Treatment of Alcoholism in Private Practice with a Disulfiram-Oriented Program

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Abstract
A method of treating alcoholic patients with disulfiram is described. Prior to starting the treatment course, each patient (7 men, 9 women) made a contract to continue the program for a year, paying for it in advance. Each patient was hospitalized and after physical and psychological tests was given 2 g., 1. 5 g and 1 g of disulfiram daily in divided doses, and on the fourth day 0. 5 g and an alcoholic beverage containing 10 to 20 cc of alcohol to bring on a moderately severe reaction. The patients were then discharged on a maintenance dose of disulfiram varying from 0.25 to 0.75 g daily, and returned for alcohol tests weekly for 4 weeks, then monthly for 4 months, then bimonthly for the rest of the year. In addition each patient received a minimum of 1 hour of psychotherapy weekly. Four patients developed polyneuropathy and their treatment had to be discontinued. Of the remaining 12, 8 completed the year with uninterrupted abstinence; 2 had relapses but returned for treatment and remained abstinent; and 2 interrupted treatment permanently. Illustrative case histories of 3 patients are given. It is suggested that this high rate of success is attributable to the year''s commitment by both therapist and patient, the advance payment (even if made by relatives), the weekly supportive psychotherapy, and the psychological and physiological effects of the disulfiram-alcohol tests.