How Bad Is Antabuse?

By Jeff Forester 11/10/11

When you don't trust yourself to stay away from a drink, you can take a pill to make drinking unbearable. Antabuse may be effective, but is it worth the cost?

Antabuse Side Effects
Aversion therapy in a bottle Photo via

Offer someone a pill that will give them blinding headaches followed by crippling nausea, blurred vision and, in some cases, pounding heart and most people would turn it down.

Alcoholics are not like most people.

In fact, many newly sober alcoholics take Antabuse (also known as Disulfiram), a drug that was discovered in the 1920s when researchers were looking for a way to kill intestinal parasite. When they tried the drug on themselves, scientists discovered awful side effects when they drank alcohol—effects so severe they began to use the drug as a way to prevent alcoholics from ever lifting a bottle to their lips.

Doctors have long sought a magic pill to “cure” alcoholism. With more than 18 million people in the United States abusing or addicted to alcohol, two million seeking treatment each year, and relapse rates of close to 90%, drug companies and docs are well motivated to find a reliable drug treatment for alcoholism.

The recent push to frame addiction/alcoholism as a medical instead of moral or even psychological issue has jumpstarted pharmacological research. So far, treatments rely on combinations of anti-depressants/anti-anxiety medications and/or opioid agonists along with psychosocial therapies like AA. Doctors have had moderate success with drugs that target the brain's addiction pathways like Naltrexone, the European-approved drug Campral, and Vivitrex, the once-a-month injectable form of Naltrexone. And researchers in Australia believe that they will soon have an “anti-drinking” pill that blocks the affects of alcohol, but even that is still years away from market.

Antabuse can help a newly sober person keep from drinking long enough to “get the program,” but they need to work some type of program if they hope to remain sober.

Almost a century after its discovery, Antabuse remains one of the main tools in the pharmacological tool chest to treat alcoholics. In Europe, where it is more commonly prescribed, research shows that with long-term use, sobriety rates begin to approach 50% as people “develop the habit of not drinking.”

Antabuse blocks alcohol’s primary metabolite, causing a buildup of acetaldehyde in the body, the chemical that causes hangovers. Without alcohol, Antabuse has no impact. But when a person drinks with Antabuse in their system, they suffer amplified hangover effects—headaches, nausea, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, heart palpitations and anxiety. Then they vomit. And vomit. And vomit. Faced with one such experience, even the most hardened alcoholic may well decide not to drink after that: classic aversion therapy.

Hank, a 60 year-old alcoholic in Minnesota, says that just drinking one and a half beers on Antabuse is enough for him to start feeling effects like headache and nausea. Hank first got sober at 24 for “a cute girl who told me I acted weird when I drank.” That sobriety lasted nearly as long as the ephemeral relationship, and Hank was off to the races until his thirties. Then, in the early 1980s, “my alpha wife said you can either get an attorney or a counselor.” Hank chose a counselor and enrolled in an outpatient program at Hazelden. For over 25 years he was an AA regular, a sponsor, sponsee, and trusted servant. He built a sober life.

Then, in 2010, he retired. “I thought I could drink again,” he says. “I had a couple with no consequences. Then after a few months I went off the deep end.” The “deep end” came one night while Hank was watching TV with his wife. He had three quarters of a bottle of Jamison Irish Whiskey in the trunk of his car left over from a charity he was involved with. With no other thought in his head besides that he “could drink that whiskey,” Hank got up, went down to the garage, drank the bottle and was back on the sofa beside his wife before the commercial break was over.

When he fell off the sofa, his wife called the paramedics, thinking he was having a diabetic issue and called an ambulance. Later, at the hospital, he blew a .29. “I thought I was screwed,” he recalls. “I was at step zero, having to go every day to AA and having wicked mental cravings while scheming to have my next drink.” So, remembering his brief sobriety in his 20s, he went to a psychiatrist to get a prescription for Antabuse. He has been on it for the last eight months. “I’ve taken one a day, two if I am feeling nervous,” he says. “Now, if I so much as smell a cork, I puke.”

