Internet peer review

Sir: We describe the results of disulfiram im plantation over a five year period within clinical practice at an alcohol service at a district general hospital. The pharmacological basis of usage of disulfir am lies in its action on alcohol dehydrogenase preventing breakdown of acetaldehyde In the metabolism of ethanol. Early uncontrolled stud ies of disulfiram implantation showed significant improvement in abstention and social function ing (Malcolm & Maddens. 1973: Whyte & O'Brien. 1974). More recent placebo-controlled studies have consistently shown no differences between placebo and active treatment groups with regard to a wide set of alcohol-related variables (Borg et al 1985: Johnson & Morland, 1991). We reviewed the case notes of all patients (n=12) treated with disulfiram implants at Princess Alexandra Hospital between 1989 and 1994. All patients were seen by one psychiatrist (OJD), and implantation under one surgeon (MWM). Patients were encouraged to take oral disulfiram for 8 to 12 weeks prior to implanta tion. They were given an explanation of the mode of action of disulfiram before the medication was prescribed and gave informed consent. The 'challenge' approach was not used. Implantation