While far from perfect, and only to be used as a part of a more comprehensive drug treatment program, acamprosate or a combination of acamprosate and naltrexone offers some protection against relapse through a reduction in experienced cravings, and a reduction in withdrawal symptoms during the first few months of sobriety.
There are few things as poorly understood as the remarkable complexity of the human brain, and addiction as a function of the brain is only very minimally understood at the neuronal level. Thankfully continuing research initiatives continue to uncover ever increasing pieces of this complicated puzzle, but for now, existing pharmacological interventions for addictions recovery remain imperfect.
Three of the most commonly used medications in the treatment of alcohol addiction, are disulfiram, naltrexone, and the newest medication, acamprosate.
Disulfiram works by making recovering alcoholics very ill if they consume alcohol concurrently with the medication, and naltrexone works by reducing the pleasurable rewards of drinking. Acamprosate works by stabilizing brain activity altered by abuse, and reducing the compulsions to abuse.
Acamprosate has its mechanism of action within the GABA neurotransmitter systems of the brain, and it is this damaged GABA system that results in dangerous tremors or convulsions during acute alcohol withdrawal, and also seems to continue to influence cravings to abuse. Alcohol is a natural GABA inhibitor and acamprosate also inhibits the neurotransmitter, allowing brain activity levels to stabilize naturally and slowly over time, with less experienced discomfort, or cravings back to abuse.
Acamprosate is no magic solution, and a significant percentage of people treated with acamprosate during the initial months of alcohol recovery will relapse back to drinking, but it does work significantly better than nothing, and some research indicates that when the drugs acamprosate and naltrexone are combined, the greatest possible efficacy is achieved.
Acamprosate can reduce some of the anxiety associated with the initial period of abstinence, and also seems to help people sleep better during initial recovery, which is important as insomnia during initial recovery is a significant predictor of relapse and further abuse. Acamprosate also seems to diminish the strength of cravings, at least in the very initial few months of recovery; allowing recovering alcoholics enough time of sobriety to regulate brain activity naturally, and develop natural motivations and strategies to continued relapse avoidance.
Acamprosate also gives addictions professionals another drug in the arsenal against relapse, particularly for alcoholics suffering liver damage, as since it is not significantly metabolized in the liver; it is safe even for cirrhotic patients.
The drug seems to be very well tolerated, and side effects most commonly experienced are headache or nausea. The drug is not intended to be used as a stand alone treatment to alcoholism, but as a part of a comprehensive drug treatment program, including significant psychosocial and behavioral components.
This is a prescription medication, and there some people who cannot take it. As with any prescription drug, you should only take the medication on a doctor’s advice, and under professional care and supervision.
Although acamprosate doesn’t cure alcoholism, it does offer some efficacy during the very tough initial few months of sobriety, and can make those few months just a little more comfortable for people suffering from a legacy of addiction, and resultant brain deficits. The risks of use seem very low when compared with the possible benefits; and when acamprosate is combined therapeutically with naltrexone, it seems to offer significant protection against relapse.
Alcoholism is a serious, stubborn and lasting disease, and while acamprosate certainly won’t cure it; anything that helps to improve the odds of recovery is to my mind a very good thing. If you are struggling with sobriety, speak with your doctor about the risks and benefits of adding acamprosate, or acamprosate and naltrexone, to your medication regimen.
We need to use everything at our disposal to give people the best chance of beating addictions, and living better lives of sobriety.