HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2026, 28: 189-194

Opiate maintenance as a last-ditch pharmacological treatment for alcoholism? It makes sense but first consider a trial of well-supervised disulfiram

Colin Brewer

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-21

Summary: This paper is a response to Ulmer's recent argument in HARCP for using opiate maintenance as something of a last resort for patients with alcohol use disorder (AUD) who had not responded to evidence-based treatments. It does not oppose opiate-assisted treatment (OAT) in principle but presents the case for advising a trial of well-supervised disulfiram (DSF) with appropriate psychosocial support before indefinite treatment with an alternative euphoriant. While Ulmer's support for supervised DSF (SDSF) is welcomed, this paper also questions some of his assumptions about its modes of action and explains why SDSF is by far the most effective drug for obtaining the lengthy periods of abstinence in the real world that are often a crucial therapeutic goal. Finally, it emphasises the importance (and widespread neglect) of placebo and non-specific effects in the treatment of AUD, as with most conditions.

Keywords: Alcohol Use Disorder; Disulfiram; Supervised Disulfiram; Opioid Agonist Treatment; Alcohol Abstinence; Relapse Prevention; Sodium Oxybate; Naltrexone; Placebo Effects; Non-Specific Treatment Effects