Experienced Acetaldehyde Reaction Does Not Improve Treatment Response in Outpatients Treated With Supervised Disulfiram

Aim: The major mode of action of disulfiram is assumed to be a psychological deterrence of an acetaldehyde reaction after alcohol consumption. However, it is still unclear whether patients need to experience an acetaldehyde reaction with the help of a "test drink" at the beginning of the therapy to achieve a better efficacy. Therefore, in this study, we test the hypothesis if an experienced acetaldehyde reaction during the therapy with disulfiram predicts better treatment outcome in alcohol-dependent patients. Method: We evaluated outcome data of 46 patients treated with supervised disulfiram with experienced versus not experienced acetaldehyde reaction. Results: Alcohol consumption during outpatient disulfiram treatment was reported by 46% of the patients. Ninety percent of these patients reported typical symptoms of an acetaldehyde reaction. Comparing the course of abstinence rates, our results suggest that the experience of an acetaldehyde reaction was not associated with any differences in treatment outcome but with a significant earlier discontinuation of the therapy. Conclusions: This study supports the position that the experience of an acetaldehyde reaction is not necessary for disulfiram's action and does not lead to a better treatment outcome. Hence, there is no evidence for the necessity of a test drink before the initiation of a supervised disulfiram therapy.