MAT for Alcohol Addiction — What is Antabuse (Disulfiram)?

Antabuse is the commercial name for disulfiram, an FDA-approved medication for treating alcohol use disorder (AUD). AUD affects 10.2% of the people in the United States and is among the most prevalent psychiatric disorders.

Disulfiram combats alcohol addiction by deterring people from drinking. It alters how the human body breaks down alcohol. If someone consumes even minimal quantities of alcohol while taking Antabuse, they’ll experience unpleasant reactions.

About 10 minutes after their drinking, their face may blush, and they may have difficulty breathing, headaches, nausea, low blood pressure, blurred vision, sweating, and chest pains. These symptoms are collectively called the disulfiram-alcohol reaction and can last for more than an hour.

Disulfiram originated in Germany in 1881 and was used in industrial processes like rubber manufacturing. During the late 1930s, observers noticed that workers in rubber plants became sick after disulfiram exposure and consuming alcoholic beverages.

In the 1940s, tests showed disulfiram’s efficacy as a treatment option for alcohol addiction, and became the first medication approved by the FDA for AUD in 1951.

Antabuse is available in tablets for oral ingestion. The medication is currently being evaluated for off-label uses, such as for managing cocaine addiction, as a form of cancer therapy, and to combat drug-resistant fungal infections.

How Antabuse Works in Alcohol Addiction Treatment

Antabuse works by blocking a liver enzyme called aldehyde dehydrogenase (ALDH). This enzyme is fundamental in breaking down alcohol and aiding in its elimination from the body. ALDH transforms alcohol into acetaldehyde and then breaks it down further into acetic acid and excretes it from the body as a toxin.

Antabuse blocks ALDH, which allows toxic levels of acetaldehyde build up in people’s bloodstream if they drink. When a person consumes Antabuse and alcohol, their face feels hot, and flushing may occur after 5-10 minutes. This is caused by the dilation of blood vessels. As this effect expands to the rest of their body, it may generate throbbing sensations in the neck and head.

From here, other symptoms like nausea, vomiting, headaches, breathing complications, sweating, blurred vision, thirst, chest pain, dangerously low blood pressure, dizziness, weakness, and confusion may manifest. You might require medical assistance and potentially stabilization with fluids and other supportive measures.

The signs and symptoms occur fast, and their intensity depends on the disulfiram dosage and amount of alcohol consumed. The symptoms eventually die down when the alcohol in the body has been broken down entirely.

It’s important to note that Antabuse isn’t a medication that regulates alcohol addiction by altering brain chemistry. Rather, the philosophy behind prescribing disulfiram is that behaviors like drinking can be reoriented once you realize that it’s harmful. Alcohol becomes less enjoyable when you start feeling sick.

Antabuse is a form of aversion therapy. You start to associate the unpleasant effects of the disulfiram-alcohol reaction with alcoholic beverages. This may reduce the desire to drink in the future. Over time, you abstain from alcohol because the threat of getting sick discourages alcohol consumption.

Disulfiram does not produce tolerance. The longer a person is on the medication, the more sensitive they can become to alcohol intake.

Starting Disulfiram

Therapy with Antabuse or generic forms of disulfiram demands total abstinence from alcohol for at least 48 hours before starting the medication.

Initially, a healthcare professional prescribes 250-500 mg in tablet form per day of disulfiram for 1-2 weeks. They may adjust the maintenance dose (usually up to 250 mg/day) based on each person’s response and potential side effects.

Benefits and Effectiveness of Antabuse Medication

Quitting alcohol can transform a person’s life. In the United States, around 178,000 lives are lost every year due to alcohol abuse. More broadly, 2.6 million people around the world die each year due to AUD.

Alcohol affects multiple systems in the human body. Approximately 65% of deaths from heart disease are associated with alcohol. About 20,000 Americans die each year from cancers related to alcohol abuse. The majority of liver transplantations (41%) are due to diseases caused by excessive alcohol intake.

AUD also augments the risk of mental health problems. It can ruin marriages and careers and is associated with domestic and sexual violence. AUD also contributes to 55% of fatal car accidents in the U.S.

Why Disulfiram is Needed

AUD is characterized by a chronic consumption pattern that persists despite the harm it causes to people’s lives. For one thing, a genetic predisposition to developing AUD can be passed down from one generation to the next.

It’s estimated that 50% of people at risk of developing AUD have inherited this genetic vulnerability. In addition, mental health disorders are associated with AUD, alongside lifelong grief and pain that often accompany addictions.

On a personal level, prolonged alcohol consumption can reshape how the brain experiences pleasure and regulates self-control. People with AUD may need continuously larger alcohol doses to experience the effects they seek.

That’s why aids like Antabuse for alcohol abuse are so beneficial. They can transform your reactions to alcohol and encourage you to break the habit. Despite not addressing the changes in the brain that promote drinking behaviors, disulfiram can help a person quit for good as the prospect of getting sick due to drinking can be powerful enough to change their behavior.

Furthermore, Antabuse has been shown to work. According to the Journal of Addiction Medicine, Antabuse is one of the most reliable medications for reducing heavy drinking and supporting abstinence in structured programs.

It’s the most effective medication to maintain alcohol abstinence when a person is motivated to stop. For people with dual diagnoses, disulfiram was the most effective medication for sustaining sobriety and increasing the days people didn’t drink. Also, those taking Antabuse have a lower risk of hospitalizations due to alcohol-related incidents.

The effectiveness of Antabuse is significantly influenced by adherence. Studies have found that supervision of disulfiram dosing by medical professionals and support from friends and family for adherence can improve abstinence and long-term results.

The ideal candidates for success with Antabuse are individuals who want to abstain 100% from alcohol and don’t suffer from liver conditions.

