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Disulfiram: The Survivor Medication

Alharbi, Fares MBBS; el-Guebaly, Nady MD

Addictive Disorders & Their Treatment: December 2012 - Volume 11 - Issue 4 - p 212–223
doi: 10.1097/ADT.0b013e318246f4af
Original Articles

Objective: The discovery of the disulfiram (DSF)-ethanol reaction dates back to 1948. Since then, major studies have questioned the efficacy of DSF in the treatment of alcohol dependence. Yet, DSF remains in use! This review explores the reasons why this is so, along with attempts to improve its efficacy in alcohol treatment and expand its use to other substances and disorders.

Method: A systematic review of the 2004 to 2011 literature was drawn from a comprehensive MEDLINE search. Clinical trials using DSF for the treatment of alcohol and/or cocaine use and/or dependence were identified, along with DSF efficacy studies focusing on supervised administration and combination strategies.

Results: Of the 83 articles retrieved within the initial search criteria, 22 were clinical trials or studies on the following subjects: comparing DSF with acamprosate and naltrexone; use of DSF in alcohol treatment with comorbidity; use of DSF in the cocaine treatment; assessment of the adherence to DSF; and combined use of DSF with cognitive behavioral therapy.

Conclusions: DSF’s complete mechanisms of action and its optimal dosage remain subjects of inquiry. The supervised use of DSF is justified for alcohol-dependent individuals struggling with their sobriety. Additional uses appear promising.

*Addiction Psychiatry

Addiction Division, University of Calgary, Canada

The authors declare no conflict of interest.

Reprints: Fares Alharbi, MBBS, Addiction Psychiatry, Department of Psychiatry, University of Calgary, Foothills Medical Centre, Addiction Centre, 1403–29 ST NW, Calgary AB T2N 2T9, Canada (e-mail:

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved