Supervised Disulfiram Should Be Considered First-line Treatment for Alcohol Use Disorder.

Area of Science:

• Addiction Medicine
• Pharmacology
• Clinical Trial Design

Background:

• Alcohol use disorder (AUD) has limited FDA-approved medication options.
• Disulfiram is a second-line AUD treatment due to perceived inconsistent evidence and safety concerns.
• Current guidelines often misinterpret evidence by relying solely on double-blind randomized controlled trials (RCTs).

Purpose of the Study:

• To re-evaluate the efficacy of disulfiram for alcohol use disorder (AUD).
• To advocate for the redesignation of supervised disulfiram as a first-line treatment.
• To highlight the importance of considering disulfiram's behavioral intervention aspects.

Main Methods:

• Review of existing evidence, including open-label randomized controlled trials (RCTs).
• Analysis of disulfiram's efficacy when considered as both a medication and a behavioral intervention.
• Critique of the interpretation of evidence from traditional double-blind RCTs.

Main Results:

• Open-label RCTs demonstrate overwhelmingly favorable efficacy for disulfiram, especially when supervised.
• Supervised disulfiram shows significant potential as an effective AUD treatment.
• Traditional interpretations of evidence may underestimate disulfiram's therapeutic value.

Conclusions:

• Supervised disulfiram should be considered a first-line intervention for alcohol use disorder.
• Treatment guidelines and clinical pathways should be updated to reflect disulfiram's efficacy.
• The addiction medicine community should re-engage with disulfiram as a vital therapeutic option.