Disulfiram for Alcohol Treatment

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Treating Alcohol Use Disorder With Disulfiram

If you are suffering from alcohol use disorder, or AUD, then you might be wondering what treatment options are available. Some people find individual therapy to be most helpful while others go to group therapy or 12-step groups to get support from others.

There’s also the medication route. There are several medications that can either reduce cravings or any pleasurable feelings associated with alcohol. One such medication is disulfiram, or Antabuse. It has been shown to be very effective, but there are pros and cons to be aware of.

What Is Antabuse?

Antabuse is a medication that is most frequently used in treatment for those with AUD. There are several medications that have been approved by the Food and Drug Administration (FDA) for alcohol treatment. What many people don’t know is that Antabuse was actually the first medication created for this purpose.

Some medications for alcohol reduce cravings, so you might be wondering how Antabuse works. This medication reduces cravings by making drinking unpleasant. If used regularly, then this is thought to replace your pleasurable feelings associated with alcohol with feelings of discomfort.

How Does Antabuse Feel?

Because Antabuse makes drinking uncomfortable, this is supposed to reduce your cravings as alcohol as it will no longer provide the same feel-good sensations. That being said, you might be wondering what Antabuse feels like.

If you take it and there is no alcohol in your system, then you won’t notice a difference. It doesn’t affect your body at all. Things are very different if you drink, however.

The symptoms you can expect to feel include the following:

• Flushing
• Nausea and vomiting
• Sweating
• Headaches and neck pains
• Respiratory difficulty, but this shouldn’t be significant enough to require medical attention
• Low blood pressure
• Weakness
• Confusion
• Blurred vision

If you think that this sounds awful, you’re right. This is how Antabuse works. It makes drinking intolerable. Many people find it incredibly difficult to ignore these symptoms, which causes them to immediately stop drinking. Some people believe that this can encourage a permanent change. These symptoms last around 30 minutes to several hours for most people.

Many people are worried about their first dose of Antabuse or returning to it after a relapse. While each body is different, it’s suggested that you stop drinking for a minimum of 12 hours before taking this medication.

It will also last for several weeks in the body. Even drinking a few days after taking your last Antabuse dose can cause a reaction. Both starting and stopping this medication is best done under medical supervision.

Avoid Products With Alcohol

Obviously, you can’t drink alcohol on Antabuse unless you’re willing to suffer from the side effects. You might be wondering what happens if you use products with alcohol. For example, many sauces, medications, and vinegars have a small to moderate amount of alcohol. Is it a small enough amount that Antabuse won’t hurt you?

The unfortunate truth is that Antabuse is effective even with very small amounts of alcohol, so chances are that products with alcohol will cause the side effects. They tend to scale with the amount of alcohol, but it can still be unpleasant. If you have a very small amount of alcohol, then the side effects usually aren’t as bad as drinking a glass or bottle of alcohol.

Be sure to read the label before using products. This is incredibly important when you first start using Antabuse because chances are that you’re using these products without knowing it. This includes many food items, mouthwash, medications, aftershave, sauces, desserts and much more.

Even though the reaction might be reduced if there is only a small amount of alcohol, it’s in your best interest to ensure that all products you use contain zero alcohol.

What Form Does Antabuse Come In?

Antabuse only comes in tablets, but there are several different strengths that are available. While some people swallow the tablets, you can also crush the pills and mix them with liquid like coffee, water, milk or juice.

While your doctor will ultimately determine how much you need, this is most commonly taken once a day. Be sure to follow your doctor’s instructions though to ensure the medication is effective.

Is Antabuse Effective?

Before embarking on any new treatment option, you want to know if it’s effective. Can Antabuse help stop your alcohol use, and how effective is it overall?

By the Numbers

There are various studies on this subject. Even larger meta-studies, or studies that combine the results from various other studies, have found that Antabuse is very effective when it comes to reducing alcohol use.

Depending on the study, Antabuse has been found to be around 50% effective and sometimes up to 70% effective in control studies and while in treatment centers. Those who take the medication longer also tend to have a better success rate in terms of long-term abstinence. Many people consider 20 months the ideal amount of time.

Does Not Reduce Cravings

One important thing to keep in mind is that Antabuse does not biologically reduce cravings. The primary action of Antabuse is that it makes drinking uncomfortable. While that might reduces cravings for some, others will go back to drinking after they stop using this medication. This is largely why 20 months or more is considered essential for this medication to work.

