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Antabuse Explained: Is It an Effective Treatment for Alcoholics?

“It is important to emphasize that the chief value of Antabuse lies in the fact that it paves the way for psychotherapeutic procedures… Antabuse in conjunction with psychotherapy may prove superior to other methods of treatment of chronic alcoholism.” ~Drs. Eugene Barrera, Walter Osinski, and Eugene Davidoff, speaking to the American Psychiatric Association Alcohol is the most-used and the most-ABUSED intoxicating substance in the world. According to the National Institute on Alcohol Abuse and Alcoholism, over 15 MILLION adults in the United States and another 623,000 adolescents and teenagers currently struggle with alcoholism. Even though the problem is so widespread, only about 1 in 10 people who require professional alcohol abuse treatment are receiving it. This means that there is always a pressing need for new ways to fight the disease of alcohol addiction. Medication-Assisted Treatment is one of the most-effective ways to meet that need, and for almost 70 years, Antabuse has been a life-saving option drinkers around the world.

What Is Antabuse?

Antabuse is the brand name for disulfiram, one of the oldest medications used to treat Alcohol Use Disorder. Although it was first synthesized in 1881, disulfiram was largely ignored as just another new organic compound. Fascinatingly, the use of disulfiram to curb problem drinking was discovered by accident thanks to two separate discoveries in completely different fields – the rubber and pharmacological industries . Disulfiram was originally used to speed up the vulcanization of rubber. In 1937, Dr. E. E. Williams, a physician working at an American rubber plant, noticed how workers in the plant would get ill whenever they drank alcohol. Williams made the connection that disulfiram might someday be developed as a “cure for alcoholism”, but aside from making the observation, he never followed up on the idea. Disulfiram was also used to kill parasites, such as the mite that causes scabies. In 1945, Doctor Erik Jacobsen, a Danish position and biochemist, was searching for a drug that could kill intestinal worms. Reasoning that what could kill scabies mites would also work on other parasites, Jacobsen chose to evaluate the side-effects by using himself as a test subject. After having later drinking wine, Jacobsen discovered disulfiram’s effect. The experience is best described in his own words: “It only took a few days to confirm that the disulfiram tablets really change the effect of alcohol in a most unpleasant direction.” What became known as Antabuse – or “Antabus” in Jacobsen’s native language – was granted a Danish patent in 1952, with patent protection, going back to 1949. Today, 1 out of every 5 people who use Antabuse to curb their problem drinking are from Denmark. Antabuse was granted an American patent in 1951, followed by Naltrexone in 1994, and acamprosate in 2004.

How Does Antabuse Work?

Antabuse is a medication that prevents the abuse of alcohol by deterring ALL use. It blocks how alcohol is broken down by the body. Under normal circumstances, the body metabolizes alcohol into acetaldehyde, the toxin that causes painful hangovers, before further oxidizing the acetaldehyde into harmless acetic acid. Antabuse interrupts that metabolic process, causing a buildup of toxic acetaldehyde that is up to 10 times greater than the amount normally produced when someone drinks. This means that someone drinking even a small amount of alcohol will experience extremely unpleasant effects lasting as long as the alcohol remains in their system. These effects, which can occur within 10 minutes of alcohol consumption, may include:

  • Extreme Nausea
  • Copious, Uncontrollable Vomiting
  • Throbbing Headache
  • Excessive Sweating, combined with Extreme Thirst
  • Intense Neck Pain
  • Physical Weakness
  • Shortness of Breath, combined with Hyperventilation
  • Low Blood Pressure
  • Rapid Heartbeat
  • Chest Pain
  • Dizziness
  • Fainting
  • Blurred Vision
  • Confusion
  • General Uneasiness

Those are just the “mild” effects. Depending upon the Antabuse dosage and the amount of alcohol consumed, they can be much more severe:

  • Respiratory Depression
  • Unconsciousness
  • Convulsions
  • Irregular Heart Rhythm
  • Heart Attack
  • Congestive Heart Failure
  • Cardiovascular Collapse
  • Death

What Are the Positives of Antabuse Use?

