By Sunil D. Khushalani, MD, DLFAPA, FASAM (bio)
Several articles on this website have discussed the use of disulfiram and argued that it is an invaluable treatment for alcohol use disorder but is currently underutilized. Please start by reading the following two articles about disulfiram:
Disulfiram: A shortcut to sobriety?
How to use disulfiram to help with alcoholism
Before going into specific tips that we should share with patients starting on disulfiram, we should convey to them the general principles discussed below.
Principle no. 1
They must avoid alcohol in ALL forms, including oral ingestion, applying it to the skin, and so on.
Even though oral ingestion is by far the most dangerous, exposure to alcohol in other ways can also lead to significant problems depending on many factors.
Principle no. 2
They must be vigilant for “hidden” sources of alcohol. They must be very careful to check all medications, foods, cosmetic items, etc, for the presence of any alcohol.
These hidden sources include:
– Other medications (for example, cough syrups)
– Foods (for example, vinegar, sauces, some desserts)
– Cosmetic items (for example, mouthwash, aftershave, creams, lotions)
Principle no. 3
To avoid any chance of making a mistake in this regard, we should tell patients:
In case of doubt as to whether something does or does not contain alcohol, do NOT use that thing.
Tip: How to help patients gain confidence that they can avoid exposure to alcohol
Some patients may feel that having to be vigilant about the presence of alcohol in food, cosmetic items, and so on is difficult and a barrier to their starting on disulfiram.
A metaphor that I have found helpful in such situations is for these patients to think of themselves as having developed an “allergy” to alcohol after having made a commitment to being treated with disulfiram. This is especially helpful with patients who are in the preparation and action stages of change. They are ready to accept disulfiram and just need some guidance with these day-to-day practical matters.
If they had a family member who had an allergy to peanuts, for example, they would make sure that any food the family member had definitely did not contain any peanuts. Allergy to certain types of foods is a very common problem, and people with such allergies maintain vigilance to avoid the allergen. Thinking of the analogy between having to avoid alcohol and having to avoid an allergen helps patients who fear that avoiding hidden sources of alcohol may be too difficult. It can help patients realize that avoiding hidden sources of alcohol is something that they can do. Once they have accepted this in principle, we can move on to discussing specific strategies to avoid hidden sources of alcohol.
Having reviewed the general principles discussed on this page, please see the following articles on this website for specific tips for sharing with patients about how to avoid alcohol in food and beverages, mouthwashes, and fragrances:
Specific tips to give to patients about how to avoid “hidden” alcohol in food and beverages
What are “non-alcoholic,” “alcohol-free,” “low alcohol,” and “reduced alcohol” beverages?
Where to find/ buy non-alcoholic or alcohol-free beer
Non-alcoholic or alcohol-free beer in patients with past alcohol use disorder?
Do we need to specifically tell persons with alcoholism to avoid drinking kombucha?
Recommend these alcohol-free mouthwash options to patients on disulfiram or with a dry mouth
Patients on disulfiram may appreciate being told about these alcohol-free options for fragrances
Related Pages
Anti-Addiction Medications—Disulfiram
How to use disulfiram to help with alcoholism
Disulfiram: A shortcut to sobriety?
Tips on offering disulfiram for alcohol use disorder
Anti-Addiction Medications—Disulfiram—Avoiding “hidden” sources of alcohol
Specific tips to give to patients about how to avoid “hidden” alcohol in food and beverages
What are “non-alcoholic,” “alcohol-free,” “low alcohol,” and “reduced alcohol” beverages?
Where to find/ buy non-alcoholic or alcohol-free beer
Non-alcoholic or alcohol-free beer in patients with past alcohol use disorder?
Do we need to specifically tell persons with alcoholism to avoid drinking kombucha?
Recommend these alcohol-free mouthwash options to patients on disulfiram or with a dry mouth
Patients on disulfiram may appreciate being told about these alcohol-free options for fragrances
Anti-Addiction Medications—Disulfiram—Side Effects
How common is liver toxicity with disulfiram, and when does it occur?
When and how often should hepatic function tests be done in patients on disulfiram?
References
Allen JP, Litten RZ. Techniques to enhance compliance with disulfiram. Alcohol Clin Exp Res. 1992 Dec;16(6):1035-41. doi: 10.1111/j.1530-0277.1992.tb00695.x. PMID: 1471757.
McNichol RW, Sowell JM, Logsdon SA, Delgado MH, McNichol J. Disulfiram: a guide to clinical use in alcoholism treatment. Am Fam Physician. 1991 Aug;44(2):481-4. PMID: 1858605.
Copyright © 2025, Simple and Practical Medical Education, LLC. All rights reserved. The content on this website may not be reproduced in any form without express written permission.
Disclaimer: The material on this website is provided as general education for medical professionals. It is not intended or recommended for patients or other laypersons or as a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified healthcare professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most recently updated information.
Leave a Reply: