How does disulfiram function in AUD treatment and what are contraindications?

• A. Inhibits aldehyde dehydrogenase; contraindicated in liver disease, pregnancy, poor adherence.
• B. Opioid receptor antagonist.
• C. NMDA receptor modulator.
• D. Partial mu agonist with ceiling.

Answer: (A)

Disulfiram works by irreversibly inhibiting aldehyde dehydrogenase, so when a person who takes it drinks alcohol, acetaldehyde rapidly builds up. That buildup triggers uncomfortable, aversive effects (flushing, tachycardia, nausea, vomiting, hypotension, headache), creating a strong discouragement against drinking. The idea is to support abstinence through this conditioned negative reaction.

This approach carries serious risks for people with liver problems, because the drug’s effects depend on liver processing and the acetaldehyde surge can be hazardous if the liver is already compromised. It’s also unsafe in pregnancy due to fetal risk. Because the aversive reaction only occurs if alcohol is consumed, and adherence is essential to maintain the protective effect, disulfiram is contraindicated in individuals who have poor adherence to the medication regimen.