Management of Alcohol Dependence after Detoxification: The Potential Role of Acamprosate

Alcohol dependence is a major health problem associated with substantial social and healthcare costs. Until recently, the only available management options for maintaining abstinence in alcohol-dependent patients after detoxification were psychosocial/behavioural therapies (including self-help groups) and aversive therapies such as disulfiram. Although these approaches can reduce alcohol intake, their efficacy is limited and aversive therapy is associated with potentially serious adverse events and poor patient compliance. A greater understanding of the neurobiology of alcohol dependence has resulted in the investigation of a range of agents with effects on the various neurotransmitters and neuromodulators involved in this condition. Acamprosate, a glutamatergic agent, and naltrexone, an opioid antagonist, have shown the most promise; acamprosate has been the most extensively studied. Acamprosate is the first agent to be developed specifically for the prevention of relapse in detoxified alcohol-dependent patients. This well tolerated drug increases mean continuous alcohol abstinence rates, the cumulative duration of abstinence and the time to first alcoholic drink compared with placebo. Its efficacy may be enhanced by the addition of disulfiram. Comparative trials with naltrexone and other active treatment approaches are required before the definitive position of acamprosate can be determined. In the meantime, acamprosate, as an adjunct to psychosocial/behavioural therapies (including counselling), can be considered a promising first-line pharmacological therapy for the maintenance of abstinence in detoxified alcohol-dependent patients.