WHAT IS DISULFIRAM THERAPY FOR ALCOHOLISM?

Introduction

Alcohol dependence has been recognized to be a chronic relapsing illness and the desired goal of long-term abstinence often remains elusive. The chances of relapse are more in the first few months of abstinence. Hence detoxification alone may not be enough and the treatment needs to be continued for an extended period to achieve long-term abstinence.

This phase of treatment, termed the 'maintenance phase' is often difficult and challenging. Several psychosocial and pharmacological modalities have been used in the maintenance phase. One of the most important pharmacological modality is the use of deterrent therapy. Disulfiram is the most widely used medication for such therapy.

The following protocol gives the guidelines to be followed during introducing patients to disulfiram and subsequent follow up.

Rationale for use.

Disulfiram is used as an aid in the management of alcohol dependent individuals who want to remain in a state of sobriety, but are unable to maintain an abstinent state. It acts as a deterrent and helps in delaying the decision to drink if motivation reduces temporarily. Disulfiram should be used in conjunction with supportive and psychotherapeutic interventions for the best results.

Substantial literature has been generated on the use of disulfiram in alcoholism, but the number of controlled clinical trials is limited. There is little evidence that disulfiram enhances abstinence, but there is evidence that disulfiram reduces drinking days especially in patients with supervised therapy. Studies have also suggested that the use of a 'disulfiram contract' is an effective approach to enhance adherence and maintain abstinence.

Used alone, without proper motivation and supportive therapy, disulfiram is unlikely to have more than a brief effect on the drinking pattern. The therapy is more successful if disulfiram is used for an extended period of time. Among several measures, compliance is a strong predictor of outcome.

What is the Side effects of Disulfiram?

 Common - Transient mild drowsiness, fatigue, impotence, headache, acneiform eruptions, allergic dermatitis and a metallic or garlic-like aftertaste may be experienced during the first 2 weeks of therapy. These complaints usually disappear later during therapy or with reduced dosage.

  

Induction

Setting - Disulfiram can be started in the outpatient as well as inpatient setting.

What is the duration of disulfiram therapy ?

Usually disulfiram therapy should be continued for a period of 6 to 9 months till the time the patient feels confident to abstain from alcohol without the need for treatment for the same, the risk for relapse has been reduced and patient is rehabilitated. However, in some patients, the therapy would have to continue for a longer period of time. Patients neither develop tolerance to disulfiram nor to the disulfiram ethanol reaction.

During this time, he is expected to be able to master the coping strategies necessary to deal with difficult situations without resorting to alcohol.

Disulfiram alcohol reaction .

Disulfiram plus alcohol may produce reactions. Even a small amount of

alcohol taken while on disulfiram may produce redness of the face, throbbing in the head and neck, headache,breathing difficulties, stomach distress, vomiting, sweating, thirst, chest pain, fast heartbeat, faintness,marked uneasiness, weakness, sensation of surroundings revolving around you, blurred vision, and confusion. Rarely in severe reactions, there may be a decrease in breathing, shock, acute heart failure,

unconsciousness, convulsions, and death.

What is the Side effects ?

 Side effects of disulfiram taken alone may include drowsiness, numbness in extremities,metallic taste, and/ or allergic skin reaction. Liver damage is an uncommon reaction.