I relapsed about six weeks after I was discharged from rehab, drinking for about a week before I came to my senses, resulting in returning to rehab for a five-day tune-up. I was prepared for my second discharge with familiar instructions to go to 90 AA meetings in 90 days, use my support group, talk to my sponsor, and do the other things a good AA does to stay sober. But my doctor didn’t think that was enough. He suggested I take Antabuse. (Click here for more on treatment drugs.)

Antabuse is the commercial name for the drug disulfiram. It petrifies you into not drinking. Normally, alcohol is metabolized in the liver by enzymes that neutralize the harmful byproducts. Antabuse interferes with this process, resulting in higher concentrations of toxic metabolites. In short, if you drink on Antabuse you quickly poison yourself, inducing excruciating consequences. For the most sensitive people, a reaction can be triggered by exposure as small as a dab of perfume. Just as important, Antabuse negates alcohol’s intoxicating effects.

At the dose my doctor prescribed, it takes three or four days to clear the body. So if you miss a pill for a day or two you still can’t drink. After taking it daily for months it’s as long as three to four weeks to metabolize completely.

The first I heard about Antabuse was from one of my rehab mates, a graduate of multiple treatment facilities. Despite taking Antabuse, he drank anyway. He described the agony of the experience: heart-attack-like pounding in his chest and endless retching, among other gruesome reactions. Then he added the tag line that focused my attention: “And you don’t even get high!” I heard similar stories from several others too.

If you drink on Antabuse there’s the possibility — rare but hardly unheard-of — of cardiac arrest and death. My doctor repeated the warnings I’d heard from the rehab grapevine in such precise medical detail I had to agree drinking on it would be the very definition of insanity. He also included his personal insight. When he’d relapsed, Antabuse saved his ass, he said. He’d taken it for more than a year.

I had grave doubts whether I could stop drinking even under threat of getting violently ill. But I was grasping for straws. Whether it was a drug, a voodoo spell, or whatever, if it could help I was game, because after relaspsing I was desperate in a way I hadn’t been before. And I wanted to show my family I would do everything it took to stay sober to repair some of the damage caused by my slip.

My urgency was also fanned by something else always in the background at a rehab, but which I had yet to encounter: death. I heard who it was, but having never met him, all I recall is that a long-time alum, a heroin addict with years of sobriety, OD’d. When the news hit, it was as if the hospital itself shuddered from a deep chill. The staff grieved and urged us to learn from it. I didn’t have to be told I might be next. They told me anyway.

In the face of all of this trepidation and despair, Antabuse offered hope that fear would work where nothing else had. I tried to set aside my doubts about whether I might drink in any case and started taking a daily dose.

The first time I realized with a true sense of finality that drinking was no longer an option, I was on my way to the hospital to attend an AA meeting. I was in pretty bad shape emotionally, still gravely shaken from my relapse. I passed a restaurant with a large wooden sign of a martini glass. I’d passed it many times, never giving it a moment’s thought. But this time when I saw the martini glass I was overcome with a soul-burning thirst for a case of gin. My instinct for drink cried out, no questions, no delays, no cognitive behavioral bullshit. In that moment I was channeled to stop at a bar a few blocks farther, or the grocery across the street from it to get a bottle. Once again, amnesia struck all sobriety training from my mind.

Abruptly, I had a memory flash of swallowing a pill. I recalled taking Antabuse that morning, the one before and the one before that. I thought, “If I drink I’ll get sick! Emergency room. Right now. And I won’t even get high! No. Can’t risk it.” I kept driving.

Then the strangest thing happened. The craving went away. It was only one time, but I hadn’t failed. It seems so simple in retrospect. I said no. I didn’t give in to the craving despite its fate-twisting strength. My rational mind intervened to break the link between intention and action, accomplishing the impossible because I had no alternative. That gave me a tiny bit of confidence to build on. If I could get through one mammoth craving, maybe I could do it again. I finally understood the AA saying, “This too shall pass.” Little by little, I gained confidence in my ability to endure. I kept taking the drug that made it possible.

