Disulfiram (Antabuse) – unfashionable but effective alcohol treatment
Approved by the USA as an alcohol treatment in 1951, disulfiram has suffered from a reputation as a dangerous medication only suitable for highly motivated and strictly supervised drinkers who totally avoid alcohol, and therefore too the aversive physical reactions the drug causes after drinking. But experience has shown that at currently recommended doses it is acceptably safe and, in the right circumstances, a drug chosen and taken by many severely dependent drinkers seeking to sustain abstinence.

Stimulated by the first systematic synthesis of research (first entry below), this bulletin focuses on new and seminal disulfiram research from the UK and overseas available in the Effectiveness Bank. This work both shows that it can be an effective aid for many drinkers, and also exemplifies its key weakness - that without the right support and motivation, most patients simply stop taking or never take the tablets.

• The efficacy of disulfiram for the treatment of alcohol use disorder.
Jørgensen C.H., Pedersen B., Tønnesen H. Alcoholism: Clinical and Experimental Research: 2011, 35(10), p 1–10.
Under effective supervision from family or clinicians to sustain compliance with taking the tablets, the drug disulfiram which produces an unpleasant physical reaction to drinking does act as an aid to abstinence in the treatment of alcohol dependence.

• Audit of alcohol detoxification at Leeds Addiction Unit.
Rana A., Luthra V., Wazir M.N.K. et al. Drugs and Alcohol Today: 2012, 12(1), p. 45–50.
In a specialist hospital unit in Leeds, virtually all the alcohol dependent outpatients completed detoxification and all but a few went on to try to sustain their drinking reductions using the aversive medication disulfiram, indicative of what can be achieved in these settings.

• Disulfiram in severe alcoholism – an open controlled study.
Ulrichsen J., Nielsen M.K., Ulrichsen M. Nordic Journal of Psychiatry: 2010, 64(6), p. 356–362.
From Denmark a randomised trial of disulfiram in the treatment of alcohol dependence reveals the major weakness of the treatment - that among some sets of patients, few will consistently take tablets they know will cause unpleasant effects if they drink.

• Disulfiram treatment of alcoholism.
Chick J., Gough K., Falkowski W. et al. British Journal of Psychiatry: 1992, 161, p. 84–89.
Still relevant today, from the early 1990s this UK randomised trial of disulfiram in the treatment of alcohol dependence found that, given daily supervision to make sure patients took tablets they knew would cause unpleasant effects if they drank, the effect was to significantly reduce drinking.