Antabuse does what it is supposed to – it acts as a strong deterrent to anyone who tries to drink while taking their prescribed dosage. The effects are so harshly unpleasant that many Antabuse patients would rather avoid alcohol completely than feel so profoundly sick again.

  • Research shows that patients prescribed deterrent drugs remain abstinent from alcohol at rates up to 50% higher than individuals not taking such medications.
  • It provides a “little extra help” when cravings strike. Some people in recovery for alcoholism use Antabuse regularly during those tough early months of sobriety, but then keep a supply on hand for other possible high-stress situations that could trigger a relapse – holidays, vacations, parties, etc.
  • Antabuse’s effects are triggered by even very small doses of alcohol – less than one drink. This means that patients who try to cheat or try to “manage” their alcohol addiction through moderation WILL experience the unpleasantness of deterrence.
  • Antabuse stays in the person’s system for up to two weeks, and will continue to cause sickness whenever alcohol is consumed during the whole time. This means that a person can’t just quit recovery and immediately resume drinking.
  • Because most drug addicts ALSO drink, Antabuse can peripherally aid in recovery from drug abuse as well. Drinking – even “social drinking” – lowers inhibitions and impairs decision-making. This often results in resumed drug use. However, if the recovering addict is unable to drink, it is less likely that they will suffer a relapse.

One way to judge the effectiveness of the medication is to hear what the people taking that medication have to say. Reviews of Antabuse on drug information websites rank the medication very highly, saying it has helped them achieve and maintain sobriety.

What Are Limitations of Disulfiram?

While Antabuse has been proven to be effective at deterring alcohol use, it does suffer from several limitations:

  • It doesn’t help with alcohol withdrawal. Chronic heavy drinkers who abruptly discontinue alcohol use are at risk for dangerous withdrawal symptoms.
  • It doesn’t help with alcohol cravings. A person taking Antabuse still feels the urge to drink. They are only prevented from doing so by the unpleasant effects of the medication. These powerful cravings can be a significant source of stress that can impede or even disrupt recovery. This is a major limitation of Antabuse, because other medications, such as Naltrexone, DO significantly alleviate alcohol craving, allowing patients to focus on their own recovery.
  • Interactions can be a problem. Because the intended effects of Antabuse can be triggered by very small amounts of alcohol, there are literally HUNDREDS of foods, medications, and other products that must be avoided.  This would include some:
  • Over-the-Counter Cold Remedies and Cough Syrups
  • Mouthwashes
  • Toothpastes
  • Hand Sanitizers
  • Antibacterial Soaps
  • Colognes and Perfumes
  • Aftershaves
  • Deodorant Sprays
  • Lotions
  • Backrub Products
  • Cosmetics
  • Laxatives
  • Anti-Diarrheals
  • Internal Pain Relievers
  • Toothache/Cold Sore Medicines
  • Asthma Inhalers
  • HIV Protease Inhibitors
  • Anticoagulants
  • Vitamins and Supplements
  • Chewing Tobaccos
  • Air Fresheners
  • Cleaning Products
  • Adhesives
  • Insect Repellents
  • Windshield Wiper Fluid

Foods and drinks that often have hidden alcohol include:

  • Sugarless Gums
  • “Non-alcoholic” Beers or Wines
  • Candies
  • Hot Sauces
  • Barbecue Sauces
  • Vinegar
  • Extracts
  • Ripe Fruits
  • Protein/Energy Bars or Drinks
  • Salad Dressings
  • Marinades
  • Sauces
  • Desserts
  • Many Specific Dishes – Veal Marsala, Grasshopper Pie, Cherries Jubilee, Beer Bread, Guinness Stew, Beef Bourguignon, Beer Cheese Soup, Vodka Sauce, Fruitcake, etc.

This means that if a person taking Antabuse brushed their teeth and used mouthwash, put on deodorant and cologne, and then went to a birthday party where they ate barbecue and a piece of cake, there might be enough alcohol contained in those products to trigger a reaction.

  • Compliance Can Be an Issue. The take-home tablet formulation of Antabuse places the responsibility of taking the medication as prescribed squarely on the shoulders of a person with an admitted drinking problem. Not surprisingly, a 2009 study discovered that noncompliance rates for Antabuse patients are as high as 80%.

