Disulfiram (Antabuse) Withdrawal & Treatment

Overcoming addiction can be challenging, but it’s one of the most transformative decisions a person can make. For those battling alcohol addiction, medications like Disulfiram—commonly known by its brand name Antabuse—can be a powerful recovery tool. While Disulfiram is not a cure for addiction, it creates a strong physical deterrent to alcohol consumption, helping people stay committed to long-term sobriety in the face of temptation.

That said, taking Antabuse comes with potential risks and challenges, including the process of discontinuing its use (disulfiram, aka Anabuse withdrawal). This page explores how Disulfiram works, how it supports sobriety, its risks and benefits, and how to get compassionate and effective treatment for alcohol abuse.

What is Disulfiram?

Disulfiram (Antabuse) is a prescription medication used to support individuals in their recovery from alcohol addiction. Approved by the FDA (U.S. Food and Drug Administration) in 1951, it was the first drug approved to treat alcohol use disorder [1]. Unlike other medications that target brain chemistry, Disulfiram serves as a behavioral deterrent, discouraging alcohol consumption by provoking unpleasant reactions when alcohol is consumed while taking Antabuse.

The medication is most effective when combined with a comprehensive treatment program that includes counseling, talk therapy, and support groups. It’s not a standalone cure for alcoholism but rather a tool that reinforces a person’s commitment to staying sober. Disulfiram is typically prescribed to individuals motivated to quit drinking and prepared to adhere to its strict guidelines.

Although the medication can be highly effective, it’s not suitable for everyone. Before starting treatment, individuals should undergo a thorough medical evaluation to ensure it’s safe for them. Conditions such as liver disease, cardiovascular complications, or pregnancy may rule out its use.

How Does Disulfiram Work?

Disulfiram’s effectiveness lies in its ability to interfere with the body’s natural process of metabolizing alcohol [2]. Typically, alcohol is broken down by enzymes in the liver. The first enzyme, alcohol dehydrogenase, converts alcohol into acetaldehyde, a toxic compound. A second enzyme, acetaldehyde dehydrogenase, then breaks acetaldehyde down into acetic acid, a harmless substance that the body can safely eliminate.

Disulfiram blocks the second enzyme, causing acetaldehyde to accumulate in the bloodstream when alcohol is consumed. This buildup leads to a range of unpleasant symptoms, including:

• Severe nausea and vomiting
• Facial flushing
• Dizziness
• Rapid heartbeat
• Chest pain
• Difficulty breathing
• Intense headache

The severity of these symptoms typically discourages individuals from drinking alcohol while on the medication. Reactions can occur within 10 minutes of consuming alcohol and may last for several hours, depending on the amount of alcohol ingested.

These reactions aren’t limited to alcoholic beverages. Products containing even small amounts of alcohol, such as certain mouthwashes, sauces, vinegar, and medications, can trigger a reaction. People using Disulfiram must be cautious and read labels carefully to avoid accidental exposure.

Disulfiram for alcohol withdrawal is ineffective, and it does not reduce cravings. Instead, it works as a psychological and physical deterrent, helping individuals avoid relapse by making the consequences of drinking unbearable.

Dangers & Risk Factors Associated with Disulfiram Treatment

While Disulfiram can be highly effective, it also carries potential risks. The medication can cause mild to moderate side effects, even when alcohol is not consumed [3]. These may include:

• Drowsiness or fatigue
• Headache
• A metallic or garlic-like taste in the mouth
• Mild skin rash or itching

For most people, these symptoms are temporary and diminish as the body adjusts to the medication. However, a healthcare provider should be consulted if they persist or worsen.

In rare cases, Disulfiram can lead to severe side effects or complications. Some individuals may experience:

• Liver toxicity or damage, which can manifest as jaundice, abdominal pain, or dark urine.
• Neuropathy, including numbness, tingling, or pain in the extremities.
• Psychiatric symptoms such as depression or confusion.

