Description of the condition
Alcohol consumption varies enormously among countries, over time and among different population groups (Alcohol and Public Policy Group 2010). In 2009, the average consumption of alcohol by adults (aged over 15 years) in the European region was 12.5 litres of pure alcohol per person per year, which corresponds to nearly three drinks per day. This is the highest alcohol consumption in the world, and nearly double the world average (WHO 2012). Alcohol accounts for approximately 4% of all deaths and 4.65% of the global burden of injury and disease (Rehm 2009; WHO 2011).
Alcohol Use Disorders (AUDs) include alcohol dependence and harmful alcohol use, which are both recognised as mental health disorders by the World Health Organization (NCCMH 2011; WHO 2011). Alcohol dependence is defined as a cluster of behavioural, cognitive and physiological symptoms that may develop after repeated alcohol use, whereas harmful use refers to alcohol consumption that results in consequences to physical and mental health (WHO 2010). Worldwide, approximately 3% of the population suffer from AUDs. The prevalence among men is 6% compared to less than 1% among women (Rehm 2009).
Description of the intervention
Non-pharmacological treatment of AUDs include brief interventions and specialised treatment programmes, and the effect of these interventions has been evaluated in different settings and populations (Kaner 2007; McQueen 2011). Interventions originating from mutual self-help groups such as Alcoholics Anonymous have been evaluated in research (Ferri 2006).There are few pharmacological interventions for treating AUD, and many are alternative treatments with no evidence. The current pharmacological interventions involve acamprosate, naltrexone and disulfiram. New treatments under evaluation include GHB, ondansetron, baclofen and topiramate (Leone 2010; Edwards 2011).
Disulfiram has been available for more than 60 years as an effective supplement to behavioral treatment of alcoholism ( Krampe 2010). Today, disulfiram is primarily used in a supervised manner and, like acamprostae and n(altrexone, combined with behavioral therapy in the treatment of AUDs.
How the intervention might work
Disulfiram inhibits the liver enzyme aldehyde dehydrogenase. Alcohol intake during treatment leads to accumulation of acetaldehyde, which probably causes the disulfiram-ethanol reaction in the form of increased pulse and respiration, tachycardia, facial flushing, nausea, vomiting, hypotension, and - at worst - cardiovascular collapse. Disulfiram is therefore indicated for patients who wish to remain abstinent ( Martin 2007 ). A recent review showed that supervised treatment with disulfiram has some effect on short-term abstinence and relapse prophylaxsis ( Jørgensen 2011).
Why it is important to do this review
Alcohol-related disease and injuries kill and harm millions of people each year. Effective prevention and treatment strategies can reduce these alcohol-related consequences. Even though disulfiram is the o ldest of the available pharmacological options for treatment, many questions remain unanswered including the long-term effect of disulfiram on abstinence, which may help to reduce alcohol-related diseases and consequences. It is therefore important to systematically summarise the effects of disulfiram in order to help clinicians and other staff working with AUD patients to make the best possible treatment option for their patients.