Disulfiram For Alcoholism Treatment

Medication-assisted treatment has become an important tool in the battle against alcohol addiction, particularly for individuals who have not had success with traditional treatments like therapy alone. Disulfiram is one such treatment commonly used to help people overcome their addiction. By inducing an unpleasant reaction in the body when alcohol is consumed, disulfiram acts as a deterrent to drinking. Despite concerns regarding its effectiveness and side effects, it remains a viable treatment option for many individuals struggling with alcoholism.1

In this article, we will take a closer look at disulfiram as a treatment for alcoholism, examining how it works, its potential benefits and risks, and its effectiveness compared to other treatments. We will also explore some of the common disulfiram side effects and discuss who might be a good candidate for this type of treatment. By the end of this article, you will have a better understanding of what disulfiram is and whether it might be a suitable treatment option for you or someone you know who is struggling with alcohol addiction.1

Statistics of Disulfiram Medication Usage for Alcoholism Treatment 

Disulfiram, commonly known as Antabuse, has been a treatment option for alcoholism for nearly 80 years. According to the National Survey of Substance Abuse Treatment Services, the number of patients receiving disulfiram for alcohol withdrawal based on the type of care was:1,2

  • 3365 patients in outpatient care.
  • 216 patients in residential inpatient care.
  • 229 patients in hospital inpatient treatment.

More than 4000 or 67% of all addiction treatment centers surveyed in the same report offer disulfiram treatment for alcoholism.2

While its effectiveness is a topic of debate, some studies have shown that disulfiram can be an effective deterrent to drinking, particularly when combined with counseling and support. However, it is important to note that disulfiram is not a “cure” for alcoholism and may not be effective for everyone. Older patients who are more prone to relapse, are socially stable, not suffering from depression or compulsion, and are capable of following doctor’s instructions are those clinical studies have found to get the most benefits from disulfiram for alcohol withdrawal. Some individuals may not experience any significant changes in their drinking behavior, while others may have an adverse reaction to the medication.3

Disulfiram use has been associated with several potential side effects, such as skin rash, fatigue, and headache. While disulfiram side effects are generally mild and go away on their own, some people may experience more serious reactions. It is essential to take these potential risks into account when considering disulfiram as a treatment option.1

How Does Disulfiram Work for Alcohol?

Disulfiram is used to treat alcohol addiction by inducing an unpleasant reaction when alcohol is consumed. It works by inhibiting aldehyde dehydrogenase, which breaks down alcohol in the body. At a prescribed dose, disulfiram reacts with alcohol and causes unpleasant symptoms such as palpitations, nausea, vertigo, flushing, tachycardia, and hypotension. When accumulated, these symptoms discourage patients from consuming alcohol. Therefore, disulfiram does not influence addiction’s neurobiological mechanisms but works to inhibit alcohol use.1

The effects of disulfiram can begin within a few minutes of consuming alcohol and can last for several hours, depending on the amount of alcohol consumed, the individual’s tolerance, and the dose of disulfiram taken. The severity of the reaction can vary, and for some people, it can be severe enough to require emergency medical attention.4

Disulfiram acts as a deterrent to drinking by creating an unpleasant reaction to alcohol. However, it does not cure alcoholism or address the underlying psychological and behavioral issues that contribute to alcohol addiction. It is often used as a part of a comprehensive treatment plan, including therapy and other supportive measures.1

While disulfiram can be effective in reducing drinking behavior, it is not suitable for everyone. People with certain medical conditions, such as liver or kidney problems, may not be able to take disulfiram for alcohol withdrawal, and others may have a sensitivity to the medication or experience adverse side effects.1

Apart from treating alcohol addiction, disulfiram has also been studied for its potential use in treating cocaine addiction. By blocking the dopamine beta-hydroxylase (DBH), an enzyme that converts dopamine to noradrenaline, disulfiram could potentially reduce the pleasurable effects of the drug and thereby decrease its abuse potential.1

How to Take Disulfiram Properly in Alcohol Addiction Treatment? 

