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Heroin Addiction and Related Clinical Problems: 2026, 28: 5-14

Scientific evidence and clinical experience in the treatment of Alcohol Use Disorder: Disulfiram versus opioid agonist approaches

Albrecht Ulmer

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-2

Summary: Background: Alcohol Use Disorder (AUD) remains a highly prevalent chronic condition for which no pharmacological treatment has achieved widespread acceptance in routine clinical practice. Despite formal approval of several medications, long-term clinical outcomes are often disappointing, leaving many patients without effective medical management. This situation has fuelled an ongoing debate between abstinence-oriented strategies, particularly Disulfiram, and agonist approaches derived from clinical experience with opioids. Methods: This article presents a narrative analysis that integrates long-term clinical experience, observational data, and the existing literature to examine the relative merits and limitations of Disulfiram-based abstinence strategies versus opioid agonist approaches in AUD. Particular attention is paid to mechanisms of action, adherence, patient experience, safety considerations, and long-term clinical trajectories. Results: Clinical experience suggests that Disulfiram can be effective in selected patients, particularly under supervised conditions, but its punitive mechanism and adherence issues limit long-term applicability. In contrast, opioid-based agonist strategies, mainly using dihydrocodeine or buprenorphine, have shown clinically meaningful reductions in alcohol craving and consumption in a subset of treatment-resistant patients, with approximately one quarter achieving long-term symptom remission and many others substantial stabilisation. Conclusions: AUD requires flexible, individualised treatment pathways. For patients unresponsive to abstinence-based approaches or other pharmacological interventions, carefully structured opioid agonist treatment may represent a clinically meaningful harm-reduction strategy, complementing rather than replacing established treatments.

Keywords: Alcohol Use Disorder; Disulfiram; Opioid Agonist Treatment; Harm Reduction; Clinical Experience