Do you think that you or someone you love may have a problem with alcohol abuse? Alcohol use disorder, commonly referred to as AUD, is characterized by compulsive drinking habits that become a source of distress and harm to self and others. Those diagnosed often experience symptoms that range from mild, moderate, to severe. A few of the most common signs of AUD are:

  • Uncontrollable need to drink frequently
  • Inability to stop drinking or limit alcohol intake
  • Higher alcohol tolerance developed over time
  • Risky or potentially destructive behaviors
  • Onset of mental and physical withdrawals in the absence of alcohol

AUD is likely more prevalent than you may realize. According to the National Institute of Alcohol Abuse and Alcoholism (NIH), around 16 million people in the United States alone have been diagnosed with the disease. Anyone can be affected, regardless of age, gender, ethnicity, body type, and personal beliefs. NIH also estimates that alcohol misuse is responsible for a total of 88,000 deaths per year, making it one of the leading causes of preventable death in the nation.

While consuming too much alcohol can result in risky behaviors that increase the potential for injury or death, it also leads to several medical problems. According to the Centers for Disease Control and Prevention, heavy drinkers are also more prone to developing certain cancers, chronic diseases, learning problems, and memory issues. Prolonged use of alcohol also increases susceptibility to mental health issues and causes irreparable damage to the liver and brain.

It’s important to realize, however, that AUD isn’t a choice you or your love one makes. AUD is a chronic relapsing brain disease that must be diagnosed by a professional healthcare practitioner. If you or a loved one is struggling with alcohol addiction, speak with a trained healthcare physician right away.

While AUD is an extremely complex and dangerous disease, it can be overcome with proper treatment. Most specialists recommend recovery plans that include participation in therapy and mutual-support group sessions, but certain medications have proven useful in AUD treatment as well. The three medications most commonly prescribed are naltrexone, acamprosate, and disulfiram.

What is disulfiram?

Disulfiram, branded as Antabuse, is a drug that’s been used to treat AUD for the last 60 years. In fact, it was the first medication to be approved for use during alcohol treatment in the United States. With many AUD specialists and physicians prescribing disulfiram to help maintain sobriety, it’s estimated that approximately 200,000 people take the drug regularly.

While there is no cure for AUD, disulfiram does discourage drinking. It is an alcohol-adversive agent and causes an extremely adverse physical reaction when mixed with alcohol.

In its purest form, disulfiram is a mostly white and essentially tasteless powder. It’s commonly distributed in pill form. Because disulfiram is water and alcohol soluble, however, patients can crush the tablets and mix them in water, coffee, tea, milk, fruit juice, or a soft drink.

How is disulfiram used in treating alcoholism?

Disulfiram is frequently prescribed in conjunction with therapy to help eliminate alcohol consumption in AUD patients. Those taking this drug on a daily basis will experience significantly unpleasant effects when any amount of alcohol is consumed. Negative reactions to drinking develop quickly, with symptoms showing as little as ten minutes after alcohol has entered the system and lasting an hour or more. The ultimate goal of disulfiram is to discourage drinking and encouraging abstinence; patients will learn to actively avoid contact with alcohol in order to prevent the unpleasant effects of the drug.

It’s possible for a response to trigger after merely breathing or touching products like lotions, colognes, disinfectants, cough syrups, paints, paint thinners, and shellacs that contain alcohol in them. While the impact may be minor - a mild headache, nausea, local redness, or itching - it’s imperative that patients take precaution once disulfiram has been prescribed.

Not everyone struggling with addiction should take disulfiram. Only those who can go a minimum of 12 initial hours without alcohol, are committed to abstaining in the future, and agree to take the medication are suitable candidates. In general, physicians assess those suffering with AUD carefully and closely before offering disulfiram as a potential option. The following steps must be taken prior to a prescription approval.

  • Education. Those interested in disulfiram must be educated thoroughly on the drug, the way it works, and how they might be impacted.
  • Consent. Patients must formally consent to taking disulfiram, as intent to abstain from alcohol consumption completely is required.
  • 12 Hour Abstinence Period. Due to the severe reaction disulfiram causes when alcohol is in the system, new patients are required to abstain for 12 hours before taking their first dose. A blood alcohol level of zero is necessary.
  • Physical Exam. Physicians will perform a physical exam to assess liver and kidney function prior to writing a prescription for disulfiram. Women must also be tested for pregnancy and will be questioned about breastfeeding.
  • Medical History. In addition to a physical exam, patients must also complete a full medical and psychiatric history. This can vary from person to person, but will likely include determining allergies, noting current prescriptions taken, and discussing any family history of cardiovascular disease, diabetes, thyroid disease, seizure disorder, central nervous system impairment, or kidney or liver disease.