Living on antabuse was an indelible lesson in approaching sobriety one day at a time. Every morning before I popped the pill, I thought, “Today I’m going to do something sane,” and afterward, “I can’t drink today no matter what.” Sometimes I said it out loud.

Over time, my relationship with Antabuse changed. Since I knew it would take three or four weeks to be Antabuse-free even if I stopped immediately, my daily declaration not to drink expanded to an awareness I’d have to abstain for the next month. This gave me freedom to stop fixating. Why obsess over something that’s been so irrevocably settled?

In the longer run, the most important and lasting lesson was grasping I could get through emotional shit — the terrible lows that someone feels in new sobriety — without drinking. This was astonishing, a way to see strength I didn’t know I had. Previously, I understood intellectually that if I took the first drink, I was finished. But I’d hedged my bets. In the back of my mind giving in to booze if things got intolerable remained an option and I’d fret the consequences later.

I didn’t know how dangerous this attitude was, for it carved out an exception to the prime directive: no drinking no matter what. However, when I started to take Antabuse, drinking was finally foreclosed in my mind. Living under the threat imposed by the drug short-circuited the part of my addict brain that wouldn’t let go of the option, forcing me to endure the travails I thought I needed alcohol to cope with. That, in turn, proved I could.

I’m not sure whether “I’ll get sick,” or “I won’t get high,” was more persuasive, but between them I grasped what it meant to live up to the goal set by my rehab’s Alumni Meeting moderator, who closed every session saying, “Don’t pick up a drink or a drug this week even if your ass falls off.”

For the next article, The Challenges of Taking Antabuse click here.

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11 Responses to “ Antabuse ”

  1. I totally unsendtard the trying and trying again. I have been doing it for 7 years and my longest time sober has been 9 months. Today is day 5, and all I know is I am not going to drink today. My life is always so much better sober being a high bottom alchoholic I can easily lull myself into a very false sense of security and have a beer or glass of wine. It always ends up the same way, me sick and tired of being sick and tired and depressd and overwhelmed with a high stress highly demanding job, with a lot of people depending on me.Sober I can do it barely.Hungover, it’s impossible.Thanks for your share.

  2. Keep trying! Don’t give up!

  3. Hey dude, I’m new to all this…got out of detox,went to my outpatient care,then to my doctor for prescriptions…Antabuse which I knew nothing about &a couple of others to help….he did say to be extremely cautious with the Antabuse….said it would make me violently I’ll if I drank…before getting the scrips I hit a few old watering holes…didn’t care about detox…told myself at least one more day …it’s not that I didn’t believe my doc but tonight I had only two pills in 2 days…wanted a beer but read yr article by mistake,thanks thanks and thanks…

  4. I’m making a short comment to see if this gets published. I’ve been through rehab 3 times and in the last 21 years I have 19 years of sobriety. My last binge after 8 yrs got me pretty bad so I asked for Antabuse to help. I’ve now been off and on for 7 months, never drinking for more than 10 days. It is not a good thing to have high tolerance, I’ve found I can drink 12 hrs after taking the drug. I’m going to add the Nalproxren to my daily regime and see if that can’t help. I see my shrink in a week and will see what ideas he has. AA isn’t for me. what a horrible disease it is and nobody understands unless they are a true alcholic

  5. Thanks for the comment. I’m obviously not in a position to advise on medication, but I have known alcoholics and heroin addicts who’ve benefited from naltrexone; Antabuse saved my ass. Be sure to discuss any drug therapy with your doctor(s), including when and how to stop taking them. And studies say drug therapies work better when accompanied by social support, so if AA isn’t for you, check out some of the other programs like SMART Recovery. Good luck!

  6. Thanks for sharing. I started antabuse a few weeks ago but had to stop it when i had weird lip swelling. Turns out it wasn’t related so I am going to start the antabuse again. I only made it 11 days before the reaction but I felt a huge relief and burden removed once I took it. I was making way too many last minute impulsive decisions before and kept screwing up my sobriety. I had 6 months earlier this year sans meds…but have had a horrible time trying to get back on track. It is definitely a progressive disease.

