Disulfiram (or tetraethylthiuram disulfide) is a derivative of thiuram and was originally used for vulcanization processes in the rubber industry.

Disulfiram is normally described as a deterrent or alcohol-sensitizing drug. It is often mistakenly referred to as aversion therapy ( - aversion therapy typically involves the repeated pairing of a target behavior with unpleasant stimuli, such as electric shocks ).

Disulfiram was first introduced as a treatment for alcohol dependency in 1948. It has also been used in the treatment of psoriasis, scabies, nickel allergy and hypertension.

Disulfiram acts by blocking the activity of the liver enzyme aldehyde dehydrogenase (A.L.D.H.). This produces a build up of acetaldehyde (a toxic substance) when alcohol is consumed. This results in the disulfiram-ethanol reaction (D.E.R.).

Symptoms occur within 5 to 15 minutes and include including tachycardia (increased heart rate), palpitations, nausea, vomiting, headache, dyspnoea (breathing difficulties) and facial flushing. The severity of the symptoms appears related to both the dose of disulfiram and the amount of alcohol consumed.

The treatment of a D.E.R. may involve the use of ascorbic acid, chlordiazepoxide and / or sodium metabisulphate.

Tests conducted prior to prescribing disulfiram include a full physical examination, liver functions tests, full blood count, electro-cardiograph, blood pressure and pulse.

Alcohol challenge tests (i.e. the use of alcohol to produce a “test” reaction) are not now recommended due to the possible health risks.

It is usually recommended that treatment should not be commenced until after detoxification has been completed – so that the patient may make an informed and rational decision regarding treatment.

Prior to commencing treatment the patient should be fully briefed regarding the D.E.R. Informed consent forms are used by many treatment agencies.

Disulfiram is contra-indicated in cases of cardiac failure, C.V.A. (stroke), angina, myocardial infarction, hypertension, psychosis, severe liver disease, marked cognitive impairment, personality disorder and high suicide risk.

It is strongly advised that alcohol is not taken for at least 24 hours prior to commencing treatment – and for 7 days after cessation of use (- D.E.R.s have been reported up to 14 days following the final dose).

An initial dose of 800 mg. is usually prescribed, followed by 600 mg. on the following day and 400 mg. on the next day. A dose of daily dose of 200 mg. is given thereafter. It is often advised that disulfiram be taken for up to one year. To enhance compliance it is sometimes recommended that tablets are crushed and dissolved in water.

Adverse reactions to disulfiram are relatively uncommon though possible side-effects include drowsiness, nausea, sweating, vomiting, diarrhoea, halitosis, dizziness, ataxia, hypertension, hepatitis, impotence and reduced libido.

Disulfiram also potentiates the toxic effects of certain drugs, including warfarin, phenytion, chlordiazepoxide and diazepam.

It is thought that certain sub-groups of patients may be particularly likely to benefit from disulfiram. Suggestions include those who are older; in early abstinence; relapse-prone but remaining in treatment; those with limited insight; those who failed with less-structured approaches; more compulsive patients; those in crisis/under stress; those capable of following rules and/or tolerant of dependence, and those who specifically request disulfiram treatment.

It is widely accepted that disulfiram does not constitute a “stand-alone” treatment - and should be used in conjunction with other forms of therapeutic input such as counselling, group therapy, A.A. and day-care programmes.

Supervised disulfiram treatment programmes have been used in conjunction with probation orders as a “condition of treatment” and to provide evidence of sobriety regarding employment and child care issues.

The following precautions should be observed when being prescribed antabuse.

Aftershaves: Use only alcohol free.

Vinegars & pickles: Avoid if wine or cider based.

Antiperspirants: Use alcohol-free eg. Mum roll on.

Mouth washes: Avoid unless alcohol free.

Cough medicines: Always consult a pharmacist.

Vitamin C supplements: Safe unless high potency I.V.

Cooking with alcohol: Cooking for a few minutes at high temperature will evaporate alcohol. Avoid "uncooked" alcohol eg. sherry trifles.

Hair products: Permanent dyes acceptable. Avoid alcohol based rinses.

Blood donation: Verboten.