People with a history of liver disease, cardiovascular conditions, or specific mental health disorders may be at greater risk for these complications. Regular medical monitoring, including liver function tests, is often recommended for those taking Disulfiram to ensure safety.

Patient compliance is a significant risk associated with Disulfiram treatment. Since the medication doesn’t reduce cravings, individuals who are not fully committed to sobriety may stop taking it to resume drinking. This can undermine its effectiveness and potentially lead to relapse.

The reaction caused by mixing Disulfiram with alcohol is not only unpleasant but can also be dangerous. Severe cases may result in:

• Respiratory distress
• Heart arrhythmias
• Loss of consciousness
• Seizures
• Death

Because of these risks, it’s essential to avoid alcohol in all forms while on the medication.

Some people should not take Disulfiram, including:

• Pregnant or breastfeeding women.
• Those with severe liver or kidney disease.
• Individuals with a history of severe mental health conditions, such as psychosis.
• People allergic to sulfur or Disulfiram’s active ingredients.

Disulfiram stays in the body for up to two weeks after the last dose. This means individuals must continue avoiding alcohol during this period to prevent adverse reactions. Those planning to discontinue the medication should consult a healthcare provider and create a plan to maintain sobriety through other means, such as counseling or support groups.

Who Benefits from Disulfiram Treatment?

Disulfiram is a helpful tool for individuals who are ready to commit to sobriety and need extra support to avoid alcohol. It works best for those who are motivated to stop drinking and can follow a structured treatment plan. By creating physical discomfort when alcohol is consumed, Disulfiram helps reinforce the choice to stay sober.

Disulfiram is most beneficial for people who:

• Have a strong desire to stop drinking but fear relapse.
• Have previously attempted sobriety without success.
• Need a physical deterrent to help resist the temptation of alcohol.
• Are in a structured treatment program that includes therapy or counseling.

This medication can also help those with a supportive environment, such as family or friends, who encourage accountability. External support improves adherence to the treatment plan and increases the chances of long-term success.

Treating Addiction Using Disulfiram

Disulfiram is most effective when used as part of a comprehensive addiction treatment plan. Rather than being a standalone solution, it complements other therapeutic approaches to help individuals build a robust foundation for lasting sobriety.

Disulfiram is typically introduced after the detoxification phase once the body is free from alcohol. This ensures that no alcohol remains in the system, which could trigger a reaction when the medication is taken.

During the treatment process, Disulfiram serves as a psychological and physical safeguard. Knowing that consuming alcohol will result in severe discomfort can help individuals avoid drinking, even in moments of temptation.

There are several types of programs where Disulfiram may be included as part of a recovery plan:

• Inpatient rehab: In a residential setting, patients live at the treatment facility and receive 24/7 care. This environment offers structure, support, and the opportunity to establish new alcohol-free routines. Inpatient rehab is ideal for individuals with severe addictions or those who need a stable environment to focus on recovery.
• Outpatient rehab: This option allows people to live at home while attending scheduled therapy sessions. Disulfiram can help individuals stay sober as they deal with daily responsibilities like work, school, or family commitments.
• Sober living homes: These structured environments bridge rehab and independent living. Residents commit to staying alcohol-free and may use Disulfiram as a safeguard during this transitional period.

Disulfiram is often combined with evidence-based therapies to address the underlying psychological and emotional factors of addiction. These therapies may include:

• CBT (cognitive behavioral therapy): This helps individuals recognize and change thought patterns that lead to drinking [4].
• Family counseling: Involves loved ones in recovery to build a strong support system.
• Group therapy: Provides peer support and accountability through shared experiences and encouragement.
• 12-step programs: Groups like AA (Alcoholics Anonymous) offer ongoing support and a framework for maintaining sobriety.

The combination of Disulfiram and these therapies creates a well-rounded approach that addresses the physical and emotional aspects of addiction.

Do I Need Disulfiram Addiction Treatment?

