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Does Antabuse Cure Alcoholism?

No, Antabuse does not cure alcoholism, but it can help people control their use of alcohol.

Antabuse (disulfiram) is designed for people who wish to stop drinking. There is no cure for alcoholism.

A Brief History of Antabuse

The first effects of disulfiram on those who drink alcohol were observed in people who worked in the vulcanized rubber industry. They were exposed to the drug and then became ill after they drank alcohol after work.

Disulfiram, the active ingredient in Antabuse, became involved in research studies as a potential treatment for alcoholism (alcohol use disorder) in the 1940s to 1950s. Early research used very high doses of the drug, which were potentially dangerous.

In the 1950s, the U.S.Food and Drug Administration (FDA) approved the use of disulfiram for the treatment of alcohol abuse. It remains one of the few medications that are formally approved by the FDA to treat alcohol abuse.

Later in the 1950s, it was decided that smaller doses should be used to treat alcohol use disorder and that patients who had liver damage or cardiovascular disease should not use the medication. Currently, much smaller doses of the drug are used medicinally.

The Justification of Using Antabuse

Antabuse works on the principle of aversion therapy. This psychological method borrows heavily from the principles of behaviorism.

By making the consequences of a particular action aversive (punishing), aversion therapy reduces the likelihood that the person will repeat that action. For instance, if you burn your hand when you touch a hot burner on a stove, you will be less likely to touch a hot burner again. Likewise, if you drink alcohol and become violently ill immediately after drinking, you will be less likely to drink alcohol again.

Aversion therapy is based on the notion that being punished after you perform some type of behavior will result in you being less likely to repeat that behavior. The punishment works best if:

How Aversion Therapy Works

  • It immediately follows the behavior.
  • You associate the effects of the punishment with the behavior.
  • You cannot avoid the punishment if you continue the behavior.
  • You have no way of getting around the effects of the punishment.

What Is the Reaction Between Alcohol and Disulfiram?

When you drink, the liver uses a process to break down alcohol. Alcohol is metabolized into a substance known as acetaldehyde. An enzyme in your brain and liver that is known as aldehyde dehydrogenase oxidizes the acetaldehyde into acetic acid, further breaking it down. Disulfiram blocks this process, leading to a buildup of acetaldehyde in your system.

Acetaldehyde is toxic. This leads to the effects you will experience if you drink after you have been taking Antabuse.

What Happens if You Drink on Antabuse?

  • You will feel warm, and your skin will become red and flushed, especially on your face and upper chest.
  • You may hyperventilate.
  • You will become nauseous and vomit.
  • You may experience an extreme headache and become very thirsty.
  • You may have a rapid or irregular heartbeat.
  • You may have chest pains.
  • You may become dizzy.
  • You may become confused.

The symptoms can be serious in some people, especially when high doses are taken. Some people may develop seizures or even a heart attack if they take very high doses of the drug and then drink alcohol. People who have liver damage are at risk to develop severe complications if they use Antabuse.

The dose given today is small enough that most Antabuse complications are typically not a problem. Physicians will monitor individual reactions to the drug.

Then and Now

When Antabuse was first prescribed for the treatment of alcohol use disorders, physicians were under the assumption that the patient needed to actually experience the effects of the drug first for it to work. 
Thus, if you were prescribed Antabuse in the early 1960s, a physician might have you take the medication and then drink alcohol to drive home the consequences of drinking while you are on the drug. This may seem cruel, but it also was effective. This practice is no longer followed.

Instead, physicians instruct patients on the effects they will feel if they drink alcohol while they are using the drug. Then, patients are expected to take the medication daily.

Does Antabuse Work?

Numerous studies have suggested that Antabuse can reduce alcohol intake in people with alcohol use disorders or alcohol-related legal issues. A recent review of the literature in 2014 concluded that Antabuse was more effective than a placebo in reducing alcohol use.

Many people

What Are the Best Conditions to Make Antabuse Effective?

Based on the research findings, Antabuse might be effective for you if you:

  • Have abstained from alcohol for at least 12 to 14 hours
  • Are committed to remaining abstinent
  • Are actively involved in a formal substance use disorder treatment program, including therapy and peer group participation.
  • Do not have a form of mental illness that affects your ability to make decisions or results in significant cognitive impairment

What Are the Problems With Antabuse?

People taking Antabuse can stop taking the drug one or two days before they plan to drink alcohol. This will result in the effects of the drug being minimal.

Compliance with taking the drug regularly and a commitment to abstinence have long been recognized by research studies, even decades ago, as being the major issues associated with the drug’s effectiveness. Numerous research studies have found these to be major problems associated with the drug. This is the reason why individuals who use Antabuse should also be in structured treatment programs. 
There are potential side effects to the drug. As mentioned above, people with liver damage may not be able to use Antabuse, and this includes those who have cirrhosis of the liver due to heavy alcohol use.

In the past, when higher doses of the drug were prescribed, there was the potential for serious side effects to occur in many users. However, in today’s environment, the side effects for most people are mild. Severe effects or fatalities as a result of Antabuse use are rare.

A Short-Term Solution

There is no cure for alcohol use disorder in the sense that someone can take a medication or engage in therapy and then no longer be worried about relapsing.

Antabuse is commonly prescribed for short-term use in individuals, and very few people remain on the drug indefinitely. Simply taking Antabuse will not address the issues that drove your addiction in the first place, reduce your cravings to drink alcohol, deal with triggers that intensify your cravings, and solve all the other issues in your life that you used as a reason to drink alcohol.

You can stop taking Antabuse at any time and go back to drinking alcohol if you decide to do so.

Can Antabuse Be Useful?

There is no doubt that Antabuse can help some people in recovery, particularly those who need some type of assurance that if they drink any amount of alcohol, they will suffer immediate and uncomfortable consequences.

It may give confidence to some in recovery. If you are caught up in the legal system as a result of your alcohol use, you may find that judges and probation officers are more confident in your commitment to change your behavior if you use Antabuse.

But using Antabuse does not guarantee that you will not relapse or that you will never go back to drinking.

Antabuse is not considered to be a primary treatment approach for an alcohol use disorder, but it may be useful as an adjunctive treatment that can assist a formal recovery program. You need to remain actively involved in first-line treatments for years before your risk of relapse declines significantly.

Sources

(January 2019). Antabuse. RxList. from https://www.rxlist.com/antabuse-drug.htm

(January 2015). Tracing the journey of disulfiram: From an unintended discovery to a treatment option for alcoholism. Journal of Mental Health and Human Behaviour. from http://www.jmhhb.org/article.asp?issn=0971-8990;year=2015;volume=20;issue=1;spage=41;epage=43;aulast=

(2019). Aversion Therapy. Britanica.com. from https://www.britannica.com/science/aversion-therapy

(June 2018). Antabuse Treatment for alcoholism. Very Well Mind. from https://www.verywellmind.com/antabuse-treatment-for-alcoholism-67506

(February 2014). Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis. PloS One. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3919718

(February 1992). Techniques to enhance compliance with disulfiram. Alcoholism: Clinical and Experimental Research. from https://psycnet.apa.org/record/1993-27126-001

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