Disulfiram for Alcohol Dependence
Alcohol abuse is widespread among adolescents and adults. In 2016, approximately 65.3 million Americans ages 12 and over had participated in binge drinking within the past month, and 16.3 million had engaged in heavy drinking.
Binge drinking involves consuming five or more drinks for males and four or more drinks for females in a single setting. Heavy drinking is defined as binge drinking for five or more days within a 30-day period.
In 2016, around 15 million Americans ages 12 and over met criteria for an alcohol use disorder.1 The prevalence of alcohol abuse calls for the need for effective treatments to help people quit drinking.
Disulfiram is a medication used to treat alcohol addiction and prevent future relapse. Taking disulfiram will result in the onset of negative side effects when alcohol is consumed. This unique effect provides a deterrent to continued drinking behavior which, when taken regularly, can help people resolve to stay sober. Taking disulfiram while participating in a structured and supportive treatment program can lead to positive results in patients motivated to stay abstinent from alcohol.
Is Disulfiram Used for Alcohol Withdrawal?
Alcohol withdrawal symptoms include anxiety, nausea and vomiting, increased heart rate and blood pressure, extreme confusion, insomnia, hallucinations, seizures, and sometimes delusions.4 Disulfiram, which may be more commonly referred to by the Antabuse trade name, is a prescription medication approved by the Food and Drug Administration (FDA) to treat chronic alcohol dependence.3
It is NOT used to treat or alleviate alcohol withdrawal symptoms but instead helps discourage drinking among people attempting to recover from an alcohol use disorder.2
Disulfiram may be used during alcohol detox to decrease the likelihood of relapse. However, the drug may only be taken after a person has abstained from alcohol for at least 12 hours or until the blood alcohol level has reached zero.3 People may start taking disulfiram in the first few days of withdrawal and continue for months or years.3
People with a history of excessive alcohol consumption may also be more at risk for certain infections, gastrointestinal bleeding, and pancreatitis.4 Clinicians should be vigilant to the possibilities of such medical issues, as they could complicate the course of withdrawal management. Medical emergencies that are not properly managed may lead to potentially fatal outcomes. 4
Because of the potentially serious associated risks it is important that alcohol withdrawal be closely monitored by a medical professional. This allows for immediate treatment intervention in the event of serious complications and a decreased likelihood of such complications to begin with. Detoxing from alcohol in a supervised detoxification treatment center can help ensure a safer and more comfortable withdrawal. Learn more.
How Does Disulfiram Work?
Disulfiram works by altering how the body metabolizes alcohol.3 When a person consumes alcohol under normal circumstances, the alcohol dehydrogenase enzyme converts alcohol to acetaldehyde. Then the enzyme aldehyde dehydrogenase oxidizes the alcohol acetaldehyde byproduct into acetic acid. Disulfiram inhibits this oxidation process, causing acetaldehyde to build up rapidly in the bloodstream. This buildup of acetaldehyde results in an uncomfortable disulfiram-alcohol reaction.3
Research on the effectiveness of disulfiram in reducing drinking has revealed some positive results.3,5,6 Taking disulfiram has been shown to be more effective than trying to quit without treatment in at least 6 out of 10 research studies.6 Disulfiram can deter drinking because people who take the drug anticipate a negative reaction should they consume alcohol.3 They may avoid drinking alcohol despite cravings in order to prevent the disulfiram-alcohol reaction.
The disulfiram-alcohol reaction typically begins within 10-30 minutes after drinking and can last for up to one hour or more.2,3 Side effects of drinking alcohol while taking disulfiram can include:2,3
- Throbbing of the head or neck
- Nausea and vomiting
- Heart palpitations
- Fast heart rate
- Chest pain
- Difficulty breathing
- Flushing of the upper chest and face
- Blurry vision
The intensity of the disulfiram-alcohol reaction varies depending upon the amounts of disulfiram and alcohol consumed.3 With careful dosing and medical screening prior to disulfiram treatment, the incidence of very severe reactions is exceedingly rare. However, a severe reaction is possible when high doses of disulfiram and large amounts of alcohol are consumed, which may result in:3
- Irregular heart rhythms
- Cardiovascular collapse
- Heart attack
- Heart failure
- Respiratory depression
- Loss of consciousness
Severe reactions may last longer than an hour (the normal duration of disulfiram effects) and last until the alcohol consumed has been fully metabolized.3
Who Should Use Disulfiram?
