How Does Disulfiram Work?

It's the end of a long week. You're tired, you're stressed, and your brain is nagging you for that one thing you're trying to steer clear from — a glass of wine. 

Trying to kick alcohol out of your life can be a challenging journey. You've been doing great, but some days, it’s just harder. And that's okay! But what if there was a simple science-backed tool in our medical arsenal that could make your journey a bit smoother?

Enter disulfiram — a small pill with a big mission! Disulfiram’s brand name, Antabuse, has become a hot topic for those on the alcohol journey. But how does Antabuse work? Let’s find out!

A Glimpse Into the Past: What Is Disulfiram?

Alright, first things first. What in the world is disulfiram? While it might sound like something from outer space, disulfiram is a pretty down-to-earth medication that's been helping people navigate their relationship with alcohol for many decades. 

Disulfiram's journey began in the 1920s, not in the world of addiction recovery, but — out of all things — in the rubber industry. The compound was first synthesized as part of an effort to develop better rubber accelerators. Its interaction with alcohol was discovered accidentally by factory workers, who noted that exposure to the substance caused severe physical reactions to alcohol — to the point of developing an aversion to it.

Taking note of the workers' observations, researchers began to explore disulfiram’s potential as a treatment for alcohol use disorder. In 1948, Danish researchers Erik Jacobsen, Jens Hald, and Keneth Ferguson confirmed the earlier observations through clinical experiments: disulfiram consistently induced a highly unpleasant reaction when mixed with booze, making it a possible deterrent for those looking to quit!

Based on the promising results from clinical trials, disulfiram was approved by the U.S. Food and Drug Administration in 1951 and has been a fixture in the sobriety scene ever since. It was subsequently marketed under the brand name Antabuse. When combined with comprehensive therapy and support, the drug offers a tangible, science-backed mental and physical barrier against alcohol, providing an added layer of motivation for those committed to abstaining.

The Science of the Disulfiram Reaction

So how does it work? Normally, when we consume alcohol, our body breaks it down into a substance called acetaldehyde — a highly toxic compound that’s responsible for many of the negative side effects associated with drinking. It’s quickly broken down into a harmless substance known as acetate, which is further metabolized and used as fuel for the body. 

Disulfiram throws a wrench in this process by blocking aldehyde dehydrogenase — the enzyme that breaks down acetaldehyde into acetic acid. As a result, acetaldehyde levels skyrocket, causing the so-called “disulfiram reaction.” 

To put it mildly, the disulfiram reaction is unpleasant. It includes symptoms such as flushing, nausea, palpitations, headache, and sweating. Think about the worst hangover you've ever had, then yank it up a few notches — that's the kind of unpleasant we're talking about. But remember, the medication isn’t what’s causing the nasty symptoms — it's actually the alcohol. The pill just acts as a spotlight, revealing the true nature of alcohol in all its glory.

A lot of these uncomfortable and potentially risky symptoms are similar to the symptoms of alcohol intolerance caused by a genetic glitch that hinders alcohol metabolism. In other words, this medication is essentially making you allergic to booze.

The degree of the reaction depends on how much alcohol and disulfiram you've got in your system. For some, the side effects aren't too bad — they sort themselves out after 30 to 60 minutes. But that’s not always the case. You might be in for a much rougher experience that can last for several hours or even more. And we're not talking about a mild headache here — it can get as serious as heart failure and seizures and, in some cases, can even be life-threatening.

How long does disulfiram stay in your system? Because it’s eliminated slowly, it can linger in the body for as long as two weeks, although the disulfiram reaction will probably be weaker over time.

Disulfiram: A Decision-Making Tool

The idea is that these discomforts will deter us from drinking. Remembering about the trouble that’s coming our way if we mix alcohol with disulfiram works like an internal alarm bell that reminds us of our commitment to sobriety whenever we’re tempted to take a sip of alcohol — it’s simply not worth it. 

More importantly, it also lets us free up mental space for other things, since taking the medication works as a once-and-for-all decision that we’re not planning to drink that day. In other words, there’s no tiresome mental dialogue of “should I or shouldn’t I” going on, leaving us free to think about other things.

It’s important to remember that the decision is still ours — disulfiram isn’t “making” us do anything against our will. It’s simply helping us stick to the plan that we have made, allowing us to see what being alcohol-free is actually like without the clouds of indecision and mental back-and-forth getting in the way.

Is Disulfiram for Everyone?

Just like any treatment plan isn’t a one-size-fits-all scenario, disulfiram isn’t suitable for everyone. After all, every person is unique and has a distinct physiological profile and health history that should be carefully considered with the help of a healthcare professional. That said, there are a few known guidelines that can help in making an informed decision.

Disulfiram might be right for certain people:

• Determined abstainers. For those who are fully committed to abstaining from alcohol and seeking an added layer of deterrence, disulfiram can be beneficial.
• People in structured programs. Those participating in comprehensive treatment programs, including therapy and support groups, often find disulfiram to be a helpful addition to their regimen.
• People with a strong support system. Having friends or family who understand the implications of consuming alcohol while on disulfiram can make the journey smoother.
• Well-informed patients. Those who have thoroughly discussed the risks and benefits with their healthcare provider and have a clear understanding of the potential side effects and interactions are better prepared for its use.

