Tragic logic or how evidence does not change convictions: the perception of Geneva's addictology caregivers concerning the utility of disulfiram.

In December 2007, the Division of Addictology, Department of Psychiatry, Geneva University Hospitals, decided to stop prescribing disulfiram. The healthcare team's perception of this decision was monitored. A self-administered questionnaire (31 questions) was completed by the healthcare team in June 2009 over a 3-month period to evaluate their perception of the utility of disulfiram and of the pertinence of the decision to stop prescribing it. Fifty-five participants responded (61.1%), of whom 54.1% were women (mean age = 43.7 years), 54.8% were nurses, 30.6% were medical doctors, 9.7% were social workers, and 4.8% were psychologists. Of this group, 78.7% were working on the team in December 2007. The results showed that 54.6% did not agree with the decision to stop prescribing disulfiram. Although 72.2% thought that the decision was based on evidence-based medicine (EBM), 69.1% thought that disulfiram works because of the context of administration and 69.1% because of the fear generated by its effects. Among the participants, 75.5% still believed that disulfiram is useful for some patients (76.8% at the time of the decision). Despite the fact that aversive treatment in addictology has failed to demonstrate efficacy through EBM, the perception of its utility is still strong in caregivers. Although most caregivers acknowledge that aversive treatment works mainly through psychological constraints, they do not support the fact that EBM could generate a practice change such as discontinuing the prescription of disulfiram.