Controlled research has shown that supervised disulfiram is an effective treatment for alcoholism. Despite this, little is known about the effects of disulfiram in persons with alcoholism and severe mental illness. We conducted comprehensive chart reviews on 33 patients with alcoholism and severe mental illness (70% schizophrenia or schizoaffective disorder) who had been prescribed disulfiram. Twenty-one percent reported side effects from disulfiram, whereas significant psychiatric complications were not reported. Although 76%% of patients reported drinking while on disulfiram, only 28%o experienced negative reactions to alcohol. Sixty-four percent of the patients saw a remission of alcoholism for at least one year during a three-year follow-up, and 30%o experienced a two-year remission. Disulfiram treatment was associated with decreases in days hospitalized but not with changes in work status. The results suggest disulfiram may be a useful adjunctive treatment for alcoholism in patients with severe mental illness and that controlled research is needed to evaluate its effects in this population.