Alcohol Use Disorder and Relapse
Problem drinking comes in many forms, including binge drinking or heavy drinking. These can be destructive, but the most life-altering is alcohol use disorder. This form of addiction, originally called alcoholism or alcohol addiction, leads to compulsive behaviors to acquire and consume alcohol. When cravings for and consuming alcohol begin to interfere with a person’s work, social life, family, and health, they may be struggling with alcohol use disorder (AUD). However, to know for sure, it is important to work with a physician or therapist to get a diagnosis.
Once AUD has been diagnosed by a medical professional, the individual and their doctor can work together to develop a treatment plan. Part of this process involves safe detox from alcohol, then entering a rehabilitation program. After detox, the individual may receive a prescription for an abstinence maintenance medication, such as Campral.
The media portrayal of addiction and relapse, unfortunately, insists that people can use their willpower to prevent themselves from consuming intoxicating drugs, like alcohol; when the person relapses, with this narrative, the assumption is that they didn’t care enough or they have no willpower, and have somehow failed. All of this is wrong, and this perception can be harmful when trying to overcome an addiction like AUD.
The evidence-based, medical understanding of addiction is that it is a chronic disease of the brain. The main symptoms are compulsive behaviors, with the goal of triggering the release of dopamine, serotonin, and other neurotransmitters that stimulate the reward system. For people with AUD, alcohol is the substance that triggers their reward system, and they seek out this experience repeatedly, even when other parts of their lives suffer because of the addiction. In order to treat addiction, the best plan involves safe detox, therapy to change the behavior around drugs, and ongoing support groups or other emotional support when rehabilitation is complete.
Increasingly, doctors are using maintenance medications to treat conditions like opioid addiction and alcohol use disorder. With alcohol, the person must stop drinking first, then the medication will help them stay sober – either by reducing cravings or by inducing negative side effects if they do drink. Campral, the brand name for acamprosate, adjusts brain chemistry so the person does not experience intense cravings for alcohol.
Relapse is an expected part of many chronic illnesses, like diabetes, hypertension, asthma, and addiction. A relapse simply means that symptoms of the disease reappear, and the individual needs to return to treatment or develop a new treatment plan.
The National Institute on Drug Abuse (NIDA) is clear that relapse is often part of addiction recovery. It is not a personal failing, and it does not mean treatment doesn’t work. Learning the signs of relapse is part of rehabilitation, and using medications to reduce the risk of relapse is part of ongoing treatment.
Acamprosate, the generic medicine in Campral, changes brain chemistry in those who may have imbalanced neurotransmitters due to their struggles with AUD. The medication has been used to treat AUD in Europe since 1989, but it was not approved by the Food and Drug Administration (FDA) until 2004 to treat people in the United States. It is the third abstinence maintenance drug, after disulfiram and naltrexone, to be approved for prescription use in the US.
Unlike other AUD prescription medicines, Campral is believed to work by mimicking gamma-aminobutyric acid (GABA). GABA receptors are involved in calming a person down, and many medications that treat anxiety, insomnia, and epilepsy interact with these receptors to release GABA. Alcohol also binds to these receptors, so long-term abuse of alcohol can change how GABA is released by the brain. Campral can decrease cravings for alcohol by stimulating the pathways that alcohol would normally stimulate.
Before taking Campral, a person must have undergone detox and stopped drinking. The medication, combined with behavioral therapy in a rehabilitation program, can dramatically reduce the risk of relapse.
There are no known drug interactions with Campral, making it one of the safer maintenance medications for people overcoming AUD.
However, it can cause some side effects, including:
- Physical weakness
- Nausea, diarrhea, and gas
- Loss of appetite
- Sweating and itching
- Insomnia or other sleep disturbances
- Dry mouth
- Tingling or numbing in extremities
However, Campral is very unlikely to be abused or cause dependence and tolerance. The worst potential side effect involves mood changes, especially depression. Intense depression or thoughts of suicide should be immediately reported to a doctor. There is some risk of overdose, but there are no recorded deaths from overdose; additionally, the dose must be very high for a person to overdose on Campral.
