Pharmacopsychiatry 2016; 49(04): 137-141
DOI: 10.1055/s-0042-103592
Review
© Georg Thieme Verlag KG Stuttgart · New York

Current Findings and Mechanisms of Action of Disulfiram in the Treatment of Alcohol Dependence

J. Mutschler
1   Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
3   Privatklinik Meiringen, Meiringen, Switzerland
,
M. Grosshans
2   Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
,
M. Soyka
3   Privatklinik Meiringen, Meiringen, Switzerland
4   Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
,
S. Rösner
5   Forel Klinik, Ellikon an der Thur, Switzerland
› Author Affiliations
Further Information

Publication History

received 02 December 2015
revised 04 February 2016

accepted 11 February 2016

Publication Date:
17 March 2016 (online)

Abstract

As an alcohol-aversive agent, disulfiram occupies an exceptional position in the pharmacological relapse prevention of alcohol dependence. In contrast to anti-craving drugs, disulfiram does not modulate neurobiological mechanisms of addiction, but rather works by producing an aversive reaction when combined with alcohol. Therapeutic and adverse effects are therefore closely related: On the one hand, the aversiveness of the disulfiram ethanol reaction has the potential to support abstinence in a subgroup of alcohol-dependent patients, while on the other hand it becomes a health threat if the patient fails to maintain complete abstinence. The exceptional position of disulfiram is also related to the role that expectations play in the mediation of therapeutic effects. These are not determined by the pharmacological effects or the actual occurrence of a disulfiram-ethanol reaction, but are attributable to patient awareness that the drug was consumed and the corresponding anticipation of an aversive reaction if combined with alcohol. This is in line with the findings of a recent meta-analysis that only showed significant effects for disulfiram in open-label trials. The authors of the meta-analysis conclude that due to expectations induced in both the treatment and placebo groups, blinded studies are incapable of distinguishing a difference between groups. The mediation of therapeutic effects through expectation has a number of consequences for clinical practice and future research on disulfiram.

 
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