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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 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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Sher, K. J., & Verges, A. J. (2013) · Oxford University Press eBooks · doi:10.1093/obo/9780199828340-0126
Ross, J. D., Gastfriend, D. R., & Renner, J. A. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4377-1927-7.00014-5
Carpenter, J. E., & Tulk, S. (2019) · Springer eBooks · doi:10.1007/978-3-030-05384-0_10
Screening For Problem Drinking (an excerpt from Guide to Clinical Preventive Services, 2nd Edition)
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Kiefer, F., & Soyka, M. (2011) · Springer eBooks · doi:10.1007/978-3-642-19844-1_58
Brock, D. C., Tofighi, B., Lee, J. D., & Fastenberg, J. H. (2012) · Springer eBooks · doi:10.1007/978-1-4614-4779-5_5
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Conversation with Richard Fuller
Fuller, R. (2003) · Addiction · doi:10.1046/j.1360-0443.2003.00546.x
Self-citationKumar, S., Shanmugham, S., Tan, F. Y., Kong, A. H. Z. X., Foong, C. X., Chan, J. E., Antony, P. T., Smales, F. C., Ching, S. M., Vadakkechalil, H., et al. (2025) · European Journal of Clinical and Experimental Medicine · doi:10.15584/ejcem.2025.4.15
A Novel ALDH2 Inhibitor for the Treatment of Alcohol Use Disorder: Preclinical Findings
Marshall, R. D., Fowlie, A., & Sabouni, A. (2026) · Cells · doi:10.3390/cells15020123
“In the largest controlled trial of disulfiram to date (Fuller et al., 1986 [22]; n = 605), there was 80% nonadherence, as demonstrated by urine testing for riboflavin, which was incorporated into the disulfiram tablets.”
InfluentialKhan, Z., Rajan, K., Awana, R., et al. (2026) · Indian Journal of Physiology and Pharmacology · doi:10.25259/ijpp_613_2025
Sloan, M. E., Praecht, A., Werner, R. B., Grory, S. Y.-M., & Petrakis, I. L. (2026) · Springer eBooks · doi:10.1007/978-3-032-24174-0_8
Rodriguez, P. J., Lusk, J. B., Mehta, H. B., Levy, J. F., Kalogeropoulos, A. P., Soneji, S., Do, D., Holler, E., Webber, E., Gluckman, T., et al. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-109259 · Cited by 2
Alevizopoulos, A. G., Vasilakos, V., Kritikos, I., Alevizopoulou, M., Korompoki, E., Ψαλτοπούλου, Θ., & Paschou, S. Α. (2026) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253261457548
Danovitch, I., Truman, K. A., Brown, H., Miller, M., Shah, S. R., Totlani, J., Kaidbay, D.-H. N., Tessema, K. K., Minasyan, Z., IsHak, W. W., et al. (2026) · CNS Drugs · doi:10.1007/s40263-026-01334-4
Ein Überblick über substanzbedingte Störungen und ihre Behandlung
Saunders, J. B., Sitharthan, T., & Krabman, P. (2000) · Springer eBooks · doi:10.1007/978-3-642-59627-8_16
Evidence-based pharmacotherapy of nicotine and alcohol dependence
van den Brink, W. (2012) · Cambridge University Press eBooks · doi:10.1017/cbo9780511910395.012
The conservative treatment of myasthenia gravis.
Aird, R. B., & CAMPBELL, M. B. (1950) · PubMed
Burbach, R. V. (2014) · Springer eBooks · doi:10.1007/978-88-470-1738-2_8
Metadata
- 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 › Clinical Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- disulfiram, alcoholism, alcoholism treatment, disulfiram-ethanol reaction, abstinence, drinking frequency, relapse, medication adherence, counseling
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