Never Enough: the neuroscience and experience of addiction (The Addicted Brain)

by Judith Grisel

The first drug prescribed specifically to treat alcoholics was based on the premise of positive punishment. Antabuse interferes with the metabolism of alcohol and leads to a buildup of acetaldehyde, which is toxic. This metabolite produces uncomfortable physiological effects including flushing, sweating, and irregular heartbeat. Though it is still used to some benefit by highly motivated individuals, forty years of research have largely confirmed what most parents and pet owners already know: in general, punishment is not an especially effective way to change behavior. Some people live as if permanently taking Antabuse because of a natural deficiency in the enzyme that metabolizes acetaldehyde, caused by a common gene variation. These mutations are fairly rare in those with European descent but present in about half of northeast Asians. Within an hour after consuming alcohol, such people experience allergic-like reactions to the drug, including facial flushing, hives, and shortness of breath. Not surprisingly, this mutation decreases the tendency toward excessive drinking; however, it doesn’t totally prevent alcoholism, demonstrating the limited efficacy of punishment on behavior.