Another drawback is that while Antabuse works for about two weeks or so after your last dose it will stop working after this point. Some people will go back to drinking because there is no fear of the side effects. While there is a chance that medication can change your behavior, it’s often best to think of this as a supplement to your overall treatment.

Therapy can help target your behaviors and help you find ways to change them. Antabuse is a barrier that will prevent you from drinking in the moment, but many people need extra treatment for it to be truly effective.

Second-Line Treatment

Another important thing to keep in mind about effectiveness is that Antabuse is considered a second-line treatment. This means that it’s often used if first-line treatment options aren’t working.

In terms of medication-assisted treatment for alcohol use, the first-line treatment options are naltrexone and Acamprosate. The primary reason why these are used first is that they reduce cravings on a biological level. Many people find that they no longer want to drink once having these medications; Antabuse, on the other hand, creates feelings of discomfort and disgust when using alcohol.

Another reason is that Antabuse isn’t considered as safe as the other treatment options. Keep in mind that this medication intentionally creates significant side effects from drinking alcohol. Having a high dose of medication along with drinking a significant amount of alcohol can create very severe side effects.

Other Treatment Options

When it comes to any substance use, whether it be drugs or alcohol, it’s best to take advantage of all the available resources. Some people think that they can only use one treatment option at a time, but it’s often best if you combine several different treatment options.

Antabuse is considered medication-assisted treatment, or MAT. This term is more frequently associated with opioid use and medications like methadone and suboxone, but it’s also commonly used with alcohol use. While Antabuse may be effective on its own, it’s even more effective with other forms of treatment.

The other treatment options help you discover your unique pattern of use, triggers and cravings. They also help you find support with like-minded peers who are looking to recover from drug and alcohol use.

Group Therapy

Group therapy, especially when combined with MAT and psychiatric medications, has been shown to be very effective in reducing alcohol use. There are several different types of groups, depending on how much clinical time you need.

If your use is relatively mild and you don’t have legal involvement, then you might have a one-hour group therapy session once a week. This gives everyone time to check-in and support one another. You will also learn more about your unique pattern of use and coping skills.

However, many people need intensive outpatient, or IOP, groups. These groups have three meetings per week, and each one lasts three hours. You will also have a one-hour individual session with your counselor for a total of 10 clinical hours per week.

This is designed more for moderate-to-severe alcohol use, and many clients are there for legal reasons. Others come willingly to treatment. These groups last longer in order to give you more recovery time. The longer period gives you more time to learn more about your use and new ways to modulate your stress.

Individual Therapy

Some people find that weekly individual therapy is enough to help reduce their use. While every therapy and client are different, most agree that the most effective modalities here are cognitive-behavioral therapy and motivational interviewing, or CBT and MI respectively.

CBT takes a two-prong approach to help you understand and change your thoughts and behaviors. MI helps the therapist draw out “change talk” from you to enhance your motivation to remain sober. Both of these are often used in conjunction with substance use as they directly impact your specific reasons for using while helping to keep your motivation up throughout the process.

Both of these methods can be used in group therapy, too, but some clients prefer the privacy of an individual session. Another benefit is that you can often get into deeper issues with these sessions.

Many clinics that implement group therapy also include individual sessions as well. This allows you to reap the rewards from both group and individual therapy.

Self-help Groups

Antabuse also works well with self-help groups such as 12-step groups or Alcoholics Anonymous. While this is a group, it shouldn’t be confused with group therapy.

Group therapy is led by a trained therapist whereas self-help groups typically don’t have clinical staff. Group therapy maintains a more formal client-therapist relationship while self-help groups foster friendships and sponsorships between members of different recovery levels. There are pros and cons to both of course, so it’s often best to implement both in your recovery. One of the best things is that these groups are often very easy to find, they’re run at different times of the day and they can give you the support you need when you need it.

There are many options for recovering from alcohol use. While Antabuse is one MAT option, there are other MAT options along with other treatment options in general that can help you. It’s all about finding the right one that works for you. Antabuse is useful because it creates uncomfortable physical symptoms when you ingest alcohol, which might be exactly what you need to recover. Be sure to speak to your treatment team in order to find the right recovery options for you.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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