ARTICLE OVERVIEW: No. Disulfiram does not directly address alcohol cravings. Instead, disulfiram produces a sensitivity to alcohol which results in a highly unpleasant reaction if/when you drink even small amounts of alcohol
TABLE OF CONTENTS
- What’s a Craving?
- Are Cravings Normal?
- What Is Disulfiram?
- How It Works
- Main Effects
- Who Should Use It
- Before You Get a Prescription
- Prescription Guidelines
- Safety Precautions
- Is It Effective?
- Measuring a Craving
- Other Treatments for Cravings
- Your Questions
What Is An Alcohol Craving?
The words “urge” and “craving” refer to a broad range of thoughts, physical sensations, or emotions that tempt you to drink, even if you have a desire not to. You may feel an uncomfortable pull in two directions or sense a loss of control. The International Classification of Diseases (ICD–10) includes craving as an optional diagnostic criterion for addiction to alcohol or other drugs, defining the term as:
“A strong desire or sense of compulsion to [drink].”
Fortunately, urges to drink are usually short-lived, predictable, and controllable. In fact, when you apply a recognize-avoid-cope approach commonly used in cognitive behavioral therapy, you can change unhelpful thinking patterns and reactions. It also helps to uncover the nature of your urges to drink and to make a plan for handling them. The NIAAA recommends disulfiram as one of three medications used to treat cravings related to problem drinking. See the section at the end of the article for more on naltrexone and acamprosate.
Are Cravings Normal?
So, are cravings normal?
Yes, cravings are an expected side effects that occurs as you quit drinking As you change drinking patterns, it is normal and common to have urges or a craving for alcohol. Learning to cope with alcohol cravings takes practice. And as you successfully move through a craving, the easier it gets over time…until cravings not longer occur.
So, how can disulfiram help you deal with alcohol cravings?
Disulfiram was the first medication approved by the U.S. Food and Drug Administration to treat chronic alcohol dependence.
What Is Disulfiram?
Disulfiram is the main ingredient found in Antabuse. If you’re taking disulfiram and drink, you feel really, really sick. In this way, it is used as a deterrent to drinking to help maintain sobriety in the treatment of chronic alcoholism or alcohol dependence. In fact, when used in conjunction with supportive and psychotherapeutic measures, disulfiram can be successful in creating longer periods of sobriety or total abstinence.
In its pure state, disulfiram is a white to off-white, odorless, almost tasteless powder, which is soluble in water and alcohol. But disulfiram is an alcohol-aversive or alcohol-sensitizing agent. So, the medication causes an acutely toxic physical reaction when mixed with alcohol. How?
How it Works
To understand how disulfiram works, we have to get a little technical.
Normally, the enzyme alcohol dehydrogenase (ALDH) found in the liver and brain transforms alcohol into acetaldehyde. ALDH oxidizes the acetaldehyde byproduct into acetic acid. Disulfiram blocks this oxidation by inhibiting ALDH, causing a rapid rise of acetaldehyde in the blood when alcohol is consumed. The result is called a disulfiram-alcohol reaction, and it may increase the acetaldehyde concentration in blood to 5 to 10 times that occurring without disulfiram.
As a result, disulfiram causes unpleasant effects when even small amounts of alcohol are consumed. This knowledge of a possible severe reaction to alcohol consumption is thought to increase a person’s motivation to remain abstinent. To repeat, disulfiram is not a cure for alcoholism, but discourages drinking.
When you combine disulfiram with alcohol, the two create a chemical reaction that results in effects, which can include:
- Blurred visión.
- Breathing Difficulty.
- Chest pain.
- Flushing of the face.
- Mental confusion.
The disulfiram-alcohol reaction usually begins about 10 to 30 minutes after alcohol is ingested. Its adverse effects range from moderate to severe. Intensity varies by each person’s unique individual characteristics.
