Clinical Efficacy of Acamprosate in the Treatment of Alcoholism

Abstract

The pathophysiological and neurochemical basis of alcohol dependence, craving, and relapse are not yet fully understood (for review see Littleton et al. and Lovinger, this volume). However, a variety of studies implicate several neurotransmitters and receptors as very likely to be involved in the development of alcohol tolerance and dependence, including the dopaminergic and serotonergic system (DiChiara and Imperato 1988; Engel et al. 1990; LeMarquand et al. 1994: Sellers et al. 1981, 1992), opiates/endorphines, GABA, and glutamate (Littleton et al. 1991; Lovinger et al. 1989). This has led to new pharmacotherapeutic approaches in the therapy of alcoholism. In addition to chemical aversion therapy (Annis and Peachey 1992; Banys 1988; Fuller et al. 1986), tricyclic antidepressants (Soyka and Naber 1992), and lithium (Fawcett et al. 1984), various other substances have been tested in an attempt to increase abstinence rates in alcoholics, all with little or no success. More recently a variety of substances have been examined as an adjunct in relapse prevention in alcoholism; these include serotonergic substances, especially serotonin uptake inhibitors, buspirone, dopaminergic drugs, and opiate antagonists such as naltrexone and nalmefene (Amit et al. 1991; Balldin et al. 1994; Mason et al. 1994; O’Malley et al. 1992; Sellers et al. 1981; Volpicelli et al. 1992; for review see Soyka 1995). None of these compounds has so far found general exceptance as anticraving drug.