  7. Thanks for sharing your experience and good luck with Antabuse. It helped me a great deal, especially with what you identify as a problem: learning not to give in to the rash impulse of the moment. It forced me to pause, recognize what was going on and then respond rationally (“Don’t be crazy!”) rather than irrationally (“Make it a double.”).

    Another thing Antabuse helped give me was time — sober time within which my brain could start to heal and restore more of a balance between emotional impulses and rational responses. Over time, the neuroscience suggests, the power of those emotional impulses recede, making it easier to exercise willpower when confronted by impulse. That’s certainly been my experience, it gets easier the longer you do it, until “Don’t be crazy” becomes a kind of default setting.

    But it takes time, months rather than weeks, and in my case well over a year (the second time I was on it). So give yourself time and remember every day when you take the pill that you’re doing something really positive and potentially life saving, since, as you say, it’s a progressive disease.

  8. Disulfiram Here’s my story with the drug. I am a 36 year old male with a 5 year history of problematic alcoholism, and 15 year history of more than average drinking.

    Unfortunately this drug has created a lot of problems for me as well as it’s very positive intended effect, as you describe. My first two months after inpatient detox at rehab were a breeze! I had almost zero or very mild cravings and they were far and few between. I just knew that I couldn’t drink, not even on the strongest impulse because I took my pills every day.

    My alcoholism was severe but not the morning drinker and I never drank strong liqor but I knew that I had to quit or lose everything and lose my life… it was a matter of life or death to me. It took me a second try after a failed attempt in 2011 (only 6 months of sobriety after outpatient detox – relapsed and drank again for two years) and this time I was prepared, my life was in much better shape now and apart from alcohol I had no big problems anymore. But I drank. I drank heavily and daily and the cracks were appearing.

    Anyway, the disulfiram for me was just a way to feel safe. I asked my doctor for it on my own accord and was (and am) highly motivated to beat this. Changed a lot in my life in terms of routines, patterns and stuff and things were going very smoothly. At work I was going like a rocket. With friends things were much more enjoyable. I was on a constant dopamine rush that I hadn’t felt sober for over 10 years.

    But two weeks ago disaster struck. I had some mild side fx from the disulfiram since the beginning. Tiredness and headaches, but they were manageable but didn’t subside so I talked to my doctor. He said “try taking the pills every other day but take two” . This I did and happily I continued my sobriety, the headaches subsided but the tiredness became worse. Cravings were seldom but one evening I felt so tired and shitty that I had a hard moment with cravings. For the first time since I got sober I felt it hit me. But I overcame the cravings and besides I was on the pills so no way I was going to drink.
    That night I felt so tired also from battling my cravings that I went to bed at 8:30pm and just wanted to sleep.

    In the days after though, what would manifest itself was pure hell. The tiredness became worse and worse and my mental state became really worrisome, but I continued on. No cravings anymore just feeling exhausted and mentally broken. Not depressed but weird like forgetful, not able to concentrate well, irritable and nothing I did seemed to help : I slept 12+ hours a day, got to bed at 7pm dead tired, drank lots of water, took walks outside but it didn’t pass. I started to become really worried. Was this PAWS? Was it the medication? Was there something in my food containing alcohol that triggered a mild reaction on the pills? Cosmetics? Was I ill? I became paranoid about being poisoned with some household chemicals by accident.

    One evening it became so bad I was unable to think straight. My dad called me for a chat on skype and I was unable to follow his questions, it was very hard to answer him due to my mind feeling very foggy. Was I overexhausted due to the long hours I put into work? I started reading the disulfiram sidefx and came a cross the rare ones : psychosis, nervoussystem conditions, etc. This triggered me instantly because I never thought I would get those side fx and forgot about them.

    I called my GP and found it immensely hard to describe my symptoms because I was feeling very confused. Even in my times of hard boozing I had not felt so bad. My mind felt like I had drank a gallon of booze! It became frightening and I was worried that the GP would not take me seriously or worse : suspect a relapse.
    The GP told me to just sleep and see what would happen tomorrow. I live in the Netherlands so I don’t know about healthcare statesside but here the system is clearly overloaded. I felt desperate but followed her “advice”.

