CLINICAL QUESTION

Is disulfiram effective in the treatment of cocaine dependence?

EVIDENCE-BASED ANSWER

Disulfiram appears to increase point abstinence (i.e., the number of abstinent participants at completion of treatment) compared with placebo (risk ratio [RR] = 1.58; 95% CI, 1.05 to 2.36; number needed to treat [NNT] = 6). Disulfiram does not appear to affect frequency of cocaine use, amount of use, continuous abstinence, or drop-out rate compared with no treatment or placebo.¹ (Strength of Recommendation: C, consensus, usual practice, disease-oriented evidence, case series for studies of treatment or screening, and/or opinion.)

DISCUSSION

Cocaine use disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) as cocaine use plus clinically significant impairment or distress caused by at least two of the following criteria from four groups in the preceding 12 months: (1) physiologic criteria, including craving, tolerance, and withdrawal; (2) loss of control of cocaine use; (3) cocaine use taking precedence over other activities (e.g., responsibilities at home, work, or school); and (4) other negative consequences from cocaine use.² Cocaine dependence, or cocaine use disorder, affects millions of people globally, and approximately 21.5 million people aged 15 to 64 years used cocaine at least once in 2020.³ Among people 12 years and older in the United States in 2021, the latest year for which statistics are available, 4.8 million people reportedly used cocaine and 996,000 people used crack cocaine.⁴