I am unfamiliar with direct treatment comparison of patients with alcohol dependence randomly assigned to treatment with naltrexone or acamprosate versus disulfiram. This type of research is necessary before we can decide which treatments are ideal for which patients, and when. At this point, no single treatment for alcohol dependence has proven to be more effective than any other, and prospective matching of patient to treatment has, thus far, been disappointing. Previous treatment success or patient confidence in the success of treatment with disulfiram, as well as the cost and unavailability of alternatives, has kept disulfiram in the pharmacopoeia. Detoxification is not treatment.
Treatment happens after detoxification to prevent a relapse and rebuild a healthy, productive life.
As with other chronic diseases, such as diabetes, the need for continuity of care, monitoring of progress and referral when necessary make addiction a primary care disease. Relapse prevention in alcoholism is similar to that in diabetes or hypertension. The physician must work within the therapeutic relationship, maintain a nonjudgmental attitude, communicate empathy and reinforce meeting participation and behavioral changes while working with the patient and the family. A statement on the generalist physician from the American Boards of Family Practice and Internal Medicine. Eliason and Lewan for their excellent review of the diagnosis and treatment of gastroenteritis in children .