Acamprosate effective in supporting alcohol abstinence

Clinical question: 
How effective is acamprosate in supporting continuous abstinence after detoxification from alcohol?
Bottom line: 
Compared to placebo, acamprosate added to psychosocial treatment strategies was shown to significantly reduce the risk of any drinking (NNT* 9) and to significantly increase the cumulative abstinence duration, while secondary outcomes (gammaglutamyltransferase, heavy drinking) did not reach statistical significance. Diarrhoea was the most frequently reported side effect with acamprosate. Overall, side effects did not cause more participants to stop treatment when taking acamprosate compared to placebo. Even though the sizes of treatment effects appear to be moderate, they should be valued against the background of the relapsing nature of alcoholism and the limited therapeutic options currently available for its treatment. The effects of acamprosate did not differ in industry-sponsored and non-profit funded trials. Three trials compared acamprosate and naltrexone, and did not indicate a superiority of one or the other drug in effect on return to any drinking, return to heavy drinking and cumulative abstinence duration. *NNT = number needed to treat to benefit 1 individual.
Caveat: 
Effect sizes reflected the additional benefit of adding acamprosate to psychosocial treatments rather than its benefit compared to placebo – a fact which often remained unconsidered in the interpretation of treatment effects. Treatment duration varied from 8 weeks to 1 year, with 6 months treatment being most common.
Context: 
Alcohol dependence is among the leading health risk factors in most developed and developing countries. In the year 2004, 3.8% of all global deaths and 4.6% of global disability-adjusted life-years were attributable to alcohol.¹ The therapeutic success of psychosocial programmes for relapse prevention is moderate but could potentially be increased by an adjuvant treatment with the glutamate antagonist acamprosate. 1. Rehm J et al. Lancet 2009;373:2223–33.
Review CD#: 
CD004332
PEARLS No: 
289
Date: 
July, 2011
Authored by: 
Brian R McAvoy