Dr. Jonathan Tallman, a general practitioner in Minneapolis, is no stranger to treating addiction. He does not, however, tend to prescribe Antabuse. “It is not proven to work,” he says. “In a 52 week trial on veterans with a placebo, it did not reduce the time to first drink or increase abstinence.” Those that wanted to drink simply stopped taking the pill, waited two weeks for the drug to clear, and drank.

Penny Paulsen, an AA sponsor with 14 years of sobriety who’s also a counselor at New Life Outpatient Center in Iowa, adds, “I think Antabuse is a crutch. You lean on that instead of leaning on your Higher Power.”

In 2010, one of Paulsen’s sponsees went to a doctor that specialized in addiction, asking for an Antabuse prescription and wrangling another for Xanax. But over time, she stopped going to AA and began abusing the Xanax. A few months after that, she stopped taking the Antabuse, and started drinking again. Despondent, she attempted suicide by trying to overdose on the Xanax. Today she is back on the Antabuse and Xanax—and, at Paulsen’s insistence, is also attending AA. 

“On Antabuse, nothing changes,” Paulsen says. “The person does not need to change to stay sober. I have one sponsee that said she was going to stay on Antabuse the rest of her life. She didn’t need AA.” As so often happens, over time Paulsen lost track of this woman. While admitting that sometimes, early in sobriety, Antabuse can help a newly sober person keep from drinking long enough to “get the program,” Paulsen emphasizes that they need to work some type of program if they hope to remain sober. “Alcoholism is a thinking disease,” she says. “So if you are not changing your thinking, you will be just as miserable.”  

Hank’s perspective is different. “AA is very helpful,” he says, “but without Antabuse, I would be drinking. It stops my brain. I start thinking it would be really nice to stop off at the bar, have a good whiskey and strong ale but then I remember that I’m on Antabuse. If I drink, I’ll puke. So I start thinking about something else.” Bill W. talks about that blind spot coming before the first drink. And for Hank, Antabuse shines a light on that specific spot. 

Essentially, for Hank, Antabuse works just the way it’s advertised to work. If he takes it first thing in the morning, when he’s less likely to have a craving, then later, when the craving hits, he’ll  know that he cannot drink without serious repercussions. 

Tallman notes wryly that some alcoholics are able to rig this game. “I have had patients ‘forget’ to take their Antabuse for a few weeks and end up drinking,” he reports. “And some patients can power through despite the bad affects. They keep drinking and seem to develop different pathways to metabolize alcohol.” 

“Antabuse is like a chemical first step,” says Paulsen. “But it becomes an addict’s Higher Power. They are turning their lives over to a drug.” Perhaps that is the point. For those that cannot find a Higher Power, Antabuse serves to fill the gap. Interestingly, Hank agrees with that assessment. “I don’t believe in God,” he says. “For me, God is the group. I don’t believe in this happy horseshit.”

Hank is coming up on nine months since his relapse and still hits meetings nearly every day because, he says, “I know that connecting with others who are screwed up like me helps keep me sober.” He has gone on a three-day silent spiritual retreat. He admits that he believes in “an energy—an existence that I cannot perceive that is everywhere.” But this is not the Higher Power many have found in AA. “It doesn’t care if I drink,” Hank says. “There are over seven billion people on the planet. Do you think God cares?”  He admits he is sober because he wakes up every morning and takes a pill.  For the time being, that is enough for him.

Jeff Forester is a screenwriter and author in Minnesota. His book, Forest for the Trees: How Humans Shaped the North Woods, an ecological history of his state's famed Boundary Waters, came out in paperback in 2009. He has also written about sober high schools and painkillers, among many other topics, for The Fix.

Please read our comment policy. - The Fix
Jeff Forester.jpg

Jeff Forester is a writer in Minnesota. His book, Forest for the Trees: How Humans Shaped the North Woods, an ecological history of his state's famed Boundary Waters, came out in paperback in 2009. Jeff is the Executive Director of MN Lakes and Rivers Advocates MLR and you can follow him on Twitter.