Disulfiram is used as an alcohol deterrent to aid in the management of alcohol dependence. The drug is not a cure for alcohol dependence, and disulfiram therapy should be confined to selected, highly motivated patients in conjunction with supportive psychotherapy. The efficacy of disulfiram therapy has not been established. Without proper motivation and adequate supportive psychotherapy, it is unlikely that disulfiram therapy will have more than a brief effect on the pattern of alcohol consumption in patients with alcohol dependence. Although appreciable, short-term improvement (e.g., abstinence, improved social functioning) has been reported by patients with alcohol dependence during disulfiram therapy, these effects probably result from nonspecific, nonpharmacologic factors (e.g., supportive psychotherapy) rather than from the pharmacologic effects of the drug. A goal of disulfiram therapy is to allow the alcohol-dependent patient to establish the resources and self motivation that are necessary to maintain abstinence once the drug is discontinued. After ingesting as little as 15 mL of 100 proof whiskey or its equivalent, a patient maintained on disulfiram experiences an extremely unpleasant reaction within 5-15 minutes, usually severe enough to require medical attention. (See Cautions: Disulfiram-Alcohol Reaction.)
Disulfiram treatment should be initiated in a hospital or physician's office after a complete physical examination. The patient must be fully aware of therapy and thoroughly understand the disulfiram-alcohol reaction. In addition, the patient should be strongly warned against drinking alcohol while taking disulfiram and cautioned that reactions may occur up to 2 weeks after discontinuance of the drug. For optimum results, disulfiram therapy should be supervised by regular office visits and accompanied by psychotherapy. Although disulfiram can be administered under court order or coercion in some jurisdictions and rehabilitation programs, such mandatory use of the drug has been questioned because of the lack of evidence from well-controlled studies of its efficacy and because of the associated risks of therapy.