to be directly related to the efficacy of the drug and thus the disulfiram group must be open to their treatment in order to maintain these expectancies. Likewise, the control group(s) must be open to their treatment in order to be free of the DER expectancy. Secondly, participants in a blinded trial can easily unmask the blind by taking a small dose of alcohol, leading to compliance problems. To summarize, the fundamental problem in blinded trials is that the psychological threat of a DER is present and active in both arms of a given trial, impeding a clear distinction between the active and placebo groups. Indeed, if we postulate that the psychological threat of an aversive reaction is the pivotal mechanism of action of the drug as opposed to its actual pharmacodynamic properties when combined with alcohol, then there would be no chance of finding any difference between disulfiram and a control group in a double-blind design [18].
