IIRC, my doc did a liver function test before prescribing it. It is uncommon, but Antabuse-induced liver injury is a thing.. And drinking on it can be dangerous. When I did Antabuse monitoring for parolees, if a parolee had a reaction, my instructions were to call an ambulance first, and then his parole officer.
I found taking Antabuse helpful in temporarily removing the obsession. When it ceases to be a choice, my mind moved onto to other things, like dishes and laundry.