A medication exists that discourages alcohol consumption by producing highly unpleasant physical effects if alcohol is ingested. This medication supports individuals in their efforts to abstain from drinking.
Understanding the Medication
The primary medication for this effect is disulfiram, known by the brand name Antabuse. While a “shot” is sometimes mentioned, disulfiram is most commonly an oral tablet.
Its use in medicine dates back decades, with its alcohol-aversive properties first observed in the 1930s among rubber industry workers. Danish researchers formally identified this interaction in 1948, leading to its development. The U.S. Food and Drug Administration (FDA) approved disulfiram in 1951 for treating chronic alcohol dependence, using it as aversion therapy.
How the Medication Works
Disulfiram interferes with the body’s process of breaking down alcohol. Alcohol is first converted into a toxic substance called acetaldehyde by alcohol dehydrogenase. Normally, acetaldehyde is then converted into a harmless substance, acetic acid, by aldehyde dehydrogenase (ALDH).
Disulfiram inhibits ALDH, preventing acetaldehyde breakdown. This leads to a buildup of acetaldehyde in the bloodstream, often reaching concentrations five to ten times higher than usual. The accumulation of this toxic compound causes the severe and unpleasant symptoms experienced when alcohol is consumed.
The Alcohol-Medication Reaction
When alcohol is consumed while disulfiram is active, a distinct set of symptoms known as the disulfiram-alcohol reaction rapidly ensues. Symptoms typically begin within 10 to 30 minutes of alcohol intake. Common reactions include flushing, throbbing in the head and neck, severe headache, and profuse sweating.
Individuals may also experience nausea, vomiting, chest pain, and heart palpitations. Shortness of breath, dizziness, weakness, and blurred vision can occur. The intensity of these reactions ranges from mild to severe, depending on the amount of alcohol consumed. In serious cases, the reaction can lead to respiratory depression, cardiovascular issues, and can potentially be life-threatening.
Role in Alcohol Use Disorder Treatment
Disulfiram serves as a tool within a broader treatment strategy for alcohol use disorder (AUD), rather than a standalone cure. Its primary function is to deter impulsive drinking, supporting abstinence. The medication is most effective when integrated into a comprehensive treatment plan that includes counseling and behavioral therapies.
Patient commitment to abstinence and consistent adherence to the medication regimen are important for its success. Medical supervision is necessary to monitor progress and manage any potential issues. Disulfiram is often recommended for individuals highly motivated to maintain sobriety.
Important Safety Information
Beyond the alcohol reaction, disulfiram can have other effects. Common side effects include drowsiness, skin rash, mild headaches, or a metallic or garlic-like taste in the mouth. More serious effects can involve liver damage, nerve damage (neuropathy), or psychiatric disturbances such as psychosis.
Disulfiram is not suitable for everyone and has contraindications, including severe heart disease, liver disease, or certain mental health conditions. It is crucial to avoid all forms of alcohol, not just beverages, while taking disulfiram and for up to 14 days after the last dose. This includes hidden sources found in mouthwashes, cough syrups, aftershaves, sauces, and certain foods. Medical consultation and ongoing supervision are necessary before and throughout treatment to ensure safety and effectiveness.