The reaction is generally proportional to the amounts of disulfiram and alcohol ingested. Mild effects may occur at blood alcohol concentrations of 5 to 10 mg/100 ml. At 50 mg/100 mL, effects usually are fully developed. When the concentration reaches 125 to 150 mg/100 mL, unconsciousness may occur.
Some experts (Schuckit, 2006) question disulfiram’s effectiveness because the time between alcohol ingestion and the reaction can be up to 30 minutes apart and the intensity of the reaction is unpredictable…
As with other medications used for addiction, general efficacy increases when disulfiram is administered in conjunction with intensive talk therapy.
Who Should Use It?
People who face a drinking problem can benefit from the use of disulfiram. The 2015 NSDUH estimates that about half of American are current drinkers, and that about 15.1 million people aged 18+ have a drinking problem.
The consensus among experts is that disulfiram is most effective for persons who have undergone detoxification or are in the initiation stage of abstinence, especially when they are committed to abstinence and receive adequate, ongoing supervision. Disulfiram may not reduce the urge to drink alcohol. However, it can motivate you to avoid drink.
Persons with severely impaired judgment or who are highly impulsive from a severe mental illness or cognitive impairment may be inappropriate candidates for treatment with disulfiram.
Before You Get a Disulfiram Prescription
Physicians should not administer disulfiram until the following steps have been taken.
1. Doctors should first complete a medical and psychiatric history. One goal is to identify possible allergies to disulfiram or other drugs. So, you’ll need to list prescription and nonprescription medications you’re taking. Be sure to communicate a history of cardiovascular disease, or kidney or liver disease; and for women, reproductive status, including current pregnancy or plans to become pregnant or to breast-feed.
2. Doctors will also perform a physical exam, baseline liver and kidney function tests, and a pregnancy test for women. Perform an electrocardiogram if clinically indicated (e.g., history of heart disease).
3. You need to get educated about disulfiram and give informed consent that you are OK to use the medication.
4. Finally, before you begin taking a disulfiram prescription, you need to wait until you’ve abstained from alcohol at least 12 hours and/or breath or blood alcohol level is zero.
Disulfiram comes in tablets to take by mouth. It should be taken once a day. If you cannot swallow the tablets, crush them and mix the medication with water, coffee, tea, milk, soft drink, or fruit juice.
Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take disulfiram exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Disulfiram has been used to treat drinking problems for almost 60 years. Although disulfiram-alcohol reactions can be life threatening, the reduced dosages and careful screening now in practice have made this outcome extremely rare. In fact, deaths from the disulfiram-alcohol reaction have become rare because lower dosages are used and persons with severe cardiac disease are excluded from disulfiram treatment. Its hepatotoxicity in some persons remains a concern.
Furthermore, disulfiram is contraindicated in persons who are currently intoxicated by alcohol, or who have been diagnosed with cardiovascular disease, or psychoses. Disulfiram is also contraindicated in individuals hypersensitive to the drug or other thiuram derivatives such as those used in pesticides or rubber vulcanization. People with a history of rubber contact dermatitis should be evaluated for hypersensitivity to thiuram derivatives prior to administration of disulfiram.
It is Effective?
The jury is not yet out.
When used in combinations with psycho-social therapy, disulfiram may decrease the quantity and frequency of drinking among recovering alcoholics, but the medication does not appear to increase the proportion of persons who maintain total abstinence.
Disulfiram’s effects on craving have not been specifically evaluated in clinical trials. However, disulfiram has been shown to interfere with the metabolism of dopamine, potentially influencing the development of craving. Still, recent reviews of placebo-controlled clinical trials with disulfiram have failed to confirm the drug’s efficacy in alcoholism treatment.
Measuring a Craving
Believe it or not, reliable methods for measuring craving are required to support meaningful experiments or clinical evaluations. Many studies simply ask the subject to rate the intensity of his or her desire to drink, sometimes in the presence of an alcohol-related cue. Additionally, researchers have developed multi-item scales to make self-report instruments more precise.
