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.