Adherence to Disulfiram Therapy in Outpatients with Alcohol Dependence: A Mixed Methods Study

Abstract Background and Aims: Adherence to prescribed medications is an important determinant of efficacy. Treatment of patients with alcohol dependence sometimes becomes a challenge for the family members due to poor adherence to disulfiram. The present study aimed to understand the adherence to disulfiram and its supervision-related aspects in patients with alcohol dependence. Methods: This was an embedded concurrent mixed methods study conducted in India. The quantitative exploratory aspect of the study included 50 patients with alcohol dependence. Their adherence to treatment, readiness to change, and family functioning were assessed. The qualitative aspect of the study included 34 family members of patients with alcohol dependence who had been prescribed disulfiram, and thematic analysis was done. Results: Among the patients, an overwhelming majority reported that disulfiram was effective. Many had experienced disulfiram-ethanol reactions in the past. Medication adherence was generally quite good. Exploratory analysis found poorer adherence to be associated with a higher number of drinking days (Spearman rho = −0.36, P = 0.01) and heavy drinking days (Spearman rho = −0.55, P < 0.01). Inductive thematic analysis of the qualitative interviews revealed three major themes: administration of disulfiram, problems faced by family members during supervision of disulfiram, and ways by which family members handle these problems. Conclusion: Poor adherence to disulfiram portends to alcohol consumption. Family members face certain challenges to disulfiram supervision and devise strategies to ensure supervision in their own context.