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Topics:
General Internal Medicine • Psychiatry • Addiction • Substance Use Disorders • General Hospital Medicine • Addiction Psychiatry
When do you consider using disulfiram in patients with alcohol use disorder?
In what patient populations would you consider using disulfiram (Antabuse) instead of, or in addition to, acamprosate or naltrexone? In your experience, do any clinical or psychosocial characteristics predict better outcomes with disulfiram? How do you approach informed consent and patient education about the risks of disulfiram?
Answer from: at Community Practice
I love Antabuse, I’m a hero with Antabuse. There is no other treatment in medicine like it. It’s aversion therapy. If you take it, nothing happens. If you drink on it, you get really sick. Amazing if you think about it.
I’ve been prescribing Antabuse since 1986. I tell patients, i...
Answer from: at Community Practice
I have prescribed disulfiram for thousands of patients as part of an addiction IOP program. It works best when given under supervision. We used to have patients taking their disulfiram at the beginning of each daily group activity. The dose does not need to be higher: 125 mg/day is enough, or 250 mg...
Answer from: at Community Practice
I guess I must be the odd one out in this success group...
I have prescribed it to only a select few, since most do not want to take it when they hear about the aversive reaction.
The ones that did get the prescription, I suspect, took it for a few days initially but stopped completely at some poi...
Answer from: at Community Practice
I’m a big fan of Antabuse for patients who are using it as part of a bigger system (therapy, AA, etc.) for alcohol abstinence/reduction. When used as a deterrent to prevent people from drinking (in patients willing to take it, who usually quickly learn the consequences of drinking on it), it c...
Answer from: at Community Practice
Alcoholism and all addictions are compulsive behaviors with a clear psychological mechanism. It's important to deal with medical/social emergencies, but treating an addiction without making the psychology that underlies it the primary treatment focus, is neglect. AA has an overall success rate of be...
Binge drinkers versus daily drinkers seem to do pa...
I prescribe Antabuse to anyone who wants to quit d...
Exactly, it’s a huge relief to patients, ver...
Makes good sense