Deciding whether Disulfiram is the right choice depends on your personal history with alcohol and your readiness to commit to sobriety. Understanding your unique needs and circumstances can help you make an informed decision.

If you’re unsure whether Disulfiram treatment is right for you, consider the following questions:

• Do I struggle to stop drinking on my own?
• Have I experienced relapses after attempting to quit?
• Do I drink to cope with stress, anxiety, or depression?
• Have I experienced blackouts, memory loss, or physical health problems due to alcohol?
• Do I feel cravings for alcohol that interfere with my daily life?
• Have my relationships, career, or education suffered because of drinking?

If you answered yes to several of these questions, Disulfiram might be a valuable addition to your recovery plan.

Starting Disulfiram treatment requires careful preparation and commitment. Here’s what you can expect:

• Medical evaluation: A healthcare provider will assess your overall health, review your medical history, and ensure Disulfiram is safe.
• Detoxification: You must be free from alcohol for at least 12 hours before starting Disulfiram. Detox helps eliminate alcohol from your system and reduces the risk of adverse reactions.
• Daily medication: Disulfiram is taken as a daily tablet. Adhering to the prescribed dosage is central to maintaining its effectiveness.
• Regular monitoring: Your doctor will schedule follow-up appointments to monitor your progress, adjust dosages if needed, and address any side effects.
• Supportive care: Disulfiram is most effective when paired with therapy, counseling, and peer support to address the root causes of addiction.

Disulfiram treatment requires a high level of commitment to sobriety. Unlike medications that reduce cravings, it relies on the individual’s willingness to take the medication daily and avoid alcohol altogether. For those ready to embrace this responsibility, Disulfiram can provide a powerful incentive to stay on the path to recovery.

If you’re considering Disulfiram treatment, the first step is to consult with a medical professional or addiction specialist. They can help determine whether this medication fits your needs and guide you toward a treatment plan that supports your long-term goals.

Disulfiram | FAQs

Why was Antabuse discontinued?

Antabuse was not completely discontinued but faced temporary shortages due to manufacturing and supply chain issues. While some pharmaceutical companies stopped producing it due to high concentrations of nitrosamine (a carcinogen), it remains available through manufacturers like Alvogen, and it’s also available in generic form (disulfiram).

How long after stopping Antabuse can you drink?

You should wait at least 14 days after your last dose of Antabuse before consuming alcohol. This ensures the medication is cleared fully from your system and mitigates severe reactions.

What happens when you drink on Antabuse?

Drinking alcohol on Antabuse triggers a reaction that causes intense symptoms like nausea, vomiting, rapid heartbeat, chest pain, and dizziness. It may lead to severe complications like respiratory distress or seizures in rare cases.

How does the drug Disulfiram work?

Disulfiram blocks the enzyme that breaks down acetaldehyde, a toxic byproduct of alcohol metabolism. This causes acetaldehyde to build up in the body, leading to unpleasant symptoms that discourage alcohol consumption.

Get Disulfiram Treatment for Alcohol Abuse at Renaissance Recovery

If you or someone you care about has been abusing alcohol and needs help getting back on track, reach out to Renaissance Recovery. We treat all addictions, using MAT where appropriate, at our rehabs in California and Florida.

If you choose outpatient treatment at Renaissance, you can live at home and continue meeting your everyday commitments while getting first-class treatment for alcohol addiction.

All alcohol use disorders are unique, so all our treatment plans are customized to reflect this. Therapies might include:

• Medication-assisted treatment with disulfiram
• Psychotherapies
• Motivational therapies
• Family therapy
• Group therapy
• Counseling
• Holistic treatments
• Aftercare planning

When you’re ready to move beyond alcohol abuse, call 866-330-9449.

Sources

[1] https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/disulfiram

[2] https://www.ncbi.nlm.nih.gov/books/NBK459340/

[3] https://www.ncbi.nlm.nih.gov/books/NBK64036/

[4] https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral