title: Experienced acetaldehyde reaction does not improve treatment response in outpatients treated with supervised disulfiram.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of General and Social Psychiatry, Psychiatric University Hospital Zurich, Zürich, Switzerland. jochen.mutschler@puk.zh.ch
authors.forename: Jochen
authors.initials: J
authors.lastname: Mutschler
authors.forename: Gülseren
authors.initials: G
authors.lastname: Dirican
authors.forename: Stefan
authors.initials: S
authors.lastname: Funke
authors.forename: Caitriona
authors.initials: C
authors.lastname: Obermann
authors.forename: Martin
authors.initials: M
authors.lastname: Grosshans
authors.forename: Karl
authors.initials: K
authors.lastname: Mann
authors.forename: Falk
authors.initials: F
authors.lastname: Kiefer
authors.forename: Alexander
authors.initials: A
authors.lastname: Diehl
mesh_terms: D000079:Acetaldehyde / Q000378:metabolism*; D000328:Adult; D000427:Alcohol Deterrents / Q000009:adverse effects / Q000627:therapeutic use*; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000378:metabolism; D000437:Alcoholism / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology*; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D023801:Directly Observed Therapy; D004221:Disulfiram / Q000009:adverse effects / Q000627:therapeutic use*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D012054:Reinforcement, Psychology; D012189:Retrospective Studies; D016312:Treatment Refusal / Q000523:psychology
chemical_list: D000427:Alcohol Deterrents; D000079:Acetaldehyde; D004221:Disulfiram