Antabuse, or disulfiram, is approved for the treatment of alcohol abuse and alcohol dependence by the U.S. Food and Drug Administration. When alcohol is consumed it is metabolized by the body into acetaldehyde, and then into acetic acid, which is harmless. Antabuse interferes with this step, causing a buildup of acetaldehyde As a result, there is a build up of acetaldehyde five or 10 times greater than normally occurs when someone drinks alcohol. This causes unpleasant side effects and discourages alcohol use. FDA indication is: “in the management of selected chronic alcohol patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage. Disulfiram is not a cure for alcoholism. When used alone, without proper motivation and supportive therapy, it is unlikely that it will have any substantive effect on the drinking pattern of the chronic alcoholic.”

It is not universally effective because it is a sufficiently short acting that one can stop it and return to alcohol use in a few days. There is a high rate of noncompliance and recidivism (returning to drinking)  According to the U.S. Substance Abuse and Mental Health Services Administration,  Antabuse (disulfiram)  is more appropriate for older, motivated individuals and in those who are supervised during daily ingestion. Predictors of efficacy with disulfiram include patients highly motivated for abstinence, people who are married or have a good support system, people with behavioral contracts to take the medication, and people legally compelled to take disulfiram.”

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