THE TRUTH ABOUT ANTABUSE
SINCE January of this year a few Canadian doctors have been experimenting with a new aid in the treatment of alcoholism. It is tetraethylthiuramdisulphide, a drug better known under the trade name of Antabuse.
Through no fault of the doctors or the makers of Antabuse it has been given wide, premature and often wildly misleading publicity. If you are interested in anyone who is an alcoholic you should know the truth.
Antabuse is not a cure for alcoholism. In spite of devoted work by doctors for many years no cure has yet been found. To date the liest that can be done for an alcoholic is to help him to quit drinking. This is where Antabuse comes in. It is simply a means of keeping him on the wagon when his will power alone isn’t enough.
Antabuse works because the alcoholic who has been taking it regularly every day knows that a drink of anything whatever with alcohol in it will make him violently sick.
In an institution near Toronto I saw what happened to one middleaged man when he had his first, experience of how Antabuse works. He had l>een admitted two weeks earlier as a confirmed alcoholic whose drinking had almost ruined his life.
After the 48 hours needed to sober him up and clear his system of alcohol he had been given Antabuse daily for 12 days. During this time the doctor in charge had explained the nature and cause of alcoholism to him (or rather had told him what is now known about it, which is far from conclusive); and what is cur-
rently known about the nature and consequences of Antabuse (which is even less conclusive).
Thus, when I met the patient one bright summer morning in his private room, he had been prepared as far as possible for what was to come.
He was a spare, wiry man, deeply sunburned. His clothes were well pressed, his shirt clean and fresh. His room was tidy, the things on the bedside table neatly arranged—a pack of cigarettes, ash tray, book of matches, his glasses in a leather case. There was nothing about him or his surroundings to suggest that two weeks earlier he had been a looselipped, bleary-eyed drunken wreck, trembling, sweating and unkempt.
Sharp at 11 o’clock a nurse brought him his drink: two ounces of good rye whisky on a little tray. She offered it to him with, a gesture of social grace, as though he were a guest in her own house.
“Boy!” he said, grabbing the tumbler with an eagerness he didn’t try to hide. “Is this ever going to hit the spot!”
As things turned out he couldn’t have been more right.
A Second Shot For a Cynic
rI',HF) first reaction, which he -I evidently expected to be pretty drastic, was hardly noticeable. Five minutes after he had gulped the rye (“Glug!” the doctor said, watching him with a smile), all that happened was that his face and neck felt hot and that light sweat broke out there and on the backs of his hands.
It was nothing, he told me. After another five minutes he revised this report. He now felt, he said, almost as high and happy as he generally
did when he started his drinking day, at 6 o’clock in the morning, by knocking back about a quarter of a bottle.
That was all, though; he was disappointed. The other patients had warned him to lie flat on the bed as soon as he took the trial drink. Walking around, they said, or even sitting up straight would knock him for a loop.
He frowned and said he didn’t believe it. “They were just trying to scare me. I’m going to walk over to the window. This stuff hasn’t bothered me a bit so far, but I may as well give it a chance.”
Whereupon he swung his legs over the side of the bed, got up, and strode firmly across the room. Then he looked at me triumphantly. He admitted the walking made him a trifle dizzy and that he seemed to be short of breath, but apart from that he just felt pleasantly and surprising^ tight-
“I’m going to have the nurse bring me another rye,” he said. “Antabuse’ll never stop me drinking if this is all it does.”
He got his second shot of rye after the nurse had got permission to give it to him—only one ounce this time. She served it with distinctly less the air of a hostess and looked, I thought, a trifle tense.
Once again the patient got up and walked around the room. He now felt a little dizzier, he told me. Otherwise the chief result of the extra drink was to make him still happier and higher.
“I can’t get over it,” he said. “Three lousy ounces and I’m off to the races . . .”
Ten minutes later he shook his head, informed me the glow was beginning to wear off. He asked the nurse for a third drink.
Don’t believe all you’ve read about this drug for drunks. It can keep you sober, but in careless hands it can also kill
She said she’d have to ask the doctor’s permission and left the room. When she came back the doctor was with her.