Improving Antabuse Compliance Rates through Home Contracts

Because Antabuse helps improve abstinence when taken as prescribed, it is in the best interest of the patient to find ways to improve compliance. One of the most effective ways proven to help ensure that a person takes their Antabuse properly is to enlist the aid of a loved one. A 1984 study show that by “contracting” someone else in the household – spouse/partner, parent, sibling – to observe the alcoholic taking the Antabuse, doctors were able to significantly improve compliance rates among the alcoholic patients. Contracting is usually based on 4 mutual agreements:

  • The alcoholic agrees to take the Antabuse every day, while the other person observes.
  • The other person agrees to record their observation on a calendar.
  • After the Antabuse is taken and recorded on the calendar, both parties thank each other.
  • Both parties agree to refrain from discussing any past or possible future drinking except in therapy sessions.

Not surprisingly, this has a positive impact on lasting sobriety. At the critical three-month sobriety benchmark, 84% of contracted patients are still abstinent from alcohol. Even better, the lack of negative comments from the other family member about drinking resulted in fewer arguments, more positive reinforcement, better communication, and an overall improvement in the relationship. Specifically, couples who also engaged in Behavioral Marital Therapy (BMT) had improved marital and drinking adjustment at a two-year follow-up.

Improving Antabuse Compliance Rates through Incentives

Another way shown to increase Antabuse compliance is by offering tangible incentives – “rewards” that are meaningful to the alcoholic. Over the years, and as part of numerous studies, these incentives have taken many forms, such as:

  • Easing of probation restrictions
  • Money, in the form of a returned deposit that the alcoholic put up at the beginning of treatment
  • Job security for people referred by their job
  • Continued treatment in the same program, rather than dismissal or referral to another program

Each of these studies differed in their implementation and in their methodology, but the overall result was consistent – patients who received an incentive for taking Antabuse had better compliance rates and better overall outcomes.

What about Antabuse Implants?

Although not yet available in the United States, clinics in France and Eastern Europe offer another possible solution to noncompliance, through the use of Antabuse implants. Placed under the skin above the stomach, these implants release a steady stream of medication over the next 12 months. There, are, however, a few important considerations. FIRST, not all Antabuse implants are the same. Some do not release consistent dosages of Antabuse. SECOND, there have been recorded instances of the body rejecting the implant. THIRD, the cost of Antabuse implants can be prohibitive to most. A “medical vacation” to Europe would mean airfare and hotel IN ADDITION to the cost of the treatment itself. Because this of course would not be covered by insurance, the total out-of-pocket expense would be thousands of dollars.

What Is the Correct Dosage of Antabuse?

Each tablet contains either 250 mg or 500 mg of disulfiram. During the initial dosage schedule, patients take a single dose of up to 500 mg per day for up to two weeks. If the sedative effects present a problem, the dosage can be adjusted downward. Afterwards, during Antabuse maintenance, the average patient takes 250 mg per day, with a range of between 125 mg and 500 mg. Antabuse therapy continues until they have recovered in their daily lives and have established lasting self-control, and sobriety. This can take months or even years. In certain severe cases of alcohol addiction, some doctors will supervise a test reaction in their patients. After the initial dosage schedule of 2 weeks, the patient is allowed to slowly take one – or no more than two – 100-Proof alcoholic drinks. The purpose is to let the chronic alcoholic fully experience an alcohol-Antabuse reaction, safely, under medical supervision. A reaction test should never be performed on anyone over the age of 50.

Can I Buy Antabuse Online?

If you choose to buy your Antabuse medication via the Internet, the FDA offers a few quick tips:

  • Only buy from licensed pharmacies physically located in the United States.
  • Do not buy from a pharmacy that does not require a prescription.
  • Only buy from a pharmacy that has a licensed pharmacist available to advise you and answer any questions you may have.

