Abstract
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 tolerates 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.
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Various sections of the manuscript reviewed by: R. Anton, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA; J.G. Brecht, InForMed GmbH, Glockengiesserwall, Hamburg, Germany; P. De Witte, Laboratoire de Psychobiologie, Université de Louvain, Louvain-la-Neuve, Belgium; C. Gianoulakis, Douglas Hospital Research Centre, Verdun, Quebec, Canada; M.H. Lader, Institute of Psychiatry, De Crespigny Park, London, UK; M. Lejoyeux, Department of Psychiatry, Groupe Hospitalier Bichat Claude Bernard, Paris, France; O.M. Lesch, Universitätsklinik für Psychiatrie, Währinger Gürtel, Vienna, Austria; K. Mann, Department of Psychiatry, Addiction Research Centre, University of Tübingen, Tübingen, Germany; A. Maynard, Centre for Health Economics, University of York, York, England; M. Soyka, Psychiatrische Klinik und Poliklinik, Nervenklinik der Universität München, Munich, Germany.
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Wilde, M.I., Goa, K.L. Management of Alcohol Dependence after Detoxification. Dis-Manage-Health-Outcomes 3, 35–46 (1998). https://doi.org/10.2165/00115677-199803010-00004
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DOI: https://doi.org/10.2165/00115677-199803010-00004