The OAD Clinic
Antabuse - Disulfiram
Medication alone cannot overcome an alcohol addiction. But medication in combination with other treatment such as counselling, self-help groups, developing recovery skills and relapse prevention techniques has be proven to increase the chances of overcoming alcoholism.
How Medication Helps Alcoholism Treatment and Recovery
Numerous studies have proven that Antabuse is effective in the treatment of alcoholism and alcohol abuse. Antabuse has been used since 1951. (The generic name of Antabuse is Disulfiram.) Antabuse is not only effective in treating alcoholism, it is also helpful in treating drug addiction. If you have a drug problem, anything that helps you stop drinking will also help you stop using drugs, because alcohol usually leads to drugs.
Antabuse works by making you sick to your stomach if you have a drink. It works - because if you know you can't drink, then you won't think about drinking as much. Antabuse reduces cravings for alcohol. One study of over 250 people showed that Antabuse significantly reduces cravings for alcohol. Antabuse reduces the risk of relapse. A review of 13 clinical trials for alcoholism treatment confirmed that Antabuse in combination with treatments such as counselling, self-help groups and alcohol rehab significantly reduces the risk of relapse. (2, 3) Antabuse also reduces the risk of relapse in adolescent addicts.
People who use Antabuse feel liberated. That internal struggle that goes on every day, "Will I drink? Won't I drink?" is silenced when you're on Antabuse. Because drinking is not an option you don't waste your time thinking about drinking, and instead you focus more on your recovery. Antabuse is effective, because you have to wait for one to two weeks before you can have a drink after you stop Antabuse. You can't stop Antabuse one day and have a drink the next. It gives you plenty of time to reconsider, restart your Antabuse, and ask for help.
The Antabuse Reaction
It takes one drink to produce a reaction. It takes one bottle of beer, one glass of wine, or one shot of liquor to become sick.
The normal sequence of the Antabuse reaction is:
Flushing of the face
Low blood pressure
Nausea and vomiting
If you have one drink, you will vomit about as much as if you had food poisoning. A few people are very sensitive to Antabuse and get a stronger reaction. A quick test of whether you're sensitive to Antabuse is to see if your skin flushes when you put alcohol on your skin. If you're sensitive you may still decide to use Antabuse, but you'll have to be a little more careful about avoiding alcohol. Most people just need to show some common sense when they're on Antabuse.
The Do's and Don'ts of Antabuse
Wait at least 24 hrs after drinking before starting Antabuse. Consider the following arithmetic. If you had 10 drinks and weighed only 100 lbs (45kg), the alcohol would be completely eliminated from your system in 24 hrs. If you weighed more than 100 lbs (45kg) it would take less than 24 hrs. http://bloodalcoholcalculator.org
For most people, it takes one drink to produce an Antabuse reaction, therefore it's hard to get by mistake. You can have foods that have been cooked in wine, as long as they've been cooked the alcohol evaporates quickly. You have to be careful of some deserts that have a lot of uncooked alcohol in them. You also have to be careful of some cough syrups and cold preparations that can contain as much as 40% alcohol.
Most people prefer to use non-alcoholic mouthwashes to be on the safe side. Although the amount of alcohol you absorb from mouthwash doesn't equal one drink, assuming you don't drink your mouthwash. You can use perfumes, colognes, or aftershaves. The amount of alcohol you absorb through your skin is minimal. The standard patient information sheet on Antabuse says that you should avoid all of these things: mouthwash, perfumes, colognes, even vinegar. But I've treated thousands of patients, and I've never known any of them to get a reaction from anything other than drinking. Antabuse liberates you, if you use a little common sense.
Antabuse Side Effects
The side effects of Antabuse are less common than the side effects of relapse. During the first week or two that you take Antabuse, you'll probably feel a little more tired. It usually lasts for a week or two and then it goes away. During the first two months that people take Antabuse, about 20% develop a funny taste in their mouth. It's usually described as a metallic taste. 80% of people don't get it, and if you do get that taste, it often goes away after a few weeks or months. That's it for the minor side effects of Antabuse.
The major side effects of Antabuse are rare. The most common but still rare side effect of Antabuse is liver damage. Any drug that you take over a long-term has the potential to cause liver damage. With Antabuse, it happens in roughly one out of 30,000 people. Your doctor can do a simple blood test to check the state of your liver before you start. After you've been on Antabuse for a month you should have your liver tests repeated. Your doctor should periodically check your liver enzymes while you're on Antabuse.
Any drug can have any possible side effect. You can never say never in medicine. Every year people die from taking Tylenol (acetaminophen). But that doesn't mean we should stop using Tylenol. The benefits far outweigh the risks. And the benefits of Antabuse outweigh the risks of drinking. Before taking Antabuse you should give your doctor your entire medical history. You may not be a able to take Antabuse if you have a significant medical history of heart or blood vessel disease, diabetes, an underactive thyroid, brain disorders (e.g., seizures, brain damage), kidney disease, liver disease, a history of severe depression, a history of psychosis, or a history of suicide attempts. Antabuse can alter the metabolism and blood levels of certain drugs, especially tricyclic antidepressants, Dilantin (phenytoin), coumadin, isoniazid, and theophylline.
Do NOT take Antabuse if you're pregnant, or trying to become pregnant.
Serious Warning Signs
If you notice any of the following rare but serious warning signs, stop using Antabuse and tell your doctor immediately: dark urine, severe abdominal pain, persistent nausea or vomiting, yellowing of the eyes or skin.
Overcoming Psychological Resistance to Trying Antabuse
There are three main reasons why you may be reluctant to try Antabuse. First, because you're worried about the side effects. Although the side effects of Antabuse can be serious, they are rare. The side effects of relapsing on alcohol are common and serious. The second reason is because you want to do your recovery on your own. You've always been self-reliant and you want to be self-reliant in your recovery. But recovery involves learning to ask for help. Doing it on your own is overrated. You need to ask for help from your doctor, treatment program, 12 step group, and sponsor. Antabuse is just one more thing you can use. It is not an alternative to your supports. It complements them.
The third and final reason why you may be reluctant to try Antabuse is because you want to leave the door open to having a drink. Just in case you want to relapse there won't be anything in your way. Of course, if you leave that door open then it's guaranteed you'll relapse eventually. It's just a matter of time. If you've decided that you want to change your life. If you've decided that you have suffered enough negative consequences, then I encourage you to talk to your doctor about Antabuse.