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
Here are some practical tips for discussing disulfiram with the patient.
1. Discussing the option of disulfiram helps in assessing a patient’s motivation
Discussing the option of treatment with disulfiram for alcohol use disorder can be a “litmus test” for assessing a patient’s motivation for giving up alcohol completely and right away.
When different medication options are discussed, the patient’s reaction to the mention of disulfiram, or of how disulfiram works, and the fact that it requires 100% avoidance of alcohol can be indicative of their willingness to explore discussions about stopping alcohol and their commitment to complete abstinence.
For example, if a patient says that they are willing to do whatever is needed because they absolutely have to stop drinking right away, this indicates a much higher motivation to change. On the other hand, a patient’s reluctance to consider disulfiram could be an indicator of underlying ambivalence. Or, the patient’s reluctance to consider a disulfiram may also be an indicator they don’t trust themselves to be able to abstain from alcohol.
2. What about disulfiram if another treatment is tried first but does not work?
Even if a patient does not agree to be on disulfiram right away, I have found it helpful to ask the patient if they would accept disulfiram treatment if an initial trial of naltrexone or acamprosate did not work.
Patients are more likely to accept and follow through with a plan if they are offered choices and a logical sequence of options and feel that they are part of the shared decision-making process.
Patients who are not agreeable to including disulfiram at any place in the sequence of treatments are likely to be in an earlier stage of change with respect to stopping the use of alcohol. In that case, it will be important to explore both sides of their ambivalence and to work on enhancing their motivation for change.
Related Pages
Anti-Addiction Medications—Disulfiram
Disulfiram: A shortcut to sobriety?
How to use disulfiram to help with alcoholism
Tips on offering disulfiram for alcohol use disorder
Strategies to help patients starting on disulfiram avoid hidden sources of alcohol
Should we tell persons with alcoholism to avoid drinking kombucha?
Alcohol-free mouthwash options for patients on disulfiram or with a dry mouth
Do patients on disulfiram have to completely miss out on using 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.
Skinner MD, Lahmek P, Pham H, Aubin HJ. Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis. PLoS One. 2014 Feb 10;9(2):e87366. doi: 10.1371/journal.pone.0087366. PMID: 24520330; PMCID: PMC3919718.
Suh JJ, Pettinati HM, Kampman KM, O’Brien CP. The status of disulfiram: a half of a century later. J Clin Psychopharmacol. 2006 Jun;26(3):290-302. doi: 10.1097/01.jcp.0000222512.25649.08. PMID: 16702894.
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