Disulfiram Treatment of Alcoholism-Reply

In Reply.— Dr Brewer writes that we should have administered disulfiram by having someone watch the patient ingest the tablet (supervised disulfiram treatment). He believes the literature on supervised disulfiram treatment establishes the superiority of this method, which he implies is common practice. As we stated in our article, we studied the voluntary administration of disulfiram because this is the usual clinical practice, and we wanted the study to be generalizable to the usual clinical situation. We also stated that the data on the efficacy of supervised disulfiram treatment must be considered preliminary, because most of the few studies of supervised disulfiram treatment usually consisted of a small number of patients (40 or fewer) and were of short duration (three months or less). After completing our cooperative study of voluntary disulfiram treatment, we thought the next step should be to evaluate supervised disulfiram treatment and requested funds from the Veterans