    The day after it was worse. And on Monday I was completely incapacitated. I could barely dial a number in my smartphone. I saw the names but couldn’t register. My brains were fried it seemed. Also my emotions were flat, I couldn’t feel anything. And my taste too seemed affected. Was this a psychosis developing?

    I called my mother and asked her to come over immediately. I couldn’t in this state call my counsellors, I wasn’t able to converse clearly. But I was consious of the fact that I was…… which made it even worse. In my profession I am working on quite high level projects in software development as a manager but now I felt like I was becoming retarded!

    My mom called my addiction counsellor and explained the situation. The following days would prove to be Utter Hell since noone at first took things seriously or thought I was just depressed. I wasn’t though, even though the whole situation was depressing. What was happening to me?

    In the mornings I had a brief moment of clarity that lasted 30-60 minutes before losing the ability to think clearly and comprehend others. It seemed to worsen by the day. Slowly though the GP and other docters started to act. And worry too. Finally I was being taken seriously. But still taking the disulfiram. Noone told me to quit. Even despite telling them about the known -but rare- side effect of psychosis.

    5 days in my mom asked a befriended GP , a friend of the family if he could research and investigate disulfiram a bit further. He did and advised to quit since psychosis indeed was a side effect that seemed to be the case with me, despite the fact that it was still not fully developed (I had no delusions or hallucinations – yet). She asked my GP if it was ok to quit at least for now and he agreed it was ok to try – and he also confirmed that this could be a psychosis.

    Now everyone was becoming very worried – just as I was that this condition might just never go away. The addiction MD I saw earlier just wanted to give me anti depressants and keep me on disulfiram. I felt like noone listened to me but finally now the GP agreed and I quit the pills. Also I got sent to a specialised psychiatrist at rehab for observation.

    What happened then was truly remarkable.
    Each day the clarity in my mind started to return. My mind was still far from normal but every day it got better. The psychiatrist also confirmed after two meetings that this must have been the disulfiram as I take no other drugs, no other substances and have a healthy lifestyle ever since quitting. My mental problems of the past are also very much under control due to CBT and other therapies I followed before becoming sober.

    The recovery started 10 days ago when I quit disulfiram and now I feel almost 100% back to normal. I did nothing else differently other than quit the pills. Confimation of the psychiatrist who works at rehab gave me a certainty.

    I’m still tired though. This whole ordeal took 14+ days to go through and I am still not back to work. My mind feels tired still and I am forgetful of small things but it’s getting much better. I’m nearly back to my old self.

    I contemplate asking for Campral now because I want to ensure that I won’t relapse but no more disulfiram for me, ever and doctors are not allowe to presribe it anymore, the psychiatrist said.

    So long story short:

    Antabuse is a drug that can help very well prevent relapse and it did for me for two months but please be very vigilant of side fx, change in dosage or taking too much. Even if it has been going well for a while, be attentive of changes in you health or mental state.

    Becoming psychotic is no joke. Mentally it was worse than my worst hangover ever. And I had no former history of psychosis.

    Disulfiram : be careful.

  9. Thank you for sharing your experience with Antabuse. I’ve seen the reports of psychotic side effects, but have never run into anyone who suffered from them, so I appreciate your filling in that gap.

    I’m a bit surprised that no docs ever suggested lowering the daily dose in an attempt to alleviate your reaction, but then again, I’m not a doctor.

    For those thinking about using Antabuse or already on it, be aware that poisoning yourself by ingesting alcohol, whether intentionally or accidentally, is probably the biggest danger, but not the only one. Other side effects, like the ones mentioned in this comment, are rare, but do happen, so be on the lookout. I share in the advice given here: When taking Antabuse, be careful and monitor all side effects.


  11. I took Antabuse daily for over a year and was told it would take me at least a month to metabolize it all.

    But don’t take chances. The answer to your question depends on how long you’ve been taking Antabuse, how often you took it and at what dose. I urge you to talk to the doctor who prescribed it for you. And make sure you talk to him about WHY you agreed to take Antabuse in the first place, WHY you want to drink now and what the possible consequences may be.

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