Drug Trials Show Promise for Improving Abstinence in Alcoholics
Findings of a new study suggest that alcoholic patients who have undergone detox can modestly improve their chances of abstinence by taking acamprosate (Campral).
A Cochrane review supported by a grant from the German Federal Ministry of Education and Research, the study determined that the drug—when used in combination with psychosocial treatment strategies—reduced the risk of alcoholic tendencies to return to any drinking after detoxification compared with treatment with a placebo.
The study was led Susanne Rösner, Ph.D, of the Psychiatric Hospital at the University of Munich, Germany and colleagues. The research team wrote in the review that “even though the sizes of treatment effects appear to be rather moderate in their magnitude, they should be valued against the background of the relapsing nature of alcoholism and the limited therapeutic options currently available for its treatment.”
Specifically, acamprosate increased the duration of alcohol abstinence by 11 percent when compared to placebo. After treatment, participants held a 9 percent lower risk of returning to drinking for up to 12 months later.
For heavy drinking, the drug did not significantly alter risk.
The review encompassed 24 randomized controlled trials with 6,915 participants primarily located in Europe. Two of the studies were held in the U.S. and one each in South Korea, Australia and Brazil. Men comprised the majority of participants with a median age of 42 years.
While the review included both industry-sponsored and nonprofit funded trials, the findings were collaborative.
Acamprosate is one of three agents, along with disulfiram (Antabuse) and the opioid antagonist naltrexone (ReVia), approved in the U.S. for treating alcohol dependence. Three of the trials compared acamprosate to naltrexone, revealing similar outcomes for returning to drinking, returning to heavy drinking and abstinence.
It was also demonstrated that a combination of the two drugs produced a better outcome but not significant when compared to placebo. Those using the combination were also four times as likely to drop out due to side effects.
Researchers noted that the evidence was too sparse for final conclusions, and no comparisons were found between acamprosate and disulfiram. There were also no notable effects or improvements on levels of the enzyme gamma-glutamyl transferase (GGT) used as a marker of liver health and alcohol intake.
With the exception of one trial, all participants were required to undergo detoxification before beginning treatment as well as participate in ongoing psychosocial treatment.
Notably, side effects were not a factor in causing patients to stop treatment of acamprosate when compared to placebo.
Diarrhea was the most frequently reported side effect of taking the agent. The research determined that the number needed to treat to cause an additional case of diarrhea that was the same as the number needed to treat to benefit—9.09.
“All in all, acamprosate does not appear to be a magic bullet in the treatment of alcohol dependence and — considering the complexity of processes involved in the development and maintenance of addiction — there will probably never be a single strategy that can ‘cure’ alcohol dependence,” Rösner’s group concluded in the paper.
Chavis, S. (2018). Drug Trials Show Promise for Improving Abstinence in Alcoholics. Psych Central. Retrieved on July 8, 2020, from https://psychcentral.com/news/2010/09/13/drug-trials-show-promise-for-improving-abstinence-in-alcoholics/18030.html