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Chick J., Gough K., Falkowski W. et al.
British Journal of Psychiatry: 1992, 161, p. 84–89.
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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.
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.
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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