Esperal, the alcohol implant, and “getting stitched up” are common terms that have triggered strong emotions for years and are often a source of misunderstanding. In clinical practice, it is essential to distinguish between treatment of addiction as a therapeutic process and the use of an aversive medication as one of the tools that may support abstinence. Below, we explain what disulfiram is, how it works, what risks it carries, and why it does not replace comprehensive treatment of alcohol addiction.

Esperal and disulfiram

Esperal was a trade name for a medication containing the active substance disulfiram. Production of Esperal in Poland ended in 2009, but preparations containing disulfiram are still used in clinical practice. Even so, the name “Esperal” remains in everyday language as a term for disulfiram implantation, much like the phrase “getting stitched up.”

How disulfiram works and what a disulfiram reaction is

After alcohol is consumed, the body metabolises ethanol into acetaldehyde and then converts it into less toxic compounds. Disulfiram interferes with this process, leading to the accumulation of acetaldehyde. In a person who drinks alcohol after disulfiram implantation, a so-called disulfiram reaction may occur, and this reaction can be sudden and clinically dangerous.

Symptoms of a disulfiram reaction may include, among others:

• nausea and vomiting
• intense anxiety and distress
• rapid heart rate and palpitations
• shortness of breath and a feeling of not getting enough air
• chest pain
• dizziness
• marked blood pressure fluctuations

In severe cases, serious cardiac and neurological complications may occur. For this reason, disulfiram is not a “neutral” tool, and its use requires medical qualification together with a clear discussion of risks.

What aversive action means

Aversive action means that the prospect of unpleasant and potentially dangerous symptoms after drinking alcohol is intended to discourage the person from using alcohol. Unlike a hangover, which usually develops later, symptoms of a disulfiram reaction may appear quickly after alcohol is consumed.

This may support abstinence in some people, but it does not resolve the causes of addiction and does not replace therapeutic work.

What the alcohol implant procedure involves

Disulfiram implantation should be performed in medical conditions by a qualified physician. Most often, it involves placing the preparation subfascially in the buttock area under local anaesthesia. The duration of the procedure and the course of recovery depend on the patient’s individual clinical situation.

If you want a description of the procedure within a medical standard and information about qualification for the intervention, see: alcohol implant.

Can you drink beer or wine after the implant?

After disulfiram implantation, alcohol should not be consumed, including beer and wine. Caution also applies to products that may contain alcohol, such as some syrups, as well as selected foods and cosmetics if they contain ingredients that may trigger intolerance symptoms. If there is any uncertainty, decisions should be made after medical consultation.

Advantages and limitations of disulfiram

Disulfiram is sometimes considered as a tool to support abstinence, especially when the patient needs an external “safety barrier” in the early phase of recovery. In some cases, it may make it easier to maintain abstinence while therapy is beginning.

At the same time, disulfiram does not treat addiction. It does not change the psychological mechanisms of the disorder, does not resolve the causes of drinking, and does not replace psychotherapy or relapse work. From a clinical perspective, lasting improvement requires comprehensive addiction treatment.

If you want to see treatment as a process, the main point of reference is: treatment of alcoholism.

When medical help is necessary

Medical help is indicated if, after alcohol consumption, a person with disulfiram develops severe symptoms, especially chest pain, shortness of breath, fainting, disturbances of consciousness, seizures, significant heart rhythm disturbances, or sudden blood pressure changes. In such situations, safety is the priority and urgent medical consultation is necessary.

In the case of alcohol addiction and symptoms of alcohol withdrawal, the safe medical point of reference is supervised detoxification: alcohol detox.

What next if you are considering an implant

If you are considering disulfiram, it is worth treating it as one element of a broader treatment plan, not as a stand-alone method. In clinical practice, medical qualification, stabilisation, therapeutic work, and a plan of further care after residential treatment are of central importance.

If your goal is lasting change rather than only short-term abstinence, an important stage is alcohol addiction therapy: alcohol therapy.