How Disulfiram Helps Treat Alcoholism: What to Know Before Starting Treatment

What is Disulfiram?

Disulfiram, also known as Antabuse, was the first medication to receive FDA approval (1951) to treat alcoholism. Disulfiram treatment works by blocking an enzyme that is involved in the breakdown of alcohol. It is considered an alcohol deterrent or alcohol sensitizing agent because it causes unpleasant symptoms when an individual takes the medication and consumes even a small amount of alcohol. 

How Does Disulfiram Work?

Disulfiram does not affect cravings or withdrawal symptoms like the other two FDA approved medications to treat alcohol use disorder, acamprosate and naltrexone. Instead, it causes an adverse reaction. 

When alcohol is consumed, it is converted in the body to acetaldehyde. Then, an enzyme called aldehyde dehydrogenase (ALDH) oxidizes the acetaldehyde byproduct into acetic acid. 

How disulfiram works is by blocking this oxidation. It inhibits ALDH, which causes a rapid increase in the level of acetaldehyde in the bloodstream. This buildup of acetaldehyde results in symptoms that are referred to as a disulfiram alcohol reaction. These unpleasant symptoms work as a deterrent to drinking and increase an individual’s motivation to remain sober.

Disulfiram and Alcohol: The “Aversion Therapy” Effect

Disulfiram helps to discourage drinking by producing unpleasant symptoms when mixed with alcohol. These symptoms are referred to as the disulfiram alcohol reaction and can be seen within 10 to 30 minutes after alcohol enters the body. Symptoms can last for an hour or more. 

Symptoms of disulfiram reaction include:

• Anxiety
• Breathing difficulty
• Choking
• Sweating
• Mental confusion
• Blurred vision
• Chest pain
• Weakness 
• Nausea
• Vomiting
• Flushing of the face
• Headache

Disulfiram Reactions and Interactions

When taking disulfiram, it is important to remember that substances other than alcoholic beverages can induce negative disulfiram interactions. This includes the use of mouthwash, cough medication or other medications that contain alcohol. It also includes foods that contain alcohol, such as vinegars and sauces.

These disulfiram-like effects can also occur when a person is exposed to fumes from paint, paint thinner, varnish and shellac. Caution should also be used with aftershave lotions, colognes and rubbing alcohol.

Disulfiram has been shown to interact with some medications, including phenytoin, oral blood thinners, isoniazid and extended release naltrexone. Individuals who have taken metronidazole or paraldehyde should not take disulfiram without first consulting their medical provider. 

You should not be take the medication if you’ve consumed alcohol within the past 12 hours. Conversely, individuals should not drink within 14 days of their last disulfiram dose. 

Disulfiram Side Effects and Safety

As with all medications, disulfiram comes with potential side effects.

Common side effects of disulfiram include:

• Skin rashes and acne
• Mild headache
• Tiredness 
• Impotence
• Loss of interest in sex
• Metallic or garlic-like taste in the mouth

More serious side effects that should result in an immediate call to a medical provider include:

• Excessive tiredness
• Weakness
• Lack of energy
• Loss of appetite
• Upset stomach or upper stomach pain
• Vomiting
• Yellowness (jaundice) of the skin or eyes
• Dark urine or clay-colored stools
• Eye pain or sudden vision loss

Before taking disulfiram, it is important to let your medical provider know if you have diabetes, thyroid disease, brain damage, kidney or liver disease or are pregnant. All medications, supplements and herbal remedies should be discussed before starting this treatment to help prevent any drug interactions and disulfiram adverse effects.

Individuals who are taking disulfiram should have regular monitoring of liver and kidney function. 

It is also important to wear a medical alert tag or carry an ID indicating that you are taking disulfiram in case of emergency. 

Disulfiram in Alcohol Rehab: How It’s Used in Practice 

Disulfiram therapy for alcohol use disorder isn’t for everyone. Individuals who use this as a part of their treatment plan should be highly motivated and committed to sobriety. They should also have a good support system that will encourage adherence to the therapy. 

