In Reply We agree with Dr Saitz that disulfiram may benefit some patients but not that the trials cited adequately establish disulfiram efficacy. These trials were designed to evaluate closely monitored programs that included disulfiram and additional counseling, social support, coaching, or a combination of these. At best, they might allow a conclusion that the programs work for patients interested in taking disulfiram who adhere to the medication. None of these trials disentangle whether benefits can be attributed to disulfiram (ie, beyond benefits of additional counseling or therapeutic relationships). Differences between groups in motivation and goals may also underlie the findings.
Jonas DE, Feltner C, Garbutt JC. Medications for Alcohol Use Disorders—Reply. JAMA. 2014;312(13):1351-1352. doi:10.1001/jama.2014.10170