Side-Effects of Antabuse/Disulfiram

Besides the intended effects that occur when alcohol is consumed, initial use of Antabuse can produce several temporary side-effects that usually go away once the person becomes acclimated to the medication:

  • Increased Drowsiness
  • Unusual Tiredness
  • Persistent Headache
  • Garlic-like or Metallic Taste in the Mouth
  • Skin Rash
  • Impotence among Males

However, although rare, there are other side-effects to Antabuse use indicating an adverse reaction that necessitates contacting a medical professional as possible:

  • Eye Tenderness or Pain
  • Vision Changes
  • Mental or Mood Changes
  • Weakness, Tingling, Numbness, or Pain in the Hands or Feet
  • Severe Stomach Pain
  • Jaundice – Yellow Eyes or Skin
  • Darkening of Urine
  • Light-Gray Stool

Is Antabuse (Disulfiram) Right for Everyone?

Because of the potentially-serious side effects, there are several groups of people that should not be given Antabuse, including those with a history of:

  • Heart Disease
  • Arterial Blockage
  • Diabetes
  • Liver Disease
  • Psychosis
  • Benzodiazepines (Xanax, Klonopin, Valium, etc.)
  • Anticoagulants (Wayfarin)
  • Isoniazid for Tuberculosis
  • Phenytoin for Epilepsy

Also, Antabuse should not be taken by anyone who has consumed alcohol within the past 12 hours. It is impossible to build a tolerance to Antabuse. This means that the longer the drug is taken, the stronger the effects become. For this reason, it is still possible to have a reaction to alcohol or the alcohol contained in foods, medicines, and other products up to 2 weeks after the last dose of Antabuse.

Can I Start Taking Antabuse Right Away?

Even though the medication is well-tolerated, most people with an AUD can’t immediately start taking Antabuse, for two reasons. First, Antabuse cannot be taken if it has been less than 12 hours since your last drink, or you will suffer a strong and immediate reaction. Second, a chronic drinkers dependent on alcohol cannot safely discontinue alcohol use abruptly without placing themselves at-risk for serious, potentially-fatal health consequences. Alcohol addicts need to undergo medically-supervised alcohol detoxification before any other action can be taken. To be clear, you cannot take Antabuse while you are still drinking, but you cannot safely quit drinking, without medical supervision.

How Does Antabuse Compare to Other Medications for Alcohol Recovery?

During the latter half of the 20th century, Antabuse was the preferred medication to treat chronic alcoholism. However, in the 1990s and early 2000’s, new drugs were developed, specifically naltrexone and acamprosate. In 2013, the Veterans Administration compared the three medications and made recommendations for use. Pointedly, the VA said that NONE of the drugs was “consistently superior to the others”. This means that that there is no single “best” AUD medication – there is only the medication that is best for the individual alcoholic and their situation. Every problem drinker has their own unique history and their own distinct goals. Among the VA’s recommendations:

  • Acamprosate may be the best option for maintaining alcohol abstinence for those patients who have already stopped drinking. It has shown no benefit in inducing abstinence or reducing dangerous drinking. It is a first-line option for patients with liver disease.
  • Oral naltrexone improves abstinence and is better than Acamprosate at reducing heavy/binge-drinking. Significantly, naltrexone also reduces alcohol cravings. Because it is an opioid agonist, naltrexone is a first-line option for patients who also use heroin or prescription painkillers. Injectable naltrexone is available for those patients who have trouble adhering to their medication schedule.
  • Disulfiram should only be used when total abstinence – not reduced drinking – is the treatment goal. Best results occur when it is taken under close supervision.

Is Disulfiram All I Need to Recover from Alcohol Addiction?

No. Antabuse is not a “magic pill” that cures alcoholism. Addiction, in any form, is an incurable and progressive disease that requires intervention, treatment, and lifestyle changes in order to best manage the symptoms. The good news is that Antabuse can keep you from drinking – protecting your physical sobriety. This will give you the stability to find the right treatment option that will help you recover your emotional sobriety. When you understand what factors played a role in the development and continuation of your alcoholism, you can learn how to protect yourself against anything that might trigger a return to drinking. You can also learn how to repair the damage that alcohol abuse caused to every area of your life. Antabuse should rightfully be regarded as a tool in recovery – an effective pharmacological option that can support other alcohol treatment strategies, such as residential or outpatient alcohol rehab programs.