Supervised disulfiram in the treatment of alcohol use disorder: a commentary

Abstract

Background: This commentary discusses the systematic review "The efficacy of disulfiram for the treatment of alcohol use disorder (AUD)" by Jørgensen and colleagues (2011, Alcohol Clin Exp Res DOI: 10.1111/j.1530-0277.2011.01523.x). The main focus of the commentary is on long-term effects, long-term use, and psychotherapeutic application of supervised disulfiram.

Methods: A brief qualitative overview is given of previous and recent clinical studies on disulfiram in alcoholism treatment.

Results: The alcohol deterrent disulfiram is an effective pharmacological adjunct to the treatment of AUD when it is administered as supervised low-dose disulfiram and is integrated in comprehensive biopsychosocial alcoholism therapy. However, the assumed underlying psychological effects of psychotherapeutic disulfiram application have never been properly investigated. Prospective long-term follow-up studies are rare and suggest that long-term effects of disulfiram are associated with long-term use and/or integration of the medication in cognitive behavior therapy.

Conclusions: Evidence from decades of research suggests psychological effects as principal mode of action of supervised disulfiram. Future randomized controlled trials are needed that investigate psychological actions and long-term outcomes of this alcohol deterrent.