To the Editor The review by Dr Jonas and colleagues1 of the efficacy of medications to treat alcohol use disorders concluded that “well-controlled trials of disulfiram did not show overall reductions in alcohol consumption.” Although the conclusion may be true for the studies included in the review, double-blind randomized clinical trials are not the correct design to test the efficacy of a medication that works because patients know they are taking it and that it will make them sick if they drink alcohol. Participants assigned to receive placebo or active medication are both warned of the disulfiram-ethanol reaction, and they will act based on that belief and take or not take the medication, and avoid alcohol or not, accordingly. Some may experiment with alcohol to unblind themselves, but the majority will not.
Saitz R. Medications for Alcohol Use Disorders. JAMA. 2014;312(13):1349-1350. doi:10.1001/jama.2014.10152