Our meta-analysis clearly showed significant efficacy of disulfiram on our primary endpoint that was effect-size. Our first hypothesis that disulfiram should be effective compared to controls only in open-label rather than blinded RCTs was confirmed. In open-label trials, disulfiram was more effective than controls, while there was no difference in the efficacy of disulfiram compared to placebo in blinded RCTs. The effect of disulfiram on maintaining abstinence or preventing relapse is mediated by DBH and/or ALDH inhibition as has been proposed in studies mentioned previously on cocaine dependence and pathological gambling. It is noteworthy that our results in double-blind, placebo controlled trials do not advocate for a direct pharmacological effect of disulfiram in preventing alcohol relapse.
