Disulfiram TreatmentDisulfiram (also known as antabuse)is the best known drug used in the treatment of alcoholism. A long established strategy for helping people with alcohol problems to maintain abstinence is to give them antidipsotropic medication, literally, medication that stops them drinking alcohol. The rationale here is that, if drinking alcohol becomes an unpleasant experience, then people will be less inclined to do so. Disulfiram interferes with the metabolism of alcohol. Specifically, it inhibits the liver enzyme aldehyde-dehydrogenase, which is responsible for breaking down alcohol (specifically acetaldehyde). Acetaldehyde accumulates in the body, giving rise to unpleasant effects. If someone drinks alcohol after taking antabuse, their blood pressure falls and they show a flushing response - ruddiness in the face, their heart rate rises and may become irregular, they may experience dizziness, nausea and vomiting and often report blinding headaches and even difficulty in breathing. In all the effects are rather unpleasant and are thought to deter someone from drinking. Not all people will display all of these reactions, nor experience them to the same degree. However, it is easy to see how such an unpleasant experience may deter people from consuming alcohol. Indeed, the seriousness of the antabuse reaction should not be underestimated: heart attacks and strokes have been known to occur. Who benefits?Experts suggest that it should not be used as the first choice of treatment. Instead it should only be used with those who are motivated to stop but continue to relapse.Characteristics associated with successful disulfiram therapy as follows: the client should have a long heavy drinking career, the client should have a history of withdrawal symptoms, especially delerium tremens, the client should demonstrate a good motivation to succeed, the client should not be undergoing treatment with antidepressants. Of course there is no guarantee that a person fulfilling all of these criteria will be successful but they increase the likelihood of a favourable outcome. Contra-indications to prescribing disulfiramThere are a considerable number of conditions that would preclude a doctor from prescribing disulfiram. These would include :Cardiovascular disease Cerebrovascular disease Severe chronic pulmonary disease Chronic renal failure Neuropsychiatric disease including: organic brain disease psychosis depression requiring treatment Idiopathic seizure disorder Neuropathy Pregnancy Chronic liver disease complicated by portal hypertension Does it work?No medication, whether disulfiram or anything else, will be effective unless the client actually adheres to the regime. The client must be motivated to, and actually want, to stop drinkingDisulfiram is not a panacea, nor will it solve a person's problems. Many problem drinkers have problems in their social lives, legal problems and sometimes even psychological problems. Stopping drinking may help with some of these problems but will not in itself solve them. For these reasons, it is now recognised that the treatment should be combined with counselling. The research suggests that as a treatment or and adjunct to treatment, disulfiram can be very successful if taken as intended and with psychological support. However no treatment works without effort on the part of the drinker!
Return from Disulfiram to Alcoholism Treatment
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