Q: I have a friend who has a drinking problem. He can manage without it for 5 days a week but when it comes to the weekend he behaves like a drunkard. Recently on NDTV, one doctor mentioned some implants that can help cure alcoholism. I would like to have more information on this. Please help me out so that it will be a relief to his family.

A:DISULFIRAM IMPLANTS Introduction Disulfiram produces a sensitivity to alcohol that results in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol. Disulfiram blocks the oxidation of alcohol at the acetaldehyde stage. During alcohol metabolism, after disulfiram intake, the concentration of acetaldehyde occurring in the blood may be 5 to 10 times higher than that found during metabolism of the same amount of alcohol alone. Accumulation of acetaldehyde in the blood produces a complex of highly unpleasant symptoms referred to as the disulfiram-alcohol reaction. This reaction, which is proportional to the dosage of both disulfiram and alcohol, will persist as long as alcohol is being metabolized. Disulfiram does not appear to influence the rate of alcohol elimination from the body. Disulfiram plus even small amounts ofalcohol produces flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions, there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. The intensity of the reaction may vary with each individual but is generally proportional to the amount of disulfiram and alcohol ingested. In the sensitive individual, mild reactions may occur when the blood alcohol concentration is increased to as little as 5 to 10 mg/100 mL. At a concentration of 50 mg/100 mL symptoms are usually fully developed, and when the concentration reaches 125 to 150 mg/100 mL unconsciousness may occur. The duration of the reaction is variable, from 30 to 60 minutes in mild cases, up to several hours in more severe cases or as long as there is alcohol remaining in the blood. Disulfiram is slowly absorbed from the gastrointestinal tract and is slowly eliminated from the body. Ingestion of alcohol may produce unpleasant symptoms 1 or even 2 weeks after a patient has taken his last dose of disulfiram. Prolonged administration of disulfiram does not produce tolerance. The longer a patient remains on therapy the more sensitive he becomes to alcohol. Used alone, without proper motivation and without supportive therapy, disulfiram is not a cure for alcoholism, and it is unlikely that it ill have more than a brief effect on the drinking pattern of the chronic alcoholic. However, as an aid in the management of selected chronic alcoholic patients who want to remain in a state of enforced sobriety so that supportive and psychotherapeutic treatment may be applied to best advantage, Disulfiram has a valuable role to play. Disulfiram Implant We now offer a Disulfiram implant, which appears to give effective blood levels for twelve weeks on an average. It is usually inserted under local anaesthetic after detoxification is over and 2 - 3 doses of the oral Disulfiram have been given. It is inserted through a 1 cm incision in the lower abdomen or at the back of the upper arm. The implant is inserted 3-4mm under the skin. Advantages of the Implant · Makes relapse almost impossible while the implant is effective. · Avoids the need to supervise Disulfiram and the arguments it can cause. · Makes it impossible to forget to take Disulfiram and reduces craving even more than oral Disulfiram because there is no point in craving for what you cant have Disadvantages of the Implants · Involves (minor) surgery and a small scar with temporary tenderness and bruising · Occasional local infection or inflammation of implant site, usually responding to antibiotics. . Initially more expensive than oral Disulfiram. · Risk of turning to other drugs as a substitute. (Applies as much to oral Disulfiram) It must be emphasised that the need for aftercare counselling to allow thorough social integration is not reduced when implants replace oral Naltrexone. Aftercare counselling is essential to ensure that healthy and appropriate coping behaviours are learnt, rather than substituting other drugs for heroin and methadone.