Jørgensen 2011: a review of disulfiram for alcohol problems

What they tested

The authors searched three medical databases for randomized controlled trials of disulfiram, a drug that causes a reaction such as flushing and nausea if someone drinks. They found 11 trials. These compared disulfiram with a placebo (a dummy pill), with no treatment, or with other treatments meant to support abstinence.

The main outcome was keeping alcohol intake below 30 g a day for men and 20 g a day for women. Other outcomes included days until relapse, how much people drank and how many days they drank.

What they found

Six of the 11 trials found that people on disulfiram did significantly better on abstinence. Of the 9 trials that measured other outcomes, 6 found more days until relapse and fewer drinking days with disulfiram.

Most of the trials with significant results were short. Only 3 trials lasting 12 months showed a significant gain in days until relapse or a drop in drinking days.

Results varied a lot from trial to trial, and the authors rated the quality of the studies as moderate. They judged the pooled results reliable for two comparisons: disulfiram against placebo over 12 months, and unsupervised disulfiram against other or no treatment.

The authors concluded that supervised disulfiram has some effect on short-term abstinence, days until relapse and drinking days, compared with placebo, no treatment or other treatments. They called for more consistent, higher-quality trials.

Limits

• The trials differed a lot from each other, and the authors rated their quality as moderate.
• Long-term effects on abstinence had not been studied, and most of the positive trials were short.
• The trials compared disulfiram with different things (placebo, no treatment, other treatments), which makes a single overall answer harder to read.

What it means if you're considering naltrexone

For someone comparing medicines, this review suggests disulfiram can help in the short term, especially when someone supervises the doses, but it says little about lasting results. The site's comparison of naltrexone and disulfiram notes that disulfiram works by making a drink cause a reaction, while naltrexone blocks part of the reward from drinking, and that both US guidelines rate naltrexone higher for alcohol use disorder.