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Disulfiram: A Solution to Alcoholism???

By: Shawnette K. Adams

date: 11/16/2005

 

Introduction:

 

According to the Center for Disease Control, alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. Alcoholism is characterized by continuous or periodic incidences: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol use despite adverse consequences, and distortions in thinking, most notably denial.

 

Alcohol has many consequences that impact the mind, the spirit and the physical body. The most obvious effects are visible through the body's reaction. Alcohol affects people in various ways depending on the person, but there are universal reactions of which one must be aware. Alcohol is a central nervous system depressant. A depressant is a substance that lowers the vital physiological activities. It is rapidly absorbed from the stomach and small intestine, passes into the bloodstream, and is then widely distributed throughout the body. Food in the stomach slows the intake of alcohol into the bloodstream.

 

The effects of alcohol on the body are directly related to the amount consumed. In small amounts, alcohol can have a relaxing effect. Adverse effects of alcohol can include impaired judgment, reduced reaction time, slurred speech, and unsteady gait (i.e., difficulty walking). When consumed rapidly and in large amounts, alcohol can also result in coma and death. Additionally, alcohol can interact with a number of prescription and non-prescription medications in ways that can intensify the effect of alcohol, of the medications themselves, or both. Combining alcohol and any other type of drug, regardless of prescription or non-prescription, is strongly contested. Furthermore, alcohol use by pregnant women can cause serious damage to the developing fetus. http://www.cdc.gov/alcohol/faqs.htm

 

Brief Alcohol Statistics:

 

     In 2002, 54.9% of U.S adults (18 years and older) reported drinking at least one drink in the past month.

 

     In 2001, there were approximately 1.5 billion episodes of binge drinking in the U.S. Binge drinking rates were highest among those aged 18 to 25 years; however, 70% of binge drinking episodes occurred among those aged 26 years and older.

 

     Binge drinkers were 14 times more likely to report alcohol-impaired driving than non-binge drinkers.

 

     In 2003, 44.9% of 9th through 12th graders reported drinking alcohol on one or more of the past 30 days; prevalence of current drinking was higher for females (45.8%) than among males (43.8%).

 

     Alcohol use is a leading risk factor in the three leading causes of death among youth: unintentional injuries (including motor vehicle crashes and drowning); suicides; and homicides. Other adverse consequences of underage drinking include risky sexual behavior and poor school performance.

http://www.cdc.gov/alcohol/factsheets/general_information.htm

 

 

 

 

 

 

 

 

 


What is Disulfiram and how does it work?

 

Antabuse is the generic name for a drug called disulfiram, which is thought of an extremely powerful deterrent to drinking alcohol. A metabolic change occurs that causes severe, temporary toxicity. It causes unpleasant effects when even small amounts of alcohol are consumed. These effects include flushing of the face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety. These effects begin about 10 minutes after alcohol enters the body and last for 1 hour or more. This drug is only prescribed by a physician and is not sold over-the-counter.

 

What are the side effects?

As with any drug, the effects of overdosing on disulfiram can be fatal. Symptoms of overdose include memory loss, behavior disturbances, lethargy, confusion and headaches, nausea, vomiting, stomach pain and diarrhea, weakness and unsteady walk, and temporary paralysis. A common side effect is drowsiness. Infrequent effects include eye pain, vision changes, abdominal discomfort, throbbing headache, numbness in hands and feet, mood change, decreased sexual ability in men, tiredness, and bad taste in mouth. A very rare side effect is jaundice and rash. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682602.html

Claims made and supported evidence?

Through research with clinical trials, disulfiram is found to be effective, but only when the drug is administered under the supervision of another. One cannot rely on the patient to take the medication on his/her own accord. Disulfiram treatments, found in clinical trials, may work best in concurrence with therapeutic treatments or psychological counseling.

What does the research tell us?

