I have some patients on disulfiram and it works very well when they take it. The problem is definitely that they can choose not to take it if they want alcohol (or sometimes just forget for normal reasons, then opportunistically drink after they realize they’ve forgotten).
The implants are a great idea. As far as I know, the reason they’re not used is because someone would have to pay for lots and lots of studies and the economics don’t work out. Also because there are vague concerns about safety (if something went catastrophically wrong and the entire implant got released at once and then the patient drank, it would be potentially fatal) and ethics (should a realistically-probably-heavily-pressured patient be allowed to make decisions that bind their future selves)? I think this is dumb and we should just do the implant, but I don’t think it’s mysterious why we don’t, or why (in the absence of the implant) disulfiram doesn’t solve everything.
I have some patients on disulfiram and it works very well when they take it. The problem is definitely that they can choose not to take it if they want alcohol (or sometimes just forget for normal reasons, then opportunistically drink after they realize they’ve forgotten).
The implants are a great idea. As far as I know, the reason they’re not used is because someone would have to pay for lots and lots of studies and the economics don’t work out. Also because there are vague concerns about safety (if something went catastrophically wrong and the entire implant got released at once and then the patient drank, it would be potentially fatal) and ethics (should a realistically-probably-heavily-pressured patient be allowed to make decisions that bind their future selves)? I think this is dumb and we should just do the implant, but I don’t think it’s mysterious why we don’t, or why (in the absence of the implant) disulfiram doesn’t solve everything.
Wait, you don’t know? Disulfiram implants are widely used in Eastern Europe.