10 ms·

"...it is my belief that the treatment is unconscionable and inhumane." Likewise. Fortunately, I'm not an alcoholic nor have I ever been one but it's always be

"...it is my belief that the treatment is unconscionable and inhumane." Likewise. Fortunately, I'm not an alcoholic nor have I ever been one but it's always been my understanding that disulfiram was a pretty brutal way of dealing with the problem. I've seen pharmacology texts written in the 1960s warn of the dangers of disulfiram (I had the impression that by the end of the 1950s it was already recognized as a brute force method that was not that effective). Moreover, as disulfiram inhibits acetaldehyde dehydrogenase, the build up of acetaldehyde in the body alone is pretty nasty and ought to be avoided (there's nothing subtle about this chemical. (I hesitate to use the word 'drug' even though it may have effective uses in completely different areas of medicine.) Making someone feel ill by essentially 'pickling' - or should that be 'poisoning' - him/her from the inside strikes me as a treatment that should have gone out with Galen.

staticautomatic 5y ago
My recollection is that accumulation of aldehyde is also the danger of consuming methanol.
- chimeracoder 5y ago
  > My recollection is that accumulation of aldehyde is also the danger of consuming methanol. I assume you mean ethanol, because methanol is highly poisonous (even a fraction of a shot will make you go blind). But yes, alcohol is broken down into acetaldehyde.
  - staticautomatic 5y ago
    No, my recollection was that methanol is metabolized into something which “pickles” you but I may well be wrong.
    - hilbert42 5y ago
      No, you're not wrong if you're referring to methanol, you could well say methanol 'pickles' the liver and you'd be correct. With ethanol it's somewhat different, chimeracoder is correct when he says alcohol (i.e.: ethanol) is metabolized into acetaldehyde. Here's a slightly more detailed account: From my understanding acetaldehyde is formed in the body by the partial oxidation of ethanol—if one's body oxidized it completely then I guess there would be little problem (but it doesn't)! Instead, the body has two goes at 'neutralizing' ethanol, acetaldehyde being the first metabolite and the second is that acetaldehyde is converted into vinegar (acetic acid) which is essentially harmless. Methanol is worse—much more so. It's first-pass metabolite is formaldehyde (right, it's an excellent 'pickling' preservative), and the second-pass metabolite is formic acid (that's the stuff ants sting you with). Thus methanol double-whammies you and unfortunately it does it par excellence. Methanol is damn horrible stuff really, less than 100ml can kill one outright and if you survive then, as chimeracoder says correctly, you'll likely be left permanently blind not to mention ending up with other serious problems. In fact, one of the emergency procedures for methanol poisoning is to repeatedly give copious quantities of ethanol for quite some length of time—as in the first instance it substitutes for methanol, ethanol's delaying action then gives the body much longer to metabolize methanol and this delay has the effect of ameliorating some of the damage it causes. Here, ethanol is much the lesser of two evils. That said, acetaldehyde is more toxic than ethanol and it's far from being benign (for starters it's what gives you your hangover but that's not the end of it). Whilst it doesn't have the immediate punch of formaldehyde, acetaldehyde is nevertheless still dangerous for several reasons, first the body is capable of metabolizing ethanol in the liver with the enzyme acetaldehyde dehydrogenase however this process is not exactly straightforward nor is the metabolism of ethanol completely benign; second, the dangerous aspects of acetaldehyde dehydrogenase's metabolism of ethanol is that it often results in cumulative damage to the liver over the long-term, especially so when ethanol is taken in large amounts. There's a few Wikis on this but they're a bit complicated for a quick understanding, nevertheless the second link on alcoholic liver disease has a nice diagram that illustrates how long-term liver damage happens: https://en.wikipedia.org/wiki/Acetaldehyde_dehydrogenase https://en.wikipedia.org/wiki/Acetaldehyde_dehydrogenase https://en.wikipedia.org/wiki/Alcoholic_liver_disease https://en.wikipedia.org/wiki/Alcoholic_liver_disease Right, I shouldn't have used the word 'pickling' but I was using it in the vernacular and, as here, I did actually use it in inverted commas. Another way of looking at it is that long-term ethanol/acetaldehyde damage to the liver leads to cirrhosis of the liver—and cirrhosis is in effect the death of liver cells which are then replaced by scar tissue (that's close enough to 'pickling' methinks).
- deleted 5y ago
  [deleted]
qorrect 5y ago
I use Disulfiram and it has been a godsend for me. It takes away the choice, I am physically unable to drink, my mind makes this easy for me, it's simply not an option so I don't even consider it. I realize it's not for everyone but it has saved me. I had to go out of country for it, doctors do not like to prescribe it. I hoard it.
- hilbert42 5y ago
  I'm truly glad it works for you and nothing that I or others say should distract you from that course. I know it works for some people and I knew that before I posted that comment. Again, that's truly great for them. However, it's my understanding that all too many do not have your level of self-perception nor do they have the same level of self-control that you do and so they end up on a horrible carousel ride until they fall off - big-time. This seems to be the major reason why doctors do not want to prescribe it. The fact that these concerns about disulfiram have been reoccurring in the literature since the 1960s is pretty much proof of the fact. I suppose the real problem is the difficulty in determining who will actually benefit from it and who will not, and that's an age old problem that medicine hasn't solved as yet (or as I reckon won't take the necessary time with individual patients to determine those who are suitable - thus it all gets chucked into the 'too-hard' basket). Just keep at it. Best of luck. :-)
  - qorrect 5y ago
    I did not mean to dismiss it's negative side effects , this is a dangerous drug. For a general purpose anti anxiety it's a down right terrible choice, even to suggest it feels irresponsible. Chugging a bunch of alcohol while on this ( if say you forgot your anti-anxiety meds were also an anti alcohol drug ), might literally kill you.
    - hilbert42 5y ago
      Right, clearly you're on top of the info and that's what counts. Trouble is, most aren't which is most unfortunate.