In 2004, Richard Fuller and Enoch Gordis investigated the question of whether a medication that acts indirectly to deter drinking has a role in contemporary alcoholism treatment. Most of today's alcohol treatments work directly on the biological processes of the body. The early clinical trials showed that disulfiram prescribed for patients to take at their discretion has limited effectiveness. The multi-study was strongly criticized for the fact that it was known that adherence to disulfiram was poor if the patients were trusted to take it on their own and that the more appropriate method would be for the clinical staff or a relative to observe the ingestion of disulfiram.

 

A 1992 randomized clinical trial of 126 participants compared the supervised administration of 200 mg of disulfiram and the supervised administration of 100 mg of vitamin C. The trial found significantly less drinking with those who had disulfiram. It was also found that the dosage given (250 mg) is not enough to produce a disulfiram-ethanol reaction (DER) in the patients. When disulfiram was first used, 1000-3000 mg doses per day were effective, but clinical trials have concluded that there is much less toxicity of the DER with the 250 mg dosage. A practitioner would need to balance the dose of disulfiram between 250 mg and 500 mg. Depending on the patient, the amount must be enough to produce a DER, but not enough to increase the risk of toxicity.

 

The most common side effect/adverse reaction that was found is drowsiness. This can be resolved by having the patients take the disulfiram at night. A major concern with disulfiram is that there is a possibility of liver disease that could result in death. Liver function tests should be administered before the treatment begins. One must way the efficacy of the medication and the seriousness of the illness versus the toxicity of the drug. The decision to commence treatment is held in the hands of the patient, of course, with all of the essential information provided by the physician.

 

Some alcoholics are prescribed antidepressants for major depression, but these should not be taken in conjunction with disulfiram. Disulfiram interferes with the antidepressants' pharmacokinetics. Research has been conducted on each drug independently, but there are no reports about whether a combination of the two has been safely used.

 

Fuller and Gordis found that certain patients will benefit from taking disulfiram as a treatment for alcohol. Older patients may do better with taking their medication unsupervised, as will more socially stabilized patients, impulsive patients, and those in higher motivation. Also, those who are doing poorly with treatment, but want to continue in treatment with benefit.

 

In response to Fuller and Gordis's journal article, Hannelore Ehrenreich and Henning Krampe believe that due to the conclusion that only supervised administration of deterrent medication has beneficial treatment effects, then there are psychological processes underlying disulfiram treatment. Ehrenreich and Krampe have developed and investigated a new treatment approach, integrating disulfiram successfully into outpatient long-term intensive therapy for severe alcoholics. Repeated explanation of the action of disulfiram by the therapist followed by repetition of the acquired information is a precondition for the deterrent effect. It makes the habit unnecessary and provides some kind of autosuggestion. The therapist informs the patient of the consequences of drinking alcohol after taking disulfiram and the patient must then decide actively against alcohol or sobriety in front of a witness. During this therapeutic ritual, the therapist praises the patient for choosing sobriety and taking the disulfiram. This provides a continuous reinforcement of a new, sober lifestyle. Incorporating disulfiram and practicing a new lifestyle may be seen as an important step to recovery from alcoholism.

 

Conclusion

 

Alcoholism, as many may not think, is a disease and has various methods of treatment. Not all treatments will work and not every treatment will effect different people in the same manner. More investigation and clinical trials need to be conducted in order to utilize disulfiram in the safest, most effective way. For now, it is most effective when taken under the direct supervision of a physician or therapist. Future research will provide additional, safer treatments for those battling alcoholism. All hope is not lost for those who are suffering!!!

 

 

 

 

 

 

 

 


References

 

Ehrenreich, Hannelore & Krampe, Henning. (2004). Does disulfiram have a role in alcoholism treatment today? Not to forget about disulfiram's psychological effects. Addiction, 99, 26-27.

 

Fuller, Richard K., & Gordis, Enoch. (2004). Does disulfiram have a role in alcoholism treatment today?. Addiction, 99, 21-24.

 

MDAdvice gives general information about disulfiram including side effects, dosage and usage information, warnings and precautions, possible interactions with other drugs and substances, etc.

http://www.mdadvice.com/library/drug/drug163.html

 

Shawnette K. Adams, Vanderbilt University- Nashville, Tennessee

Health Psychology 268; September 22, 2004

 

 

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