Monitored Antabuse in the emergency room

The Southern Tier Alcoholism Rehabilitation Service (STARS), a full-service treatment program, has for some time offered monitored antabuse to a few selected patients. This is given daily on an outpatient basis in the emergency room of the general hospital in which we are located. Over 100 patients have been served. This has been helpful for two kinds of patients: 1) those self-motivated voluntary patients making use of this on a short-term basis to extend structure, reassurance, support, and other rehabilitation services following a period of inpatient detoxification, or to get "realigned" following a brief slip, and 2) those poorly motivated patients using this on a long-term basis at the direction of the courts. About half of this latter group have been unsuccessful alumni of 30-day treatment programs outside the community. The program ensures a long-term (several months) period of sobriety in the patient's home setting, offering a chance to develop new life styles, support systems, and respect which can eventually become self-sustaining. It is unlikely that these changes would come about while the patient continued actively drinking. Specific procedures of administration, record keeping, confidentiality, and payment are discussed. The cost-effectiveness to motivated patients and cost-avoidance to taxpayers and third-party payers while providing effective therapy to long-term patients are significant advantages of the program.