Disulfiram is available in tablet form and is typically taken once a day, with or without food. The dosage may vary based on an individual’s needs and tolerance, and it is important to adhere to the prescribed amount. Daily disulfiram dose for alcohol addiction treatment should not exceed 500mg.1

To ensure the proper intake of disulfiram, it is recommended to take it at the same time every day, and it is critical not to miss any doses or take more than the prescribed amount. Doing so may lead to adverse reactions and reduce the effectiveness of the medication.4

While taking disulfiram, it is crucial to abstain from alcohol entirely, even in small amounts, as it can result in a severe reaction. Before taking any medications or supplements, individuals should check with their healthcare provider to ensure that they do not interact with disulfiram, as this can lead to adverse reactions or decrease the effectiveness of either medication. Some of the most common interactions include:4

  • Anticoagulants (Blood thinners) such as isoniazid, phenytoin, or warfarin.
  • Vitamins.
  • Non-prescription drugs that contain alcohol.
  • Amitriptyline (Elavil).

Disulfiram is not suitable for everyone, and individuals with liver or kidney problems, a history of seizures, or hypersensitivity to the medication should not take it. Pregnant women should also avoid disulfiram because it can harm the fetus.4

If you miss a dose of disulfiram, take the missed dose as soon as possible. Skip the missed dose if your next dose is almost due, and continue your regular schedule. If you missed taking disulfiram, do not take a double dose to compensate.4

What are the Side Effects of Disulfiram?

While it can be an effective treatment option, there are some potential side effects that individuals should be aware of if they are prescribed disulfiram treatment for alcoholism. While it is generally considered an acceptable risk profile drug, it may lead to severe drug-drug interactions, which may result in a fatal outcome.1

Some of the common side effects of disulfiram may include:1,4

  • Acne.
  • Skin rashes.
  • Fatigue.
  • Impotence.
  • Drowsiness.
  • Mild headaches.

Some severe disulfiram side effects may include:4

  • Extreme fatigue.
  • Low energy levels.
  • Weakness.
  • Vomiting.
  • Upset stomach.
  • Dark urine.
  • Lack of appetite.
  • Yellow tint to the skin or eyes.

If patients experience any of these severe disulfiram side effects, they should contact a doctor immediately. The side effects usually resolve after discontinuing disulfiram treatment.1,4 

Although rare, disulfiram has been associated with serious side effects such as liver damage, cardiovascular problems, and seizures. Individuals should be aware of the risk of these side effects when considering disulfiram as a treatment option.1

People who have liver or kidney disease should avoid taking disulfiram, as it may exacerbate these conditions. Individuals with a history of seizures, diabetes, or mental health conditions should also consult with their healthcare provider to discuss the potential risks and benefits of disulfiram before taking it.1

It is critical to avoid alcohol consumption while taking disulfiram, as even small amounts can lead to a severe reaction. Additionally, combined with cannabis, disulfiram side effects also tend to include psychosis and neurological adverse effects.1

Patients with severe coronary artery disease or heart failure should notify their doctor of their condition and should not be prescribed disulfiram for alcohol withdrawal. In severe myocardial diseases, disulfiram has been linked to heart failure and death shortly after initiating treatment.1

Due to these risks, it is advised to take disulfiram under close monitoring and in a controlled environment, such as an addiction treatment center. Medical experts at these treatment centers can help prescribe the right dose of disulfiram or decide that other medication-assisted treatments may be more favorable for some patients.3

Additionally, they are able to determine the best course of further treatment following diagnosis, which may include safe medical detox before administering disulfiram for alcoholism, and various treatment modalities for alcoholism based on factors such as the stage of alcoholism, personal medical history, and the symptoms of alcoholism a patient is exhibiting.3

What are the Benefits of Disulfiram?

One of the primary benefits of disulfiram is that it acts as a deterrent to drinking by creating an unpleasant reaction to alcohol. Doing so, disulfiram can help individuals abstain from alcohol and potentially reduce the risk of relapse.

There are several distinct benefits to using disulfiram to treat alcoholism, including:6

  • It has been proven as an effective treatment when others like naltrexone and acamprosate prove ineffective.
  • It creates an adverse reaction to alcohol, which discourages patients from drinking.
  • It is very effective, even if a small amount of alcohol is consumed.
  • Its effects start shortly after taking the first dose and may last up to two weeks following the last dose.
  • Disulfiram side effects are few and rare if taken properly and if the patient avoids alcohol.
  • Disulfiram for alcoholism has been well-studied and documented.

