Disulfiram implants in the treatment of alcoholism some mechanisms of action.

For nearly 20 years, disulfiram implanted subcutaneously, has been used in alcoholics who have failed to respond to other treatment. Significantly positive results have been reported in a large number of cases. Despite this extensive use, many questions remain as to how these effects are exerted. As the reaction to alcohol following disulfiram implantation occurs less frequently and in lower intensity than following oral ingestion, psychological mechanisms probably play a vital role. Based in part on out own recent series of cases, the following explanations are offered regarding the possible mechanisms of action: (1) high motivation to stop drinking is manifested by agreeing to the precedure and reinforced by the procedure; (2) palpable presence of hte drug in the site of implantation; (3) generally sufficient reactivity of the agent to indicate activity to the patient;(4) in obsessional patients there is a removal of the fear of resumption of drinking for an extended period of time. For the more sociopathic patients the implant appears to provide a more structured ego boundary to allow the patient to change.