Disulfiram as Treatment for Alcoholism

There are over 275,000 adults who contacted drugs and alcohol services between 2020 and 2021, a rise from the previous year.

Those who seek treatment for addiction to alcohol alone make up the largest group of adults in treatment. [1]

It is reported that in an average secondary school in England, around 40 students will be living with a parent who suffers from a drug or alcohol problem. [2]

Many who go into treatment will receive medication like Benzodiazepines that affect the brain’s chemistry. However, drugs that affect the body and help your body curb cravings for alcohol are also used.

What is Disulfiram?

Disulfiram was one of the first medications approved to treat chronic alcoholism. Commonly sold under the name Antabuse, this medication has been used for over 60 years to help those with alcohol use disorders (AUDs) maintain sobriety. [3]

Medications like Disulfiram are not usually used alone but are prescribed as part of an intense recovery plan. This can include inpatient rehab, outpatient rehab, detox process, behavioural therapy, counselling and self-support groups. [4]

Disulfiram for Treating Alcoholism

In its pure state, Disulfiram is a white to off-white, odourless, almost tasteless powder, usually administered in pill form. However, it can be dissolved in water and taken as a drink.

Unlike other medications used to treat alcohol dependence, Disulfiram is an alcohol-aversive agent, meaning it causes an acutely toxic physical reaction when mixed with alcohol.

Whether Disulfiram completely removes the urge to drink is uncertain. It is thought that if you or your loved one is aware that drinking while taking Disulfiram will make you sick, it will increase the motivation to remain abstinent.

Disulfiram will not be administered until at least 12 hours after the last drink of alcohol, as taking it too soon can cause a reaction that leads to severe illness. These reactions have been noted to last up to two weeks.

This medication may cause some to feel drowsy or less alert than usual. Talk to your doctor as you may be able to administer Disulfiram in the evenings.

How Does Disulfiram Work?

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Disulfiram works by blocking the breakdown of alcohol in the body, leading to a build-up of alcohol-related compounds making those who drink very sick. Disulfiram can cause unpleasant effects even if a small amount of alcohol is ingested.

Effects can include:

  • Headache
  • Nausea
  • Vomiting
  • Chest Pain
  • Weakness
  • Blurred vision
  • Confusion
  • Sweating
  • Choking
  • Breathing difficulties
  • Anxiety

On rare occasions, severe reactions can occur if you ingest a large amount of alcohol like:

  • Heart attacks
  • Unconsciousness
  • Convulsions or seizures
  • Death

These effects can take place as quickly as 10 minutes after alcohol enters the body and last for hours. It is essential to understand that Disulfiram is not a cure for AUDs but discourages you or your loved one from drinking.

Mixing Disulfiram with Products Containing Alcohol

Alcohol

It has been noted that even the most negligible ingestion of alcohol can cause a severe reaction in you or your loved one. That is why you must check food and product labels for alcohol.

If you continue to live at home while taking Disulfiram, it is suggested you carry a card explaining the medication and how any ingestion of alcohol will make you sick. The card could list symptoms most likely to occur if alcohol is ingested and a doctor, clinic or hospital to contact if you react.

Be aware that using products on your skin or hair that contain alcohol may also cause a reaction.

Products that usually contain alcohol and should be avoided include:

  • Mouthwash
  • Hair dye
  • Cough medicine
  • Antiperspirant
  • Cooking wine or vinegar

It is also good to be cautious to not come into contact with or breathe in fumes that may contain alcohol like paint thinner, paint, varnish or shellac.

This may seem like a big deal, but any ingestion of alcohol or alcohol-related products may mean you experience a severe reaction and become very sick. The aim of using Disulfiram is to curb cravings while you engage with treatment and promote long-term abstinence.

Disulfiram Side Effects

Generally taken as one pill in the morning, Disulfiram has some common side effects that include:

  • Drowsiness
  • Headaches
  • Fatigue
  • Acne
  • Metallic aftertaste.

Rare and more severe side effects can include:

  • Nerve pain and nerve damage
  • Psychosis
  • Skin Rash
  • Changes in Liver function
  • Liver failure [5]

However, do not let these effects alarm you, as Disulfiram is monitored while being used. There is no time restraint for how long you can take this medication. However, it is best administered while undergoing behavioural therapy to treat your AUD.

Most experts agree that Disulfiram is optimally used in a substance abuse program as it may be more effective in promoting short-term abstinence and treatment retention rather than preventing long-term relapse.

Rehab for alcoholism can include individual therapy, group classes, holistic therapies, cognitive behavioural therapy, and family therapy. All to teach you new coping skills and promote a life of abstaining from alcohol.

Existing Medical Problems & Disulfiram

If you have existing medical problems, you should raise them with your doctor in treatment as it may prevent you from taking Disulfiram. Especially if you have:

  • Asthma or other lung diseases
  • Diabetes mellitus
  • Heart disease
  • Epilepsy
  • Liver disease
  • Depression or severe mental illness
  • Skin allergies
  • Kidney disease
  • Underactive thyroid [6]

This is because Disulfiram may increase side effects on other medications you may be taking or aggravate other conditions. Your doctor will be well versed in this and help you decide if Disulfiram is the best medication to help treat your alcoholism.

Medications Used in Treatment for Alcohol

Disulfiram has been used in the treatment of AUDs for over 60 years; however, if you or your loved one is in rehab, you may be administered other medications to assist you through detox and prevent relapse.

Medications used in treatment include:

  • Disulfiram
  • Naltrexone
  • Acamprosate
  • Diazepam
  • Lorazepam
  • Chlordiazepoxide
  • Clonidine
  • Propranolol

These medications will be administered by a doctor or medical professional and require monitoring to ensure you or your loved one is reacting positively to treatment.

Disulfiram adds to the effect of CNS depressants, medications that slow down your central nervous system. This includes antihistamines or allergy medicine. Other drugs include sedatives, sleeping pills and prescription pain medication.

Mixing medicines may cause an increased risk of side effects but may be the best treatment for you. Your doctor will discuss if you take these medications at different times or change the doses.

They will be used alongside treatment you will receive at an addiction facility that will encourage you to learn new coping mechanisms and make your way down the road to recovery.

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References

[1] https://www.gov.uk/government/statistics/substance-misuse-treatment-for-young-people-statistics-2020-to-2021/young-peoples-substance-misuse-treatment-statistics-2020-to-2021-report

[2] https://www.local.gov.uk/publications/must-know-treatment-and-recovery-people-drug-or-alcohol-problems

[3] https://www.ncbi.nlm.nih.gov/books/NBK64036/

[4] https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Disulfiram-(Antabuse)

[5] https://medlineplus.gov/druginfo/meds/a682602.html

[6] https://www.mayoclinic.org/drugs-supplements/disulfiram-oral-route/side-effects/drg-20063488?p=1