“Why aren’t you satisfied?” the doctor asked, grinning. “There’s no sense banging your head against a stone wall. We can make you good and sick if you really insist, but what’s the use? Why don’t you just, take our word for it?”
“Listen,” the patient said earnestly. “I don’t start things I don’t finish. What I’ve felt up to now isn’t enough to scare me off the drink. This stuff won’t do me any good unless I know the worst, as you might say.”
The doctor shrugged his shoulders. “Okay. If that’s the way you want it.” The words were hard-boiled, but his voice was very kind. He motioned to the nurse who brought another oneounce shot of rye on the little tray. The time was 12.15.
At 12.16, having gulped the third drink down as greedily as he had the others, the patient suddenly stared at us and shook his head in bewilderment.
“I have a pain in my chest,” he said. “It’s getting hard to breathe. I don’t feel so good. I guess I’d better lie down.”
At the Threshold of Death
From the beginning of the test the nurse had been taking his pulse and his blood pressure at fairly frequent intervals. She took them again now; and a few seconds after her fingers touched his wrist she straightened her back and gave the doctor a meaning nod—the signal for him to take over.
At 12.18 the man was panting like a running dog on a hot day and he had
begun to cough with a flat, racking sound between a groan and a sob. Under his sunburn he was getting pale. His eyes were blank and glassy and his head twisted from side to side on the pillow. His speech had become thick and broken.
At 12.27, 12 minutes after he had gulped the fourth ounce of rye, the coughing changed to retching and one minute later he was suddenly and violently sick at his stomach.
The vomiting lasted for about five minutes and ended in what seemed to be utter exhaustion. “Tired . . .” he muttered. “Never so tired in my life. My chest . . .”
That was at 12.36. Two minutes later the muttering, which had trailed off into faint and meaningless gibberish, stopped altogether. His lips, now a pale bluish-purple, twitched and were still. His eyes stared fixedly at the ceiling with no trace of expression.
Three minutes after the muttering stopped his pulse was so faint it could hardly be felt. At 12.45 the nurse wheeled up a tall g’-een oxygen cylinder and strapped the mask over his face.
Oxygen was not enough. The pulse beat was getting fainter by the minute, dangerously close to the condition doctors call “thready” which sets in when the heart is almost at the point of fluttering to a stop.
At 12.55, exactly 40 minutes after the patient had taken his third drink, the doctor whistled briefly through his teeth, nodded to .the nurse, said “Get him ready for an intravenous.”
Antabuse, which ill-informed news stories have led many people to believe perfectly safe, had brought this man to the threshold of death.
Twenty minutes later when a pint or so of saline solution combined with 10% of glucose had dripped from a glass flask down a long tube and through a bright silver needle into a vein in his forearm, the doctor asked me to feel the patient’s pulse. It was beating like a little hammer; when I had felt it before, just as the injection was begun, my untrained fingers had been unable to pick up any beat at all.
The patient was beginning to recover.
That was how Antabuse took that man. Most people don’t react nearly as violently. As a rule all that happens is that face and neck flush brick-red and feel feverishly hot, a headache with a pulsing, hang-overlike throb arrives followed by a sudden and distressful vomiting.
But doctors have no way of knowing beforehand how drastic a patient’s reaction to alcohol plus Antabuse is going to be. There seems to be a fairly wide variation in the length of time taken to produce these symptoms and a less wide, but still appreciable, difference in the amount of alcohol which has to be drunk before they are felt.
That is why the best medical opinion is that no person who takes Antabuse should drink anything alcoholic for the first time after beginning to use the drug unless he is under the direct supervision of a doctor, preferably one who has already had experience of the treatment. The test should be made in a place where there is equipment instantly available for giving oxygen, intravenous injections, and other emergency restorative measures.
Fear Keeps Them On Wagon
After this supervised demonstration the alcoholic is all set to stay sober as long as he takes Antabuse regularly every day—usually one half-gram pill every morning though no hard-andfast rule for dosage has yet been worked out. He generally stays on the wagon because the prospect of going through another such reaction is too appalling to contemplate.
