Patterns of compliance and evasion in treatment programmes which include supervised disulfiram

Examination of the compliance patterns of 84 patients offered supervised disulfiram in aqueous suspension, and for whom adequate supervision by family members, friends or colleagues was possible, showed that 38 took disulfiram regularly and remained abstinent throughout the minimum six-month period for which it was prescribed. Twenty risked drinking alcohol while taking disulfiram, half of whom did not experience a significant reaction on doses of 200-300 mg daily. In nine patients there was a temporary lapse of supervision. Two patients induced vomiting of disulfiram. Four substituted inert medication. Nine dropped out of treatment--usually after separating from their partner--and two refused to start disulfiram. Apart from these 11 patients, attempts to sabotage or evade treatment were not necessarily associated with a poor response. In most cases it was possible to out-manoeuvre the patients by increasing the dosage or modifying the supervision techniques. Awareness of these possible patient responses is essential if the considerable potential of supervised disulfiram is to be maximised.