Alcohol Detox and Acamprosate
Acamprosate (trade name Campral) is one of a few medications that are approved by the Food and Drug Administration for treating particular symptoms that occur in alcohol use disorders. Other medications that have FDA approval for the treatment of alcohol abuse problems are ReVia (naltrexone) and Antabuse (disulfiram).
While its actual mechanism of action is not fully understood, acamprosate is believed toprimarily affect the activity of the excitatory neurotransmitter NMDA (N-methyl-D-aspirate) and the activity of the inhibitory neurotransmitter GABA (gamma-aminobutyric acid). These are two of the major neurotransmitters that are affected by alcohol use and abuse.
Acamprosate may also affect other functions in the neurons, particularly the calcium channels in neurons that are associated with excitatory neuronal functioning. It is speculated that the use of acamprosate inhibits the actions of excitatory neurons and increases the effectiveness of inhibitory neurons that primarily utilize GABA. This results in its ability to reduce cravings in individuals recovering from alcohol use disorders.
How Does Acamprosate Treat Alcohol Use Disorders?
Initial clinical research studies using double-blind controlled experimental research methodologies determined that acamprosate is an effective medicine that can be used in the treatment of alcohol abuse and alcohol use disorders. Meta-analytic research is a method that combines the results of many research studies in order to determine the overall effects associated with multiple research studies as opposed to the effects with any singular study. Using meta-analytic procedures results in more reliable and valid findings than using single standard experimental double-blind placebo-controlled research studies; the combined results of numerous studies are more convincing evidence than the results of any single study.
A sampling of the major meta-analytic research regarding the use of acamprosate for the treatment of alcohol use disorders is outlined below:
- A 2004 meta-analysis involved 17 different studies with a total of more than 4,000 participants. Moderate effects for the use of acamprosate were found. The rate of abstinence from alcohol for individuals treated with acamprosate was significantly higher than participants treated with a placebo, and this trend continued for the duration of the study (12 months).
- A meta-analytic study performed in 2008 utilized the results of 21 different studies. Acamprosate was compared against ReVia. Acamprosate was more effective than placebo, but it was not effective in controlling drinking in individuals who relapsed compared to ReVia. Overall, acamprosate was deemed to be effective but less effective than ReVia.
- A meta-analytic study in 2013 that included the results of 21 studies with more complicated outcome variables found acamprosate was more effective in promoting total abstinence from alcohol, whereas ReVia was more effective in promoting reduced drinking.
- A 2015 meta-analysis utilized the results of 22 studies where participants used acamprosate and 27 studies where participants used ReVia. Both drugs resulted in higher rates of successful abstinence compared to a placebo, but ReVia produced more adverse side effects than acamprosate. Individuals in the ReVia studies were more likely to drop out of the study than those who used acamprosate.
Reviewing the results of the meta-analytic research indicates that acamprosate can assist individuals in recovery from alcohol use disorders.
However, the conclusions from the available research on the use of the drug indicate a few key findings:
- First of all, all of above the studies mentioned that acamprosate is designed to be used in association with formal substance use disorder treatment, such as substance use disorder therapy and/or involvement in 12-Step groups. The medication is designed to be an adjunctive treatment: a treatment that adds to the effectiveness of other treatments but is not a standalone treatment itself. The use of acamprosate is not designed to be the only intervention in the treatment of alcohol use disorders, and research indicates that it is not effective in the long run when used alone without substance use disorder therapy.
- The use of the drug is most effective after the individual has already reached an initial level of abstinence. Using acamprosate while one is still drinking alcohol will not be an effective treatment. Most often, several days to two weeks of abstinence is required before it is suggested that one uses the drug. This means that individuals with moderate to severe alcohol use disorders should already be involved in a formal medically assisted withdrawal management program, beginning to get other forms of treatment for their alcohol abuse, and have a desire to stop using alcohol and other drugs altogether (see below).
- The drug appears to interact with the individual’s level of motivation to stop drinking. In all the above mentioned research studies, motivation to stop using alcohol is a moderating factor that contributed significantly to the success of treatment with the drug. Individuals who are motivated to stop drinking and have a positive experience in recovery have better outcomes even when taking the medication. Individuals who are not motivated to remain abstinent from alcohol have poorer outcomes.
- Acamprosate is not effective in reducing one’s intake of alcohol, altering the effects that one gets when one drinks alcohol, or in addressing any withdrawal symptoms associated with abstinence from alcohol. The drug is only effective in helping individuals to maintain abstinence by helping to reduce cravings for alcohol.
- It does not appear that acamprosate has sufficient research evidence to be used in the treatment of other forms of substance use disorders at the time of this writing. Its medicinal utility appears to be primarily associated with reducing cravings in individuals with alcohol use disorders who are already abstinent, but the drug may occasionally be used off label in the treatment of other substance use disorders.
Thus, the major contribution of acamprosate during the treatment of an alcohol use disorder is to help an individual control and deal with cravings while they are already abstinent from alcohol use.
There are some potential side effects associated with the use of acamprosate.
- The most common side effects include gastrointestinal issues, such as mild nausea, flatulence, and diarrhea.
- Some individuals report issues with itching or perspiration.
- Some individuals report dry mouth, dizziness, aching muscles, and insomnia.
- There are a few reports of individuals who have experienced anxiety or depression. There are very rare cases of individuals who report having suicidal thoughts while they are on the drug; however, it is uncertain whether these suicidal thoughts are due to the use of the drug or some pre-existing mental health issue. Nonetheless, reports of suicidal thoughts are extremely rare.
- Some individuals report a loss of appetite while they are using the drug.
- Individuals who have serious kidney issues should not use acamprosate.
- Like any medication, some individuals may develop an allergic reaction to the drug. This would consist of itching, hives, swelling of the lips or fingers, nervousness, nausea, etc. Any person who suspects they are having an allergic reaction to the drug should immediately stop using it and call their physician.
Acamprosate is an FDA-approved medication that can be useful as an additional treatment for individuals who are already in recovery from alcohol use disorder. The drug is useful in reducing cravings for alcohol in people who are already abstinent from alcohol, have been able to maintain abstinence for a week or longer, and are motivated to be successful in their recovery. Acamprosate cannot reduce a person’s intake of alcohol while they are still drinking or directly affect any withdrawal symptoms associated with abstinence from alcohol.