Experienced acetaldehyde-reaction is not associated with improved treatment response in patients treated with disulfiram

The major mode of action of disulfiram is assumed to be a psychological deterrence of an acetaldehyde-reaction following 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 in order 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. We evaluated outcome data of 46 patients treated with supervised disulfiram with experienced vs. not-experienced acetaldehyde-reaction. Alcohol consumption during outpatient disulfiram treatment was reported by 46% of the patients. Ninety % 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. 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.