Anyone taking disulfiram for alcoholism should also be enrolled in a structured treatment program. This may involve inpatient or residential treatment, intensive outpatient treatment, partial hospitalization programs or sober living environments. 

Disulfiram treatment is used in alcohol rehab after an individual has completely detoxed from alcohol use. They must have a blood alcohol level of 0 before the first dose. Because it is used as a deterrent to drinking, other medications such as acamprosate or naltrexone are sometimes given to help combat cravings.

Disulfiram comes in tablet form and is taken by mouth. When starting this treatment, an individual will take 500mg daily for the first one to two weeks. Maintenance dosing follows, which ranges from 250mg to 500mg. Dose changes should never be made without the guidance of a medical provider. The duration of therapy depends on the individual and could range from months to years. 

Types of Therapy That Complement Disulfiram Treatment

Medication alone is not enough to treat alcohol use disorder. Comprehensive treatment is necessary. This should involve multiple interventions, including the use of medications such as disulfiram, alongside behavioral therapy and relapse prevention planning.

Cognitive behavioral therapy (CBT) and motivational interviewing (MI) are two approaches that have proven effective in the treatment of alcohol use disorder. CBT is beneficial because it addresses maladaptive thoughts and behaviors. It helps individuals develop positive coping skills and set attainable goals toward recovery. Motivational interviewing helps by increasing a person’s internal motivation for change through a client-centered approach. Individuals explore their reasons for change and work toward a future in recovery. 

Additionally, family therapy may be included in circumstances where others have been impacted by the alcohol use. This treatment helps heal the family unit by creating positive changes and developing healthy coping skills. 

Some programs include a 12 Step approach to recovery. These programs, such as Alcoholics Anonymous, are peer-based. They help individuals develop healthy coping skills, take accountability for their addiction and learn how to avoid triggers. Participants find support that helps them maintain sobriety and focus on a future in recovery. 

Individual treatment plans should also include relapse-prevention strategies that support long-term recovery. This includes identifying situations that put a person at risk for relapse. The individual then develops strategies to cope with these stressors without the use of alcohol or other drugs. This includes building awareness, planning for emergencies, building confidence and finding alternative ways of thinking.

The use of medications such as disulfiram can benefit individuals with alcohol use disorder when combined with these therapies. Individuals with this combination of support have higher abstinence rates, fewer relapses and better coping skills, all of which support a life in recovery. 

Disulfiram Alternatives

Along with disulfiram, there are two other FDA-approved medications for the treatment of alcohol use disorder. These disulfiram alternatives are naltrexone and acamprosate. 

Naltrexone is beneficial for treating alcohol use disorder because it works to reduce cravings. It can also help to block the euphoric feelings sometimes associated with alcohol use. 

Acamprosate works by restoring the proper balance of the neurotransmitters, GABA and glutamate, which are disrupted by chronic alcohol use. Acamprosate has also been shown to reduce cravings for alcohol. The use of acamprosate should be avoided in individuals with severe kidney disease.

Pharmacokinetics: How Long Does Disulfiram Stay in the Body?

Disulfiram has a half life of 7.3 hours. Half life refers to the time it takes for the amount of a substance to reduce by half of its value. This means disulfiram stays in the body for approximately a day and a half. Because it remains in the body for so long, disulfiram is only taken once per day. 

Once disulfiram is taken, it will begin to act within 30 to 60 minutes. Depending on the amount of alcohol consumed, it will produce unpleasant symptoms for several hours. 

To prevent a disulfiram alcohol reaction, disulfiram should not be taken within 12 hours of consuming alcohol. Individuals taking disulfiram should avoid any products containing alcohol for at least 14 days after discontinuing disulfiram.

FAQs

Support, Accountability, and Long-Term Sobriety

The use of disulfiram is one potential component of a comprehensive treatment plan for alcohol use disorder. When it is used along with behavioral treatment and psychotherapies, long-term sobriety is possible. 

The first step is often one of the hardest: asking for help. There are treatment programs and providers all over the country that want to help you on your recovery journey. Reach out to get the support you need, and achieve a brighter future.