One of the best-known multi-item scales is called The Obsessive Compulsive Drinking Scale (OCDS). A key item measured by the OCDS is a person’s ability to resist or suppress urges to drink. Preliminary data suggests that measuring your cravings to drink can help to assess:
1. The severity of alcoholism.
2. The progress of a person’s treatment.
3. Treatment outcomes.
In fact, the strength of a person’s ability to get through a craving may be crucial when initially quitting drinking and the subsequent maintenance of abstinence.
Models Of Craving
Many theoretical models attempt to explain the phenomena associated with craving. Although no single model accounts for all aspects of craving, each has elements that may eventually contribute to an overall, comprehensive model.
The reinforcement model is based on alcohol’s ability to produce an elevated mood or to help relieve an unpleasant mental state such as stress or anger. According to this model, an unconscious learning process called “reinforcement” leads to repetition of the behavior that produces the positive experience. Eventually, objects, environments, or emotions consistently associated with alcohol consumption can produce a similar response as powerfully as can alcohol itself. This is why the sight of a bar, liquor store, or beverage advertisement, the company of friends who drink, or exposure to alcohol itself might bring on a craving.
According to the social learning model, cue-elicited craving during or after treatment can trigger conscious coping strategies aimed at maintaining abstinence. The success of coping depends on the drinker’s confidence in his or her ability to resist the urge to drink. This model acknowledges craving as only one of several factors necessary to induce relapse.
The cognitive processing model postulates that alcohol use becomes a habit, which requires little conscious effort or attention, just as driving down a familiar road can become automatic. In this model, craving represents the effort involved in mobilizing conscious problem-solving skills needed to block the automatic drinking behavior. Such a situation may occur when a drinker finds that his favorite bar is unexpectedly closed. Similarly, following treatment, an alcoholic who is motivated to remain abstinent might experience craving while consciously attempting to avoid cue-induced relapse
Other Treatments for Cravings
Despite the difficulties involved in the study of craving, research results have helped experts develop and validate therapies to manage the phenomenon. The two effective treatments for cravings include psychotherapy and medications. The NIAAA is looking into new treatments based on the neuroscience of the brain and addiction and has mapped parts of the brain affected by alcohol in the picture below.
1. Psychotherapy for cravings.
Relapse prevention approaches often incorporate some of the main principles of cognitive-behavioral therapy. This approach teaches you to recognize the cues that lead to drinking to be better prepared to deal with them if you encounter them. With the help of a therapist, you can develop the skills and self-confidence to cope with high-risk situations such as negative emotional states, interpersonal conflict, and social pressure to drink. The informal use of similar coping strategies may contribute to the success of 12-step self-help programs.
2. Medications for cravings.
The results of craving research have spurred the development of new medications to supplement talk therapies. Among the most promising of such medications are naltrexone (ReViaT) and acamprosate.
Acamprosate may diminish craving by helping to restore the physiological balance of the brain after abstinence has been achieved. Acamprosate improved various measures of abstinence in 14 of 16 European studies and in a 21-site multicenter trial in the United States. Acamprosate is available by prescription in Europe and is awaiting approval by the U.S. Food and Drug Administration for use in this country.
Naltrexone is the only commercially available medication in the United States that targets alcohol’s effects on the brain. When combined with psychotherapy, naltrexone has been found to:
- Decrease drinking rates.
- Prolong abstinence.
- Help people avoid relapse to uncontrolled drinking.
These findings have been reported among abstinent alcoholics who sampled alcohol during treatment. Another study concludes that the changes in craving are related to naltrexone’s efficacy in treating alcohol dependence. Some researchers would like to administer naltrexone to actively drinking alcoholics during treatment and on an as-needed basis only when drinking is anticipated.
Did we answer all your questions related to alcohol cravings and the use of disulfiram? If you have any further questions you would like to ask, please post them in the comments section at the end of the page. We try to answer each legitimate inquiry with a personal and prompt response.
References Sources: NCBI: Disulfiram
NIAAA: Alcohol alert
OXFORD ACADEMY: Reductions in Alcohol Craving Following Naltrexone Treatment for Heavy Drinking
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