Most studies support acamprosate’s effectiveness in reducing cravings and helping people stay sober. In follow-up studies involving 4,000 people taking Campral:
- Twice as many taking Campral remained sober for one year compared to a placebo (27 percent versus 13 percent).
- In those who relapsed within one year, those taking acamprosate consumed fewer alcoholic drinks compared to those taking a placebo.
- Receiving Campral through primary care physicians resulted in fewer alcohol-related problems, when the prescription was combined with regular checkups.
- Dropout rates among those taking Campral were 20 percent lower than with other medications.
Campral Can Be One Component of Alcohol Use Disorder Treatment
Like other maintenance medications for AUD, Campral should only be taken with a prescription, and it is most effective when combined with behavioral therapy in a rehabilitation program and long-term recovery support, including participation in peer support or 12-Step groups. Medication alone will not “cure” addiction; instead, working to change behaviors, using medication to reduce relapse risk, and getting social support will help a person stay abstinent and focused on recovery.
Acamprosate Side Effects
What Side Effects Does Campral Cause?
Campral produces few side effects, which may include:
- Pain or weakness
- Changes in appetite, especially loss of appetite
- Diarrhea or gas
- Low mood
- Insomnia or other sleep problems
- Dry mouth
- Numbness or tingling in the extremities
Because acamprosate adjusts the balance of neurotransmitters in the brain, it may affect some people who struggle with mental health issues.
Signs of a mood disorder may be serious side effects, including:
- Extreme anxiety or depression that does not lift
- Other mood or behavioral changes
- Thoughts about self-harm or suicide
Other side effects that may require immediate medical attention include:
- Swelling in the hands or feet
- Fluttering in the chest
- Pounding heartbeat
However, acamprosate is not addictive, and there is very little overdose risk, especially when the prescription is monitored by a medical practitioner.
Are There Risks to Taking Campral on a Long-Term Basis?
The riskiest part of taking Campral for a long time is the increased risk of developing a mood disorder – most often depression, but sometimes anxiety. Major depression may prompt suicidal ideation, which can lead to self-harm or death. Sadness, guilt, or anhedonia that does not lift, or thoughts of suicide, must be immediately reported to a doctor. The dose of Campral may be adjusted, or the physician may decide to stop the medication.
There is some potential risk to a fetus if a woman becomes pregnant while taking Campral. If a woman is taking Campral when she decides to become pregnant, it is important to discuss the risks versus the benefits of this medication with her doctor.
Are Alternatives to Campral Safer?
There are only three maintenance medications that the Food and Drug Administration (FDA) has approved to treat recovery from alcohol abuse: disulfiram (Antabuse), naltrexone (Vivitrol), and acamprosate (Campral). All of these medications produce certain risks and benefits.
Disulfiram is not prescribed as often because of potential liver toxicity and lack of evidence that this medicine is effective at helping a person maintain abstinence from alcohol. Vivitrol and Campral both show effectiveness in reducing cravings and helping a person in recovery stay away from alcohol. However, both have some benefits and some detriments compared to each other. Ultimately, the medication prescribed to maintain abstinence from alcohol is the result of a conversation between the patient and the doctor, but Campral has shown to be very safe and effective.
Is Campral Addictive?
No, Campral is not addictive. Although it adjusts brain chemistry, this is a benefit for people who have struggled with chronic alcohol abuse, whose neurotransmitters are used to the presence of this intoxicant. Campral does not take the place of alcohol, and it is not well understood how it helps a person remain sober, but it is not addictive.
Can Campral Cause Withdrawal?
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) states that acamprosate does not change brain chemistry significantly enough to induce withdrawal symptoms when it is stopped suddenly. The individual may experience some cravings for alcohol after they stop the medication, but it does not need to be tapered when a person wants to stop taking it. It also does not cause harm if a dose is missed.