title: Supervised Disulfiram's Superior Effectiveness in Alcoholism Treatment: Ethical, Methodological, and Psychological Aspects.
abstract: Disulfiram (DSF) causes the ALDH-mediated deterrence of alcohol consumption. We review recent meta-analyses showing the superior effectiveness of supervised disulfiram (SD) in alcoholism treatment compared with oral naltrexone or acamprosate (ACP). The success of SD is also consistent with the almost complete absence of alcoholism in Japanese homozygotes for 'inefficient' ALDH. However, SD is an underused treatment and some clinicians have ethical objections to DSF. We examine these objections and argue that they are based on a misunderstanding of how DSF works. In particular, we argue that SD is not as is often claimed a variety of aversion therapy but aids cognitive, behavioural, educational and psychosocial interventions. It has some unique features that need to be better understood if it is to be properly compared with other treatments and effectively employed to help alcoholic patients, especially those who have not responded to other evidence-based interventions.
authors.affiliation: The Stapleford Centre, London SW1W 9NP, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Brewer
authors.affiliation: Unité de recherche en psychophysiologie de la motricité, Université Libre de Bruxelles, Avenue F Roosevelt, 50 - 1050 Bruxelles, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Streel
authors.affiliation: AP-HP, Service d'addictologie, Hôpital Emile Roux, Limeil-Brévannes, Hôpitaux Universitaires Henri-Mondor, 94010 Créteil, France.|CESP, INSERM, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Limeil Brevannes, France.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Skinner
mesh_terms: D000077443:Acamprosate; D000427:Alcohol Deterrents / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy* / Q000523:psychology*; D026688:Bioethical Issues; D004221:Disulfiram / Q000627:therapeutic use*; D006801:Humans; D009271:Naltrexone / Q000627:therapeutic use; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000427:Alcohol Deterrents; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate; D004221:Disulfiram