However, it might not be the best option for others:

• People with certain medical conditions. Those with a history of certain conditions, such as diabetes, heart disease, hypothyroidism, epilepsy, and liver or kidney disease, may face increased risks with disulfiram and are probably better off taking a different approach.
• Pregnant or breastfeeding mothers. Disulfiram may have adverse effects on the fetus or breastfeeding infant. Consulting a doctor is essential before considering its use during this period.
• People with certain psychiatric disorders. Some psychiatric disorders might be exacerbated by disulfiram or its side effects, particularly if these conditions are not well-managed.
• Those on specific medications. Disulfiram can interact with various other medications, leading to potentially harmful effects. It's crucial to discuss any current medications with a healthcare provider before starting disulfiram.
• Those who are on the fence about quitting. For those not fully committed to abstaining from alcohol, the risks of a severe disulfiram-alcohol reaction might outweigh the benefits.
• Persons with allergies to the drug. As with any medication, some might be allergic to disulfiram or its components (the inactive ingredients that are part of it, such as crospovidone, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone, and silicon dioxide).

And, most importantly, it’s not a magic pill — it’s a tool. Disulfiram works best as part of a comprehensive treatment program that may include therapy, support groups, and a commitment to a healthier lifestyle.

Other Options

It can also be helpful to consider other medications that have been found to be useful in treating substance misuse: 

• Naltrexone (Revia, Vivitrol). Naltrexone is an opioid receptor antagonist. It works by blocking the euphoric and sedative effects of alcohol, making drinking less pleasurable and thereby reducing the urge. However, it doesn’t prevent the effects of alcohol on judgment and coordination and cannot be used in people currently using opioids or with an acute hepatitis or liver failure.
• Acamprosate (Campral). Acamprosate affects chemicals in the brain that might be imbalanced in a person who is addicted to alcohol. It works to restore this balance, reducing the urge to drink. Since it needs to be taken multiple times a day, it's best suited for those who've already stopped drinking and are looking to avoid relapse.
• Topiramate (Topamax). Originally an anticonvulsant for epilepsy, topiramate's exact mechanism in treating alcohol dependence is not fully understood. It's believed to reduce dopamine release, which is linked to the pleasurable effects of alcohol. While topiramate is not approved by the FDA specifically for alcohol dependence, it’s sometimes prescribed off-label. Possible side effects include numbness or tingling, weight loss, and difficulty concentrating.

Your Alcohol-Free Journey

Recovery is a marathon, not a sprint, and it's okay to use tools like disulfiram along the way. Think of them as training wheels rather than crutches! Being stuck in a pattern of alcohol misuse can feel like being trapped in a horror movie, wondering what's around the corner. But with the right tools and support, you'll be writing your happy ending in no time!

If you’re considering disulfiram, here are some ideas to think about:

• Consult with your healthcare provider. Always make sure you're making informed decisions about your health. Discuss your plans and expectations with your healthcare provider to assess if disulfiram is the right choice for you.
• Compile a medication journal. Keep track of any other medications or supplements you’re taking. This will help in assessing potential interactions and ensuring disulfiram fits seamlessly into your regimen.
• Set a routine. Once you've started taking disulfiram, consistency is key. Make sure you take your medication as directed, and don’t skip doses. Instead of merely setting a reminder, pair the act of taking disulfiram with a small ritual that you cherish. Maybe it's a moment of deep breathing, listening to a particular song, or sipping your morning herbal tea.
• Craft a “Why I started” letter. On a day when you feel particularly motivated, write a heartfelt letter to yourself explaining why you chose this path. When temptation strikes, reread it.
• Plan for contingencies. Prepare for scenarios where you might be tempted to drink. Have a plan in place to handle these situations effectively. For example, if you’re on vacation and are surrounded by new drinking cultures or situations, do some research in advance to find local non-alcoholic specialties, plan activities that don't revolve around drinking, and communicate your desire to stay alcohol free to your travel companions.
• Build a support network. Sobriety is easier with a strong support network. Include loved ones in your journey and consider joining a support group. Having a check-in buddy can work wonders, so find a friend or family member and plan a weekly chat about your highs, lows, and everything in between.
• Prioritize your health. Engage in activities that promote both physical and mental wellness. This could include regular exercise, mindfulness, or therapy.
• Fuel your body right. Consult a nutritionist who can help tailor a diet plan optimized for recovery. Focus on foods that stabilize mood, boost gut health, and energize without spikes and crashes.
• Keep track of your progress. Start a journal where you jot down your feelings, milestones, challenges, and even random thoughts. Over time, this can serve as a testament to your resilience and growth.

If you choose to give disulfiram a try, next time when the weekend rolls around and the old urge comes knocking, you’ll have a helper in your corner. You’ll be better equipped to say, "Not today, alcohol!" And remember, it’s all about creating better experiences and memories — and every small victory is worth celebrating!