Disulfiram: An Anticraving Substance?/Response to Müller and Banas Letter

• Published in: The American journal of psychiatry Vol. 168; no. 1; p. 98
• Main Authors: Müller, Christian A, Banas, Roman, Johnson, Bankole
• Format: Journal Article
• Language: English
• Published: Washington American Psychiatric Association 01-01-2011
• Subjects: Addictions; Addictive behaviors; Alcoholism; Behavior; Dopamine; Neurosciences; Psychopharmacology; Studies
• ISSN: 0002-953X; 1535-7228

Besides its well-known mechanism of action (i.e., aldehyde dehydrogenase inhibition), disulfiram also inhibits dopamine beta-hydroxylase, leading to an increase of dopamine concentrations while decreasing concentrations of norepinephrine in the brain (4). Since dopaminergic transmission in the ventral striatal reward system is suggested to play a key role in the development of addictive disorders and craving (5, 6) and reduced activation of this system has been shown in alcohol dependence (7), cocaine dependence (8), and nonsubstance-related addictions such as pathological gaxnbling (9), disulfiram could be hypothesized as a common treatment option for these disorders. Disulfiram can be an effective agent for treating alcohol dependence, but this is limited to populations where there is high compliance with adhering to the medication (2) or where subjects have been directly supervised (2, 3). Since the behavioral effects of monitoring alcohol consumption and direct supervision are quite powerful in helping to maintain abstinence, it is these elements that are associated with any potential efficacy for disulfiram as a treatment for alcohol dependence.