Disulfiram Treatment of Alcoholism: A Veterans Administration Cooperative Study
Abstract
We conducted a controlled, blinded, multicenter study of disulfiram treatment of alcoholism in 605 men randomly assigned to 250 mg of disulfiram (202 men); 1 mg of disulfiram (204 men), a control for the threat of the disulfiram-ethanol reaction; or no disulfiram (199 men), a control for the counseling that all received. Bimonthly treatment assessments were done for one year. Relative/ friend interviews and blood and urine ethanol analyses were used to corroborate patients' reports. There were no significant differences among the groups in total abstinence, time to first drink, employment, or social stability. Among the patients who drank and had a complete set of assessment interviews, those in the 250-mg disulfiram group reported significantly fewer drinking days (49.0 ±8.4) than those in the 1-mg (75.4±11.9) or the no-disulfiram (86.5 ± 13.6) groups. There was a significant relationship between adherence to drug regimen and complete abstinence in all groups. We conclude that disulfiram may help reduce drinking frequency after relapse, but does not enhance counseling in aiding alcoholic patients to sustain continuous abstinence or delay the resumption of drinking. (JAMA1986;256:1449-1455)
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Compliance has been a serious impediment in disulfiram research.
“Compliance has been a serious impediment in disulfiram research in numerous studies [26], [27].”
From Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis (2014) · cites this paper as [27]
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Meert, T. F., & Janssen, P. A. J. (1991) · Drug Development Research · doi:10.1002/ddr.430240305 · Cited by 66 · see citing works
Outpatient Management of Patients with Alcohol Problems
Fiellin, D. A., Reid, M. C., & O'Connor, P. G. (2000) · Annals of Internal Medicine · doi:10.7326/0003-4819-133-10-200011210-00015 · Cited by 64 · see citing works
“Despite early claims of success (145, 146), randomized trials have not demonstrated improved outcomes with disulfiram (147, 148).”
BackgroundCurrent Pharmacotherapies of Alcoholism: A U.S. Perspective
Anton, R. F., & Swift, R. M. (2003) · American Journal on Addictions · doi:10.1111/j.1521-0391.2003.tb00496.x · Cited by 65 · see citing works
The Clinical Use of Disulfiram (Antabuse®): A Review
Banys, P. (1988) · Journal of Psychoactive Drugs · doi:10.1080/02791072.1988.10472495 · Cited by 63 · see citing works
Techniques to Enhance Compliance with Disulfiram
Allen, J. P., & Litten, R. Z. (1992) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.1992.tb00695.x · Cited by 63 · see citing works
Glutathione-responsive copper-disulfiram nanoparticles for enhanced tumor chemotherapy
Chen, M., Huang, Z., Xia, M., Ding, Y., Shan, T., Guan, Z., Dai, X., Xu, X., Huang, Y., Huang, M., et al. (2021) · Journal of Controlled Release · doi:10.1016/j.jconrel.2021.11.041 · Cited by 62 · see citing works
Disulfiram-induced hepatitis. Report of four cases and review of the literature
Forns, X., Caballería, J., Bruguera, M., Salmerón, J. M., Vilella, À., Mas, A., Parés, A. R., & Rodés, J. (1994) · Journal of Hepatology · doi:10.1016/s0168-8278(94)80249-1 · Cited by 61 · see citing works
Sinclair, J., Chambers, S. E., Shiles, C. J., & Baldwin, D. S. (2016) · Drug Safety · doi:10.1007/s40264-016-0416-y · Cited by 62 · see citing works
“Drowsiness was the only reported adverse event found significantly more frequently in patients receiving disulfiram 250 mg compared with 1 mg (active control) or placebo [105]; altered liver function (elevated AST and bilirubin) was not related to disulfiram treatment, but was significantly related to drinking status…”
Phillips, T. J., Wenger, C. D., & Dorow, J. D. (1997) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.1997.tb03824.x · Cited by 57 · see citing works
Molecular mechanisms of psychiatric diseases
Blokhin, I. O., Khorkova, O., Saveanu, R. V., & Wahlestedt, C. (2020) · Neurobiology of Disease · doi:10.1016/j.nbd.2020.105136 · Cited by 58 · see citing works
“large study in veterans where only 20% of patients remained compliant (Fuller et al., 1986).”
Background
- Authors
- Fuller, R. K.
- Corresponding author
- Fuller, Richard K.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1986-09-19
- Volume
- 256
- Issue
- 11
- Pages
- 1449
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W3027683458
- Cited by
- 431
- References
- 0
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 13 · 2023: 10 · 2022: 10 · 2021: 14 · 2020: 11 · 2019: 11 · 2018: 6 · 2017: 12 · 2016: 15 · 2015: 7 · 2014: 17 · 2013: 17 · 2012: 8
- FWCI
- 7.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- disulfiram, alcoholism, alcoholism treatment, disulfiram-ethanol reaction, abstinence, drinking frequency, relapse, medication adherence, counseling
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