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Antabuse Effectiveness in Treatment of Alcohol Use Disorder

July 6, 2022

Table of Contents

Disulfiram (Antabuse) is a prescription medication to treat alcohol use disorder  (AUD). Doctors have used Antabuse for decades, and researchers have confirmed its efficacy in treating AUD.

Nowadays, Naltrexone and Acamprosate are newer medications and more commonly prescribed for AUD. However, for some individuals who have had good success with Disulfiram (Antabuse) in the past, or who cannot have Naltrexone or Acamprosate for other reasons, Antabuse might be a good choice for AUD.

Antabuse (generic name: disulfiram) is an effective therapy for people who fit the following criteria:

  • Want to stop drinking
  • Have connections that support their decision
  • Work with a qualified professional on a treatment plan

Antabuse therapy has limits. Medication alone can't treat your alcohol use disorder. But when paired with therapy, your prescription could help you change your life for the better. 

How Effective Is Antabuse?

Disulfiram is the oldest medication treatment for AUD. In a 1992 study, researchers proved that people who took disulfiram in a supervised setting drank significantly less than those who did not.[1]

Antabuse works by disrupting alcohol digestion and causing an unpleasant set of side effects that deters further drinking. Drink while your medication is active, and you'll likely feel incredibly sick. Your face will flush, your heart race, your stomach churn, and your throat burn. You'll feel as bad as you ever have with a hangover, and the symptoms will last for a few hours.

Unlike new medications (Naltrexone and Acamprosate primarily), Disulfiram does not block your alcohol cravings, so when you start therapy, you may still really want to drink. For this reason, it has fallen out of favor because it simply creates negative symptoms when taken, as opposed to other medications that actively prevent the desire or craving to drink.

In studies where people didn't know if they got Antabuse or a placebo, both sets of people drank at the same rate. But in open studies, people who knew they got a prescription drank a lot less.[2] This further supports the idea that Disulfiram does not address cravings for alcohol, but simply serves as a deterrent for people who know they will feel sick if they do drink while taking it.

Antabuse seems to work best if you know the drug will make you feel sick while drinking. The fear of illness can help deter you from having a drink. However, this also means some individuals will simply give into cravings and intentionally skip taking their medication, making it less effective than a medication that actively prevents cravings. [3]

Can Antabuse Alone Cure Alcoholism?

For some people, yes, medications alone can be enough to maintain abstinence entirely. This depends heavily on the individual, their genetics, the degree of cravings or withdrawal they experience, and their social support. For others, behavioral therapy may need to be a part of the treatment process.[4]

Therapy, support group work, and other behavioral interventions can help - in addition to medications - to maintain abstinence. Medications are not a replacement for the hard work of recovery. But they can help.[5] 

3 Traits That Lead to Effective Antabuse Programs

Ideally, you should use disulfiram in conjunction with behavioral support. People that do the best with recovering from AUD usually have:

1. High Motivation

People who really want to stop drinking take Antabuse longer, and they tend to stay abstinent longer.[6] The more you can envision a life without alcohol, the more likely you are to be successful.  

2. Plenty of Support

It's hard to take your medication every day, and some people are tempted to skip doses and drink later. The more friends and family members you have to support you, the more likely you are to succeed: Studies suggest that people with good social support are more likely to take their Antabuse regularly. [7]

3. Clinical Supervision

Some programs require people to visit doctors or pharmacists for their doses rather than take the medication at home. Systems like this can be cumbersome, but they can ensure that people take their medications properly.[8]

If you think you'll be too tempted to skip your doses, a supervised system might be worth it for you!

Antabuse & Alcohol Use Disorder FAQs 

How successful is disulfiram use?

When taken properly under a doctor's supervision, Antabuse is considered a safe and effective treatment for alcoholism. It should be paired with therapy to ensure you can change your life as well as stop drinking. 

Does Antabuse work for everyone?

Unfortunately, Antabuse does not work for everyone. You must take Antabuse daily to prevent drinking, and some people simply skip doses if they know they are going to drink. If you're not really committed to abstinence and ready to do the work, Antabuse may not be right for you. There are, however, other medications like Acamprosate and Naltrexone that actually decrease cravings for alcohol use, which may be more effective. 

Can you get drunk while on Antabuse?

If you take your doses as directed, you may still experience symptoms of intoxication, but these will likely be accompanied by other very unpleasant side effects, in order to deter you from drinking. Moreover, if you skip your doses, you can get drunk. Compliance is critical.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Does Disulfiram Have a Role in Alcoholism Treatment Today? Addiction. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1360-0443.2004.00597.x. December 2003. Accessed June 2022.
  2. Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis. PLOS ONE. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3919718/. 2014. Accessed June 2022.
  3. Contingency Management in a Municipally Administered Antabuse Program for Alcoholics. Journal of Behavior Therapy and Experimental Psychiatry. https://www.sciencedirect.com/science/article/abs/pii/0005791673900347. March 1973. Accessed June 2022.
  4. Supervised Disulfiram's Superior Effectiveness in Alcoholism Treatment: Ethical, Methodological, and Psychological Aspects. Alcohol and Alcoholism. https://academic.oup.com/alcalc/article/52/2/213/2864434 March 2017. Accessed June 2022.
  5. Doctors' View of Disulfiram and Their Response to Relapse in Alcohol-Dependent Patients. African Journal of Primary Health Care and Family Medicine. https://journals.co.za/doi/abs/10.4102/phcfm.v8i1.1053. January 2016. Accessed June 2022.
  6. Long-Term Antabuse Treatment of Alcohol-Dependent Patients. Acta Psychiatrica Scandinavica. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0447.1992.tb03314.x. November 1992. Accessed June 2022.
  7. Antabuse Contracts for Married Alcoholics and Their Spouses: A Method to Maintain Antabuse Ingestion and Decrease Conflict About Drinking. Journal of Substance Abuse Treatment. https://www.sciencedirect.com/science/article/abs/pii/0740547286900024. 1986. Accessed June 2022. 
  8. ADRS Boardwide Community Pharmacy Disulfiram Service. NHS Greater Glasgow and Clyde. https://www.communitypharmacy.scot.nhs.uk/media/4709/disulfiram-guidance-v1-aug-2021.pdf. August 2021. Accessed June 2022.

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