Several studies have shown that when used in conjunction with therapy and other supportive measures, disulfiram can be an effective tool in the treatment of alcohol addiction. In these studies, disulfiram showed promising results, with one study highlighting the effectiveness of disulfiram and Behavioral Marital Therapy (BMT), for up to 24 months following treatment.5

When Does a Healthcare Provider Usually Prescribe Disulfiram?

Disulfiram is typically prescribed to individuals who have decided to quit drinking and are committed to maintaining sobriety. It is not intended to be a stand-alone treatment but is rather used in conjunction with therapy and other supportive measures to help individuals achieve and maintain sobriety.7

The primary benefit of disulfiram for alcohol withdrawal is that it acts as a deterrent to drinking by creating an unpleasant reaction when alcohol is consumed. This can help individuals abstain from alcohol and potentially reduce the risk of relapse.7

Disulfiram is prescribed to individuals who have completed the initial phase of alcohol detoxification and are no longer experiencing acute withdrawal symptoms. It is not a suitable medication for individuals who are actively drinking or experiencing alcohol withdrawal symptoms, as mixing disulfiram and alcohol can have severe adverse effects. Patients taking disulfiram should have abstained from alcohol for at least 12 hours.7

Healthcare providers typically prescribe disulfiram after conducting a thorough evaluation of an individual’s medical history, current medications, and overall health. Individuals with certain medical conditions, such as liver or kidney problems, a history of seizures, or hypersensitivity to the medication, should not take disulfiram. Physicians may administer blood or breath alcohol tests to verify patients haven’t consumed alcohol in the past 12 hours.7

Can You Drink Alcohol While Taking Disulfiram? 

It is essential to avoid alcohol consumption while taking disulfiram, as mixing even small amounts of disulfiram and alcohol can lead to a severe reaction. Disulfiram works by blocking the body’s ability to metabolize alcohol, which causes a buildup of acetaldehyde in the body. This buildup leads to a range of unpleasant symptoms, such as flushing, sweating, nausea, vomiting, headache, and palpitations.1

The severity of the reaction to mixing disulfiram and alcohol varies depending on several factors, such as the amount of alcohol consumed, the dose of disulfiram, and an individual’s overall health. It is crucial to avoid alcohol entirely while taking disulfiram and to be aware of the potential risks associated with drinking.1

What Happens If I Overdose with Disulfiram

While disulfiram is a relatively safe medication when taken as prescribed, an overdose can lead to serious health complications. Symptoms of disulfiram overdose may include:8

  • Dizziness.
  • Nausea.
  • Vomiting.
  • Drowsiness.
  • Numbness or tingling sensation.
  • Lack of coordination.
  • Seizure.
  • Coma.
  • Psychotic behavior.
  • Aggression.
  • Ascending flaccid paralysis.

In case of an overdose, individuals should seek emergency medical attention immediately. Treatment for disulfiram overdose may include supportive care, such as intravenous fluids, oxygen, and monitoring of vital signs. In severe cases, hospitalization may be necessary.1

It is essential to take disulfiram only as prescribed by a healthcare provider and to adhere to the recommended disulfiram dose for alcohol treatment, which is 500mg on a daily basis. Overdosing on disulfiram can lead to serious health complications and potentially life-threatening situations.1

If you or a loved one is struggling with alcohol addiction, it is essential to seek help from a licensed addiction treatment center to avoid the risk of disulfiram overdose and other potential health complications. A licensed addiction treatment center can provide comprehensive care and support, including therapy, medication-assisted treatment, and other supportive measures to ensure recovery and help individuals achieve and maintain sobriety.

While the cost of addiction treatment can vary depending on the level of care and services provided, there are resources available to help individuals access affordable and effective treatment. Many addiction treatment centers offer payment plans, sliding scale fees, and other financial assistance programs to help make treatment more accessible.

In addition to professional treatment, there are also various support resources available, including addiction treatment hotlines, support groups, and online communities, to help individuals in recovery. These resources can provide valuable support, guidance, and encouragement throughout the recovery process.

Frequently Asked Questions