Supervised disulfiram in the treatment of alcohol use disorder: a commentary

Background: This commentary discusses the systematic review “The efficacy of disulfiram for the treatment of alcohol use disorder (AUD)” by Jørgensen and colleagues (2011, Alcohol Clin Exp Res DOI: 10.1111/j.1530‐0277.2011.01523.x ). The main focus of the commentary is on long‐term effects, long‐term use, and psychotherapeutic application of supervised disulfiram. Methods: A brief qualitative overview is given of previous and recent clinical studies on disulfiram in alcoholism treatment. Results: The alcohol deterrent disulfiram is an effective pharmacological adjunct to the treatment of AUD when it is administered as supervised low‐dose disulfiram and is integrated in comprehensive biopsychosocial alcoholism therapy. However, the assumed underlying psychological effects of psychotherapeutic disulfiram application have never been properly investigated. Prospective long‐term follow‐up studies are rare and suggest that long‐term effects of disulfiram are associated with long‐term use and/or integration of the medication in cognitive behavior therapy. Conclusions: Evidence from decades of research suggests psychological effects as principal mode of action of supervised disulfiram. Future randomized controlled trials are needed that investigate psychological actions and long‐term outcomes of this alcohol deterrent.