FAQs

Antabuse Side Effects and Safety Considerations

Common and Serious Antabuse Side Effects

The most common and minor side effects of Antabuse are physical ailments. You might experience mild sleepiness while still being tired. Skin irritations and rashes may break out, and you may have headaches.

Some side effects are more serious and demand your attention. You might want to seek medical assistance for signs of excessive weakness and tiredness. This may be accompanied with no desire to eat and vomiting when you do eat.

Stomach pains, fevers, dark urine, a yellowish skin tone or hue in your eyes, and low blood pressure may also result. Some clients have reported a metallic or garlic taste in the mouth. Others noted behavioral conditions. The most common was greater irritation.

Should I Take Antabuse if I Have Other Conditions?

Antabuse can increase hepatitis risk, so individuals with underlying liver conditions might not want to try an alternative treatment. It’s also necessary to monitor liver health as treatment progresses to detect potential hepatic side effects over time.

It’s also not recommended in individuals with coronary artery disease because it can increase heart complications.

People with seizure disorders are also not ideal candidates for managing AUD with disulfiram because it increases the likelihood of metabolic disorders. Those who have a history of psychotic episodes are also at risk of psychiatric adverse effects, as well as people who consume disulfiram with cannabis.

You should also remember that disulfiram affects all products that have alcohol, even those that aren’t liquor. The disulfiram-alcohol reaction can occur if you taste vinegars, sauces, cough syrups, elixirs, and herbal preparations that contain alcohol. External products, like back rubs, aftershaves, liniments, lotions and alcohol-based hand rubs, can also cause a reaction so caution is advised.

Antabuse should never be taken while intoxicated or administered without a person’s consent or understanding of alcohol consumption consequences. Disulfiram is slowly eliminated from the body, so avoid alcoholic beverages for at least two weeks after you stop taking it.

Antabuse vs Naltrexone vs Campral: How It Compares

Despite the damaging consequences of AUD, only 1.9% of individuals receive medication assisted treatment (MAT) to treat it. Currently, only three medications are approved by the FDA for managing AUD. These are disulfiram, acamprosate and naltrexone. All three can assist a person in quitting and abstaining from alcohol, but they have unique characteristics that better suit different individuals.

Choosing a Treatment that Works for You

Your rehabilitation team will make the choice of medication made based on your recovery goals, personal preferences, and underlying medical conditions. But it’s key to remember that medication is just one component of treatment.

Your clinical team will also create a personalized plan to address mental health challenges and adverse life experiences that may be fueling your alcohol consumption habits.

Naltrexone and acamprosate are medications that reduce cravings because they interact with the same regions of the brain that alcohol influences to promote its consumption. They address the neurobiology of alcohol addiction and help rebalance brain chemistry.

As noted earlier, disulfiram doesn’t target your brain chemistry, but its effects are powerful enough in many cases to deter people from drinking and can successfully modify addictive behaviors.

The best medication for AUD depends on who you are. For instance, it’s estimated that almost 50% of individuals with AUD don’t want to quit alcohol entirely, so for them, Antabuse is not the right choice because taking disulfiram consistently requires total abstinence.

Who is Antabuse for?

With this in mind, Antabuse works best for individuals with AUD who are motivated to stop drinking altogether and have supervision to make sure they “stay on the wagon.” If a person doesn’t want to quit drinking entirely, disulfiram is not suitable for them.

Underlying medical conditions must be considered before deciding on medication for AUD. People with seizure disorders, liver conditions, and suicidal ideations might be better candidates for other medications because Antabuse may predispose them to dangerous side effects.

Furthermore, compliance can be a challenge when prescribing Antabuse. Its putative mechanism of making you ill can backfire and cause some people to quit their AUD treatment altogether.

Among all the available medications for AUD, Antabuse has the lowest compliance rate, with individuals taking it only 41.3% of the days that they should. Those who elect to take Antabuse should be monitored and supported to increase adherence and improve treatment success chances.

Antabuse vs Naltrexone

Naltrexone is also effective for AUD and can be preferred over Antabuse. By reducing the craving mechanism for drinks, people can restore brain chemistry and moderate their alcohol intake. Some individuals may prefer this over the punitive mechanism that Antabuse relies on.

Naltrexone can also be prescribed as an injection, which can increase adherence as it’s applied once a month and doesn’t require a daily dose like Antabuse does. Some individuals don’t want to completely abstain from alcohol, so naltrexone may fit their lifestyle better.

People using opioids for pain management or using non-prescribed opioids should avoid naltrexone due to side effects. Individuals with alcoholic liver diseases or hepatitis should be monitored to evaluate liver enzymes and prevent adverse reactions. These reactions can include nausea, fatigue and a reduced appetite.

Antabuse vs Campral

Campral is the commercial name for acamprosate and was approved by the FDA in 2004 for AUD. Campral targets the same brain receptors impacted by alcohol. It can effectively manage withdrawal effects and reduce cravings by restoring brain balance after prolonged substance abuse.

Compared to Antabuse, Campral can be a first-line choice if a person isn’t willing to stop drinking or if their goal is to reduce their liquor intake. It might also be preferable for liver disease patients because Campral is broken down by the kidneys and bypasses the negative side effects that can affect the liver.

However, studies have shown that in the long run, Antabuse can be better for promoting sustained sobriety compared to Campral, which is more effective at controlling alcohol cravings. In part, this is because Campral’s side effects include fatigue, diarrhea and nervousness. Acamprosate is also not recommended for individuals with kidney dysfunction.

A Healthy Future

Only 15% of individuals with AUD receive treatment. However, recovery is possible, and medication can help achieve long-term sobriety. Taking the first step may seem daunting, but the future rewards of a life without alcohol make it all worthwhile. Ask for help today.