Disulfiram has been used in the treatment of alcohol dependence with consistently successful results in individuals with high compliance or when medication intake has been directly supervised [1], [2], [3]. Its mechanism of action for maintaining alcohol abstinence is thought to be primarily psychological [4], [5], [6], [7] and based on a highly disagreeable pharmacological effect if alcohol is consumed. Disulfiram blocks the enzyme aldehyde dehydrogenase (ALDH). If alcohol is present, acetaldehyde accumulates [8], [9] usually resulting in an unpleasant reaction, the disulfiram-ethanol reaction (DER), consisting primarily of tachycardia, flushing, nausea, and vomiting [8]. To prevent the first drink, however, the psychological or cognitive threat is thought to be dominant and active and thus dissuade use [5], [6], [7]. The threat of a DER, indeed the expectancy of negative consequences if alcohol were to be absorbed and ensuing thoughts about avoiding pain and sickness account for the drug's effectiveness.