Statistics are scarce on the longterm effectiveness of Antabuse, but figures on 100 users are available—50 of the patients studied by the doctors of a highly reputable Montreal institution and 50 observed during and after initial treatment at a similarly reputable institution in Toronto. Here are the results, over a period of about six months:
Eight patients tried taking a drink while they were also taking Antabuse and were so revolted by the consequences they went back on the wagon.
Eight quit taking Antabuse altogether after a few weeks and relapsed into their former active alcoholism.
Eighty-four were able, because they knew what to expect if they backslid, to stay sober.
Putting it another way 92% of the patients studied who took Antabuse regularly were definitely and successfully helped by it.
Antabuse does nothing at all to remove whatever may be the cause of an alcoholic’s craving. It merely helps him, through fear of the consequences of drinking while he is using it, to leave the stuff strictly alone.
Antabuse forces him to stay dry long enough to give psychotherapy, or even plain old-fashioned advice or spiritual guidance, a chance to make him want to stay that way. That is all.
The discovery that Antabuse could do this was made in 1948, quite accidentally, by two Danish doctors who were looking for something else. Tetraethylthiuramdisulphide has been used for years as an ingredient in medicine intended to rid animals of intestinal worms.
Dr. E. Jacobsen and his assistant, Dr. J. Hald. were working in a Copenhagen laboratory on the problem of how to use the stuff for people with
worms. As part of the standard routine of testing a new product for human use they took some themselves.
Nothing happened (they didn’t have worms) until the two doctors had their first drink of the week, Jacobsen at a cocktail party and Hald at the house of some friends.
Comparing notes afterward they were struck by the fact that each had become suddenly and violently ill within a few minutes of beginning to drink. This seemed to them to be more than mere coincidence and they figured the worm medicine might be the explanation.
It’s a Voluntary Poison
It was. When people drink anything with alcohol in it a substance called acetaldehyde is produced in the body. Acetaldehyde is a poison. Normally the quantity produced by alcohol (or, incidentally, any other carbohydrate— sugar, for example) is kept from reaching the danger level by a process called oxidation. This, in effect, burns up the surplus acetaldehyde just as you burn dead leaves or rubbish. Tetra -ethylthiuramdisulphide seems to interfere with this process; and if a person drinks alcohol when it is present in the system, too much acetaldehyde remains in the system. The danger level is passed and the Antabuse-taker is quite literally poisoned.
In the sense that it brings on the kind of reaction we have just seen a patient through this poisoning is good. In the sense that it can get out of hand unless properly controlled, even with physically sound people, it is bad. Arid sometimes, as when diabetes or certain sorts of heart trouble are present, it can be fatal.
Three deaths have definitely been attributed to Antabuse plus alcohol in Denmark (by itself the drug has little or no effect); and one in Canada, though the Canadian death cannot be definitely said to have been due to the drug.
Tetraethylthiuramdisulphide was first distributed commercially in Canada under the trade name “Antabuse” in early spring this year. It can be bought in drugstores across Canada (its makers say sales are good but won’t give figures) only when a doctor’s prescription is presented.
It costs $2.50 for a bottle of 50 halfgram tablets. As “A.A.T.,” the trade name of another maker, 50 quartergram tablets cost $2.
It is not yet widely used in Canadian hospitals; only a few have special departments for the treatment of alcoholics.
I’ll leave the last word to Dr. J. K. W. Ferguson, professor of pharmacology at the University of Toronto. Writing in the Canadian Medical Association Journal for June, he said:
“The burden of responsibility which has been thrown so suddenly on the general practitioner is heavy and indeed unfair. No large body of experience with this drug is available for guidance. The clamor for its use will be persistent. It seems likely that Antabuse will prove valuable in tht management of certain cases of chronic alcoholism. In the meantime it should be recognized as a potential hazard to life in some circumstances.
“It goes without saying that the great majority of the profession will exercise their usual good judgment in selecting the cases and circumstances suitable for experimentation with this drug. We can only hope that none of the material will get into the hands of pranksters or other irresponsible persons.”