Disulfiram is an appropriate medication for alcohol users who are motivated to quit drinking and who have abstained from alcohol for at least 12 hours.2,3
It is generally agreed upon by experts that it is most effective for those who have completed detox, are newly abstinent but motivated to stay sober, and who are receiving specialized addiction treatment. Disulfiram treatment is more likely to be successful if people are closely monitored and supervised, are given daily reminders to take the drug, and participate in therapy at the same time.3
Disulfiram is contraindicated (not recommended for use) in some cases:2,3
- People who are hypersensitive to disulfiram or thiuram derivatives, such as those used in pesticides or rubber vulcanization, should not take the drug.
- People with untreated psychotic illnesses, myocardial disease, coronary occlusion, and women who are pregnant or nursing should also not take disulfiram.
- It is recommended that disulfiram be prescribed with caution in adolescents and people with a history of cardiac disease, diabetes, hypothyroidism, epilepsy, hepatitis C, nephritis, cirrhosis, and brain damage.
Side Effects of Disulfiram
Side effects of taking disulfiram (which usually occur in the first 2 weeks and then subside) can include:2,3
- Skin rash
- A metallic or garlicky taste in the mouth
Hepatic toxicity is a serious and potentially fatal side effect that can develop in disulfiram users, even those who don’t have a history of abnormal liver function.3 If you experience any of the following symptoms of hepatic toxicity, consult with a medical professional as soon as possible:2,3
- Excessive fatigue
- Appetite loss
- Yellowing of the skin or eyes
- Dark yellow urine
- Light-colored stool
There is a risk for overdose while taking disulfiram, especially among children who may accidentally gain access to the drug. Signs of an overdose can include drowsiness, nausea and vomiting, paralysis, bizarre or aggressive behavior, and coma.3 If you suspect a disulfiram overdose, call 911 right away.
The medication does not cause tolerance or withdrawal in long-term users. However, users should understand that even after discontinuing disulfiram, they may feel the effects of the disulfiram-alcohol reaction if they drink alcohol in the 14 days after their last disulfiram dose.3
Is it Enough to Treat Alcoholism?
Disulfiram is more effective at treating alcoholism when it is combined with intensive addiction treatment.3 Addiction treatment helps people understand their reasons for drinking alcohol and learn to cope with life stressors in healthier ways.
While disulfiram may deter people from drinking, it does not deal with the underlying issues that caused the individual to abuse alcohol. Failing to deal with an addiction can lead to a relapse down the road. Disulfiram by itself is therefore not enough to treat alcoholism and either inpatient or outpatient treatment will be needed to set the foundation for sustained recovery. While disulfiram may deter people from drinking, it does not deal with the underlying issues that caused the individual to abuse alcohol.
During and after treatment, support groups can be extremely beneficial for people living in recovery from alcoholism. These groups are free and available to people in any stage of recovery. Alcoholics Anonymous is the most popular self-help group and is based on the 12 steps, which encourage people to admit their powerlessness over alcohol and develop relationships with other sober people.
It should be noted that some AA groups may still shun the use of medications in recovery, so those taking disulfiram may look for AA groups near them that are more open to the use of medications. Another alternative is to look into non-12-step groups, such as SMART Recovery, a secular recovery group that is both educational and supportive. It helps people build motivation for sobriety, control thoughts, feelings, and behaviors, learn tools for coping with urges, and create a balanced, healthy life.
- Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.
- U.S. National Library of Medicine. (2017). MedlinePlus, Disulfiram.
- Substance Abuse and Mental Health Services Administration. (2009). Incorporating alcohol pharmacotherapies into medical practice.
- Substance Abuse and Mental Health Services Administration. (2013). Detoxification and substance abuse treatment.
- Garbutt, J. C., West, S. L., Carey, T. S., Lohr, K. N., & Crews, F. T. (1999). Pharmacological treatment of alcohol dependence: A review of the evidence.Jama, 281(14), 1318-1325.
- Jorgensen, C. H., Pedersen, B., & Tønnesen, H. (2011). The efficacy of disulfiram for the treatment of alcohol use disorder. Alcoholism: Clinical and Experimental Research, 35(10), 1749-1758.