Disulfiram is the original medication to treat alcoholism. It causes you to feel ill when you drink, motivating you to stay abstinent. Gentler medications are now available, but antabuse can still work for some people.
Disulfiram is best for:
- Maintaining abstinence
- Establishing new habits
- Drinking prevention
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Disulfiram causes severe, hangover-like symptoms to appear when you drink even a small amount of alcohol. Essentially, it stops your liver from breaking down alcohol completely.
The chemistry is as follows:
- Normally your liver turns alcohol into acetaldehyde, then acetic acid
- Acetic acid is harmless, but acetaldehyde is one of the main causes of hangovers
- Disulfiram stops the whole process at the acetaldehyde stage, allowing it to build up in your system
This means that you can wind up with five to ten times more acetaldehyde in your body than normal. And the result is—you guessed it—five to ten times the hangover.
This effect can start almost immediately, and continue until the alcohol has completely left your system.
The use of disulfiram for alcohol use disorder was first discovered around the time of World War II. Before that, it was mainly used in rubber factories, and under investigation as a cure for scabies and intestinal parasites. One doctor in Denmark decided to test disulfiram on himself, and realized that it made him sick when he drank alcohol. This confirmed reports that some rubber factory workers were becoming ill after drinking. After the war, and more research, disulfiram was reborn under the name Antabuse (anti-abuse).
Because it was the only medication of its kind, Antabuse caused a stir when it was introduced, and became widely used in Denmark. The FDA approved it in 1951 for use in the U.S., and since then it has had a consistent role in alcohol treatment. Antabuse was the only approved medication option for alcohol use disorder until the 1990s.
Antabuse is a product of its time. When it was first introduced, the medical community was still getting a grip on how to treat alcohol addiction. As a result, this is very much a “tough love” way of getting yourself to quit.
Drinking alcohol when you’re taking Antabuse will make you feel severely ill. You can expect to experience flushed skin, a throbbing headache, neck pain, dizziness, nausea, vomiting, sweating, and shortness of breath, among other issues. The intensity can vary between people, but in some cases the reaction is debilitating. Before the recommended dosage was reduced some people were even hospitalized.
Despite its severity, disulfiram is still a useful drug in some cases. If a person is completely committed to abstinence and has already quit drinking, this medication can provide reinforcement for new habits and behaviors. It also remains a strong backup option for people who don’t react well to other medications or can’t stop drinking.
Because the reaction between alcohol and disulfiram is so severe, many people have trouble staying motivated to keep taking it. As a result, it is best to use disulfiram when you have a support system—such as a rehabilitation program, or a family member who will make sure you take your medication. Other solutions are available, including a slow-release implant beneath your skin. However, this is very much a medication for those who are already committed to quitting.
Disulfiram does not get rid of alcohol cravings, or change a person’s chemical dependency on alcohol. This means that it also does nothing to ease withdrawal symptoms. On the other hand, the medication does not create any dependency of its own. Your body will not develop a tolerance to disulfiram, and it generally becomes stronger, not weaker, over time. The medication begins to have an effect within 30 minutes of taking it, and can last in the body up to two weeks.
Do not begin taking disulfiram until it’s been at least 12 hours since your last drink. This medication is best for people who are already past the most severe symptoms of detox and are ready to begin pursuing abstinence. Disulfiram can be a useful emergency medication for a person who needs to quit immediately, but you should still check with your doctor if you have liver disease, since this medication acts on the liver.
Aside from the purposeful, unpleasant interaction between disulfiram and alcohol, side effects can include:
- Skin rash
- Decreased libido
- Metallic or garlicky taste in mouth
If you’re taking disulfiram, you need to be watchful for alcohol in smaller concentrations—such as in sauces, or body care products. It essentially becomes like having an allergy to alcohol, with the accompanying precautions. Ironically, considering its rubber factory origins, people with rubber allergies may also have a bad reaction to disulfiram. For a full list of possible drug interactions, speak with your doctor. In fact, this is a medication that should only be taken with careful supervision.
Disulfiram May Help If:
- You are pursuing abstinence
- You need behavioral reinforcement to stop drinking
- Other medications aren’t working for you
- You are well supervised
Disulfiram May Not Be the Best Choice If:
- You drink compulsively
- You aren’t ready to stop drinking completely
- You haven’t stopped drinking yet
Disulfiram is an admittedly “old-school” approach. It is the original of the three FDA-approved medications for alcohol misuse, and has since been followed by naltrexone and acamprosate. Both of these other options are gentler on your system, and may be preferable.
However, if strong negative reinforcement is effective for you, and you have a good support system, disulfiram can still be helpful. It is best to think of it as a tool to combine with other forms of behavioral therapy, after you’ve already committed to changing your behavior. While this is true for all medications for alcoholism, with disulfiram the effects are so severe, and the motivation to continue so low, that you need to be especially confident and well-supported going into it. If you can accomplish that, however, this medication can have a powerful effect. If you are willing to stick with it for a long time, it just might help you stay alcohol-free for good.
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