Research has shown that prolonged use of disulfiram will not result in a tolerance to the drug. Taking the prescribed does daily is recommended until long-term alcohol abstinence has been established. For some, this process may take months or even years.

How does disulfiram work?

Disulfiram works differently than other medications used to treat AUD. While most drugs of this kind affect brain opiate, y-aminobutyric acid, and glutamate receptors, disulfiram does not. It does, however, have some impact on the central nervous system, inhibiting enzyme dopamine β-hydroxylase and affecting serotonergic function.

Whether disulfiram directly decreases a patient’s urge to drink is still widely debated, but it is clear that the drug does effectively interrupt the body’s ability to metabolize alcohol properly. This is why such a severe reaction to drinking results.

When patients taking disulfiram consume alcohol, the drug prevents certain enzymes from oxidizing and the result is called a disulfiram-alcohol reaction. It doesn’t take long for this to occur, symptoms showing up as little as 10 minutes after alcohol has been introduced into the system. The amount of alcohol consumed will usually dictate the severity of the reaction, ranging from mild to severe.

In milder cases, those suffering from a disulfiram-alcohol reaction may feel the effects for 30 to 60 minutes. Symptoms include:

  • Sweating, warmth, and flushing, particularly on the upper chest and face
  • Hyperventilation, respiratory difficulty, or dyspnea
  • Acetaldehyde breath odor
  • Blurred vision
  • Throbbing in head and, or neck
  • Thirst
  • Nausea and, or vomiting
  • Chest pain and, or palpitations
  • Hypotension
  • Tachycardia
  • Vertigo
  • Syncope
  • Marked uneasiness
  • Confusion
  • Weakness

The duration of a more severe disulfiram-alcohol reaction can be up to several hours. In extreme cases where large amounts of alcohol have been consumed while taking disulfiram, the following effects are possible:

  • Respiratory depression
  • Cardiovascular collapse
  • Arrhythmia
  • Myocardial infarction (in those with preexisting coronary artery disease)
  • Acute congestive heart failure (in those with preexisting myocardial dysfunction)
  • Seizures
  • Unconsciousness
  • Death

It’s important to note that discontinuing use of disulfiram doesn’t mean the body will be able to process alcohol effectively right away. It can take up to two full weeks before the drug’s effects wear off.

Side effects of disulfiram

There are a number of side effects that can present when taking disulfiram. While these will often remain mild and subside on their own, it’s important to speak with a healthcare professional if they become severe or persist for long periods of time. Side effects include:

  • Skin rash
  • Acne
  • Mild headaches
  • Drowsiness
  • Tiredness
  • Impotence
  • Metallic taste or garlic-like taste in the mouth

In rare cases, more serious side effects can develop. Talk to your doctor immediately if you notice any of the following:

  • Excessive tiredness
  • Weakness
  • Lack of energy
  • Loss of appetite
  • Upset stomach
  • Vomiting
  • Yellowness of the skin or eyes
  • Dark urine

Professional health practitioners will often conduct a basic examination and run various lab tests to better predict individual responses to disulfiram. It’s also recommended that patients carry an identification card stating that they are currently taking disulfiram in case of an emergency.

Getting treatment for AUD

Do you think disulfiram may be an appropriate treatment method for you or a loved one with AUD? Answering these questions may help:

  • 1

    Have you consumed alcohol in the past 12 hours?

  • 2

    Are you motivated and committed to pursuing total alcohol abstinence?

  • 3

    Have you read and do you understand the consequences of drinking alcohol while taking disulfiram?

  • 4

    Are you willing to undergo supervised treatment and dosing?

  • 5

    Can you maintain abstinence throughout your entire treatment?

  • 6

    Are you medically fit to take disulfiram?

Living with AUD is difficult, but help is readily available. Contact a treatment specialist today to discuss your individual situation and determine whether incorporating disulfiram into your recovery plan will be effective.