways in to the study may have been particularly unpromising candidates for the treatment. Among other sets of patients the drug has sometimes proved an effective aid to abstinence.

For more on disulfiram treatment of alcohol dependence and in particular on British studies and guidance, see this Findings analysis of a review of relevant studies.

Last revised 04 June 2012

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Top 10 most closely related documents on this site. For more try a subject or free text search

STUDY 2012 Audit of alcohol detoxification at Leeds Addiction Unit

STUDY 2005 'Real-world' studies show that medications do suppress heavy drinking

STUDY 1992 Disulfiram treatment of alcoholism

REVIEW 2009 The state of pharmacotherapy for the treatment of alcohol dependence

REVIEW 2011 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

REVIEW 2011 Medical treatment of alcohol dependence: a systematic review

REVIEW 2011 The efficacy of disulfiram for the treatment of alcohol use disorder

STUDY 2015 High-dose baclofen for the treatment of alcohol dependence (BACLAD study): A randomized, placebo-controlled trial

STUDY 2009 Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial

STUDY 2008 Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial





Disulfiram treatment of alcoholism.

Chick J., Gough K., Falkowski W. et al.
British Journal of Psychiatry: 1992, 161, p. 84–89.
Unable to obtain a copy by clicking title? Try this alternative source.

Still relevant today, from the early 1990s this UK randomised trial of disulfiram in the treatment of alcohol dependence found that, given daily supervision to make sure patients took tablets they knew would cause unpleasant effects if they drank, the effect was to significantly reduce drinking.

Summary By blocking the breakdown of alcohol in the body, disulfiram produces unpleasant reactions in response to even low levels of drinking, so acts as an aversive deterrent. Specifically it inhibits the action of the liver enzyme aldehyde dehydrogenase, preventing the conversion of acetaldehyde to acetate. As a result, after drinking alcohol, acetaldehyde accumulates, causing flushing, throbbing headache, nausea, vomiting, and chest pain. Disulfiram is therefore indicated for patients who wish to remain abstinent.

In this the first UK controlled study of supervised disulfiram in the outpatient treatment of alcoholics, 126 patients who had relapsed after previous treatment were recruited at seven alcoholism treatment centres. They were randomly allocated to take disulfiram (200mg) or vitamin C tablets daily under supervision usually at home by their spouses or partners or by clinic staff, who also monitored their drinking. Disulfiram patients were told about the drug's effects. Patients were typically middle-aged, unemployed men. Counselling and other forms of psychosocial support were also provided. Nearly half the patients (but no more so on disulfiram) effectively rejected or dropped out of treatment.

Main findings

Based on interviews with the 8 in 10 followed up six months later and the reports of the people supervising consumption, over the six months disulfiram patients reduced their drinking days and amounts drunk by significantly more. For example, based on their own accounts disulfiram patients had increased the number of days they had not drunk at all by 44 days more than control patients and reduced their average consumption by an extra 68 UK units About 544g alcohol. per week.

By the final four weeks the reduction had evened out, and by the end disulfiram patients had lasted without drinking no longer than patients prescribed a vitamin. Remission in symptoms of dependence and amelioration of alcohol-related problems were not significantly different. Patients, supervisors and clinicians – all of whom knew which medication the patient was taking – agreed that by the end of the six months disulfiram patients had gained greater control over their drinking than patients prescribed vitamins. In contrast, this was not the opinion of the interviewers who gathered follow-up data, who were meant Though at the end of the study 65% guessed the treatment correctly. to have been kept in the dark about which pills had been taken. While two thirds of disulfiram patients wanted to continue their treatment, just a quarter prescribed vitamins felt the same.

The authors' conclusions

Though by the end of the six months the impact may have waned, supervised disulfiram plus counselling improved drinking outcomes relative to an inactive nutritional supplement, and the treatment was popular with patients and the people associated with them. Supervision of dosing may be an important element as may making patients aware of the potential adverse consequences of drinking while taking disulfiram.

Thanks for their comments on this entry in draft to Jonathan Chick. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 24 December 2013. First uploaded 31 May 2012

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Top 10 most closely related documents on this site. For more try a subject or free text search

STUDY 2012 Audit of alcohol detoxification at Leeds Addiction Unit

STUDY 2005 'Real-world' studies show that medications do suppress heavy drinking

STUDY 2010 Disulfiram in severe alcoholism – an open controlled study

REVIEW 2009 The state of pharmacotherapy for the treatment of alcohol dependence

REVIEW 2011 The efficacy of disulfiram for the treatment of alcohol use disorder

REVIEW 2011 Medical treatment of alcohol dependence: a systematic review

REVIEW 2012 Acamprosate for alcohol dependence: a sex-specific meta-analysis based on individual patient data

STUDY 2012 A pilot randomised controlled trial of brief versus twice weekly versus standard supervised consumption in patients on opiate maintenance treatment

STUDY 2010 The SUMMIT Trial: a field comparison of buprenorphine versus methadone maintenance treatment

REVIEW 2011 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence





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