staticautomatic 5y ago

My recollection is that accumulation of aldehyde is also the danger of consuming methanol.

chimeracoder 5y ago
> My recollection is that accumulation of aldehyde is also the danger of consuming methanol. I assume you mean ethanol, because methanol is highly poisonous (even a fraction of a shot will make you go blind). But yes, alcohol is broken down into acetaldehyde.
- staticautomatic 5y ago
  No, my recollection was that methanol is metabolized into something which “pickles” you but I may well be wrong.
  - hilbert42 5y ago
    No, you're not wrong if you're referring to methanol, you could well say methanol 'pickles' the liver and you'd be correct. With ethanol it's somewhat different, chimeracoder is correct when he says alcohol (i.e.: ethanol) is metabolized into acetaldehyde. Here's a slightly more detailed account: From my understanding acetaldehyde is formed in the body by the partial oxidation of ethanol—if one's body oxidized it completely then I guess there would be little problem (but it doesn't)! Instead, the body has two goes at 'neutralizing' ethanol, acetaldehyde being the first metabolite and the second is that acetaldehyde is converted into vinegar (acetic acid) which is essentially harmless. Methanol is worse—much more so. It's first-pass metabolite is formaldehyde (right, it's an excellent 'pickling' preservative), and the second-pass metabolite is formic acid (that's the stuff ants sting you with). Thus methanol double-whammies you and unfortunately it does it par excellence. Methanol is damn horrible stuff really, less than 100ml can kill one outright and if you survive then, as chimeracoder says correctly, you'll likely be left permanently blind not to mention ending up with other serious problems. In fact, one of the emergency procedures for methanol poisoning is to repeatedly give copious quantities of ethanol for quite some length of time—as in the first instance it substitutes for methanol, ethanol's delaying action then gives the body much longer to metabolize methanol and this delay has the effect of ameliorating some of the damage it causes. Here, ethanol is much the lesser of two evils. That said, acetaldehyde is more toxic than ethanol and it's far from being benign (for starters it's what gives you your hangover but that's not the end of it). Whilst it doesn't have the immediate punch of formaldehyde, acetaldehyde is nevertheless still dangerous for several reasons, first the body is capable of metabolizing ethanol in the liver with the enzyme acetaldehyde dehydrogenase however this process is not exactly straightforward nor is the metabolism of ethanol completely benign; second, the dangerous aspects of acetaldehyde dehydrogenase's metabolism of ethanol is that it often results in cumulative damage to the liver over the long-term, especially so when ethanol is taken in large amounts. There's a few Wikis on this but they're a bit complicated for a quick understanding, nevertheless the second link on alcoholic liver disease has a nice diagram that illustrates how long-term liver damage happens: https://en.wikipedia.org/wiki/Acetaldehyde_dehydrogenase https://en.wikipedia.org/wiki/Acetaldehyde_dehydrogenase https://en.wikipedia.org/wiki/Alcoholic_liver_disease https://en.wikipedia.org/wiki/Alcoholic_liver_disease Right, I shouldn't have used the word 'pickling' but I was using it in the vernacular and, as here, I did actually use it in inverted commas. Another way of looking at it is that long-term ethanol/acetaldehyde damage to the liver leads to cirrhosis of the liver—and cirrhosis is in effect the death of liver cells which are then replaced by scar tissue (that's close enough to 'pickling' methinks).
deleted 5y ago
[deleted]

qorrect 5y ago

I use Disulfiram and it has been a godsend for me. It takes away the choice, I am physically unable to drink, my mind makes this easy for me, it's simply not an option so I don't even consider it. I realize it's not for everyone but it has saved me. I had to go out of country for it, doctors do not like to prescribe it. I hoard it.

hilbert42 5y ago
I'm truly glad it works for you and nothing that I or others say should distract you from that course. I know it works for some people and I knew that before I posted that comment. Again, that's truly great for them. However, it's my understanding that all too many do not have your level of self-perception nor do they have the same level of self-control that you do and so they end up on a horrible carousel ride until they fall off - big-time. This seems to be the major reason why doctors do not want to prescribe it. The fact that these concerns about disulfiram have been reoccurring in the literature since the 1960s is pretty much proof of the fact. I suppose the real problem is the difficulty in determining who will actually benefit from it and who will not, and that's an age old problem that medicine hasn't solved as yet (or as I reckon won't take the necessary time with individual patients to determine those who are suitable - thus it all gets chucked into the 'too-hard' basket). Just keep at it. Best of luck. :-)
- qorrect 5y ago
  I did not mean to dismiss it's negative side effects , this is a dangerous drug. For a general purpose anti anxiety it's a down right terrible choice, even to suggest it feels irresponsible. Chugging a bunch of alcohol while on this ( if say you forgot your anti-anxiety meds were also an anti alcohol drug ), might literally kill you.
  - hilbert42 5y ago
    Right, clearly you're on top of the info and that's what counts. Trouble is, most aren't which is most unfortunate.