What is the primary mechanism of action of disulfiram in alcohol dependence treatment?

Disulfiram's primary mechanism of action in the treatment of alcohol dependence revolves around its ability to inhibit aldehyde dehydrogenase. This enzyme is crucial for the metabolism of acetaldehyde, a toxic byproduct that is produced when alcohol is consumed. When disulfiram is taken and alcohol is subsequently ingested, acetaldehyde accumulates in the body because it cannot be converted into the non-toxic acetic acid due to the inhibited enzyme activity. This leads to unpleasant reactions, known as the disulfiram-alcohol reaction, which can include flushing, nausea, vomiting, and palpitations. These aversive effects discourage individuals from drinking alcohol, thereby reducing the likelihood of relapse and aiding in the recovery process from alcohol dependence.

Understanding this mechanism emphasizes the role of disulfiram as an aversive agent, which leverages the body's reaction to alcohol when disulfiram is present, thereby supporting behavioral change in individuals struggling with alcohol use.