While the opioid epidemic continues to take center stage in the addiction treatment sphere, alcoholism continues to be an issue for many Americans. A large portion of people who are seeking addiction treatment are coming with alcohol use disorders. Even people who have become addicted to other substances may also develop problems with alcoholism because of its prevalence in party atmospheres. Alcohol is also the most common substance of abuse in some populations, including among veterans.
Alcohol use disorder is a chronic disease, but it’s one that can be treated with safe medical detox, psychotherapies, and several medications. Still, though it’s not inevitable, relapse is a serious threat to people in recovery, even people who have gone through treatment. One medication has recently come onto the scene and shows promise in improving treatment outcomes, and it may help to reduce the number of people who relapse after alcohol addiction treatment.
If you or someone you know has been struggling with alcohol use and may be developing alcohol use disorder, it can be helpful to learn about the options that are available to you. Learn more about acamprosate and how it can be safely and effectively used in addiction treatment.
Acamprosate is a medication that’s sold under the brand name Campral that’s used to treat alcohol dependence. The drug was approved in the United States 2004, making it a relatively recently added tool in the fight against addiction. It only took a year before the drug was integrated into addiction treatment programs all over the U.S. However, acamprosate isn’t useful in treating alcohol withdrawal symptoms. Instead, it’s used to facilitate relapse prevention, and it’s usually administered after someone already completes detox.
Acamprosate is used to stabilize brain chemistry and chemical brain signaling that would normally be disrupted by alcohol withdrawal. However, acamprosate isn’t an effective treatment for alcoholism on its own. It needs to be paired with other options such as psychotherapy and the full continuum of care in addiction treatment.
Still, studies have shown it to be effective as an adjunctive therapy, or therapy option that is used alongside formal addiction treatment. Medications used to treat addiction can be controversial, when they are used to replace formal therapy options. However, acamprosate has shown to improve treatment outcomes when it’s paired with addiction treatment but not when it’s used on its own.
The medication has several side effects, though they are generally mild. However, if the drug is taken before one goes through a detox program, it can make withdrawal symptoms come on suddenly, which can cause dangerous symptoms like seizures.
Acamprosate works to ease cravings and other issues that are common in alcohol withdrawal. However, the way it works in the brain is not fully understood, even though it has been studied extensively. Still, scientists think it works as an NMDA receptor antagonist and that it works to modulate GABA (gamma-Aminobutyric acid) receptors. NMDA receptors are affected by alcohol, and central nervous system depressants like alcohol and benzodiazepines bind to GABA receptors to increase its efficiency. GABA works to suppress excitability in the nervous system, which is what causes alcohol’s intoxication and sedating effects.
As you become addicted to alcohol, and your body gets used to the chemical in your system, your GABA receptors will start to become less sensitive to the effects of the GABA neurotransmitter. During withdrawal and in recovery, your body may have a hard time producing the usual effects of GABA receptor activation with your body’s natural chemical functions. As a result, your nervous system becomes overactive, unregulated by GABA receptors. This can cause anxiety, insomnia, nervousness, and the inability to relax.
Because you feel uncomfortable symptoms, your dependence on alcohol is deepened. Instead of drinking to socialize or for recreation, you drink to feel normal and to correct this chemical imbalance. Acamprosate works to correct the weakened GABA receptors, helping them to do their job properly, and lowering the need to drink alcohol to feel normal.
Treatment with acamprosate will start with detoxification, which is the first step in treatment for any substance use disorder. The safest way to get through alcohol withdrawal is with medical detox. Alcohol can cause some potentially life-threatening symptoms during withdrawal, including seizures and a condition called delirium tremens (DTs), which involves severe nervous system overactivity and can be deadly.
If you start to feel alcohol withdrawal symptoms such as tremors, anxiety, panic, confusion, or insomnia, it’s important to speak with a doctor as soon as possible about safe detox.
After detox, which usually lasts for about five to 10 days, or longer if needed, you can enter an addiction treatment program based on your needs and start to receive acamprosate. You will continue to take acamprosate through your addiction treatment, which may last up to around 90 days. In most cases, you continue to take the medication well after treatment before you start to wean off it. A slow and careful weaning period that is directed by your doctor is important; it allows the body and GABA receptors to adjust back to normal.
Acamprosate is one of the few medications that is specifically used to treat alcohol use disorders, but it has shown to be effective in some circumstances. When it’s used in conjunction with psychotherapies that are often present in addiction treatment, it has shown to improve treatment outcomes and lengthen a person’s time in sobriety.
A 2006 study revealed that acamprosate had “significant, but modest, effects” on treatment outcomes and retention. It’s especially helpful in the period just after detox, when a person may still have powerful cravings. Another study found that continuous abstinence rates were high after six months among patients who were treated with acamprosate. Studies also showed that acamprosate was equally effective as naltrexone, another medication that’s used to treat alcohol and opioid addiction alongside treatment.
The drug is not effective on its own, however. Alcoholism can have a wide range of causes, consequences, and underlying issues. In many ways, substance use disorders and mental disorders that need to be addressed holistically. If co-occurring problems like depression or anxiety aren’t addressed, treatment options that exclusively target the substance use problem will ultimately be ineffective.
For instance, veterans often turn to alcohol as a way to self-medicate to relieve post-traumatic stress disorder (PTSD). If someone with AUD and co-occurring PTSD is treated for alcoholism, but their PTSD is ignored, those inborn triggers will continue to cause them to relapse.
Addiction treatment is most effective when it’s tailored to individual people and when it treats multiple aspects of a person’s life, including medical, psychological, social, legal, and financial issues. For that reason, acamprosate should be treated as just one tool in a wider array of treatment options.
Kranzler, H. R., & Kirk, J. V. (2006, April 11). Efficacy of Naltrexone and Acamprosate for Alcoholism Treatment: A Meta‐Analysis. from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1530-0277.2001.tb02356.x
Mann, K., Lehert, P., & Morgan, M. Y. (2006, May 03). The Efficacy of Acamprosate in the Maintenance of Abstinence in Alcohol‐Dependent Individuals: Results of a Meta‐Analysis. from https://onlinelibrary.wiley.com/doi/abs/10.1097/01.ALC.0000108656.81563.05
National Institute on Alcohol Abuse and Alcoholism. (2018, August). Alcohol Facts and Statistics. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2013, March 01). Substance use disorders in military veterans: Prevalence and treatment challenges. from https://www.drugabuse.gov/publications/drugfacts/substance-abuse-in-military