Patient management in disulfiram implant therapy.

Data from 100 disulfiram implant, placebo, and no-implant control patients demonstrate the effectiveness of the disulfiram implant in keeping the alcoholic dry. However, the superiority of the disulfiram implant group over the placebo group is interpreted as evidence of a pharmacological component to the procedure operating independent of the disulfiram-ethanol reaction (DER). Hypotheses involving inhibition of aldehyde dehydrogenase or inhibition of dopamine-beta-hydroxylase are offered as mechanisms by which the pharmacological effect may be mediated. Finally, in view of the low (approximately 0.5) probability with which a DER follows ingestion of alcohol by a disulfiram implant patient, it is suggested that the approach to patient management should be changed to maximize the effectiveness of the disulfiram implant procedure. Guidelines are given.