Skip to main content
SpringerLink
Log in

Relapse Prevention in Alcoholics

A Review of Acamprosate versus Naltrexone

  • Clinical Review
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Objective: To compare two anticraving drugs, acamprosate and naltrexone, for effectiveness, kinetics and tolerability in patients with abusing or dependent on alcohol.

Design: This study reviewed all published double-blind, placebo-controlled trials of patients abusing or dependent on alcohol. Main clinical outcome measures were: time to relapse, cumulative relapse rate, total number of drinks during study period.

Setting: Mainly ambulant cases.

Patients: Patients consisted of 3338 acamprosate and more than 200 naltrexone cases.

Interventions: Some studies also used psychosocial support, one combined acamprosate with disulfiram.

Results: Both drugs were superior to placebo. Drop-out rates were comparable between drugs. Naltrexone caused more adverse effects than acamprosate. Acamprosate has been studied for over 1 year and has been shown to remain effective with carry-over of the effect after stopping the medication for at least 1 year; naltrexone has been studied for 3 months, with no carry-over.

Conclusion: Both drugs were effective, but acamprosate may be preferred above naltrexone because of its proven long-term effectiveness with carry-over.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. O’Connor PG, Schottenfeld RS. Patients with alcohol problems. N Engl J Med 1998; 338: 592–602

    Article  PubMed  Google Scholar 

  2. Wilde MI, Wagstaff AJ. Acamprosate. A review of its pharmacology and clinical potential in the management of alcohol dependence after detoxification. Drugs 1997; 53: 1038–53

    Article  PubMed  CAS  Google Scholar 

  3. Volpicelli JR, Alterman AI, Hayashida M, et al. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry 1992; 49: 867–80

    Article  Google Scholar 

  4. O’Malley S, Jaffe AJ, Chang G, et al. Naltrexone and coping skills therapy for alcohol dependence, a controlled study. Arch Gen Psychiatry 1992; 49: 880–7

    Google Scholar 

  5. O’Malley SS, Croop RS, Wroblewski JM, et al. Naltrexone in the treatment of alcohol dependence: a combined analysis of two trials. Psychiatry Ann 1995; 25: 681–8

    Google Scholar 

  6. Chick J. UK multicentre study of naltrexone as adjunctive therapy in the treatment of alcoholism: efficacy results. Proceedings X Congress World Psychiatric Association; 1996 August; Madrid: WPA, S–1112–3

  7. Balldin J, Berglund M, Borg S, et al. A randomized 6 months double-blind placebo controlled study of naltrexone and coping skills educational programme. Alcohol Alcohol 1997; 32: 325

    Google Scholar 

  8. Acamproasate for alcohol dependence? Drugs Ther Bull 1997; 35: 70-2

    Google Scholar 

  9. Berg BJ, Pettinati HM, Volpicelli JR. A risk-benefit assessment of naltrexone in the treatment of alcohol dependence. Drug Saf 1996; 15: 274–82

    Article  PubMed  CAS  Google Scholar 

  10. Herz A. Endogenous opioid systems and alcohol addiction. Psychopharmacology 1997; 129: 99–111

    Article  PubMed  CAS  Google Scholar 

  11. Littleton J. Acamprosate in alcohol dependence: how does it work. Addiction 1995; 90: 1179–88

    Article  PubMed  CAS  Google Scholar 

  12. Zernig G, Fabisch H. Pharmacotherapy of alcohol dependence. Trends Pharmacol sci 1997; 18: 229–31

    PubMed  CAS  Google Scholar 

  13. Schuckitt MA. Recent developments in the pharmacotherapy of alcohol dependence. J Consult Clin Psychol 1996; 64: 669–76

    Article  Google Scholar 

  14. Wilde MI, Goa KL. Management of alcohol dependence after detoxification. The potential role of acamprosate. Dis Manag Health Outcomes 1998; 3: 35–46

    Article  Google Scholar 

  15. Volpicelli JR, Volpicelli LA, O’Brien ChP. Medical management of alcohol dependence: clinical use and limitations of naltrexone treatment. Alcohol Alcohol 1995; 30: 789–98

    PubMed  CAS  Google Scholar 

  16. Weinrieb RM, O’Brien ChP. Naltrexone in the treatment of alcoholism. Ann Rev Med 1997; 48: 477–87

    Article  PubMed  CAS  Google Scholar 

  17. O’Malley SS, Jaffe AJ, Chang G, et al. Six-month follow-up of naltrexone and psychotherapy for alcohol dependence. Arch Gen Psychiatry 1996; 53: 217–24

    Article  PubMed  Google Scholar 

  18. Saitz R, O’Malley SS. Pharmacotherapies for alcohol abuse. Psychiatr Clin North Am 1997; 81: 881–907

    CAS  Google Scholar 

  19. Morgan M. UK multicentre study of naltrexone as adjunctive therapy in the treatment of alcoholism: safety results. Proceedings X Congress World Psychiatric Association; 1996 August; Madrid: WPA, S–1112–4

  20. Croop R. Long-term safety of naltrexone for the treatment of alcoholism. Proceedings X Congress World Psychiatric Association; 1996 August; Madrid: WPA, S–1112–5

  21. King AC, Volpicelli JR, Gunduz M, et al. Naltrexone biotransformation and incidence of subjective side effects: a preliminary study. Alcohol Clin Exp Res 1997; 5: 906–9

    Google Scholar 

  22. Croop RS, Faulkner EB, Labriola DF. The safety profile of naltrexone in the treatment of alcoholism. Arch Gen Psychiatry 1997; 54: 1130–5

    Article  PubMed  CAS  Google Scholar 

  23. Sandwijk JP, Cohen PDA, Musterd S. Licit and illicit drug use in Amsterdam. Report of a household survey in 1990 on the prevalence of drug use among the population of 12 years and over. Amsterdam: Inst Soc Geograf UvA, 1991

  24. Freed PE, York LN. Naltrexone: a controversial therapy for alcohol dependence. J Psychosoc Nurs 1997; 35(7): 24–8

    CAS  Google Scholar 

  25. Bills LJ, Kreisler K. Treatment of flashbacks with naltrexone. Am J Psychiatry 1993; 150: 1430

    PubMed  CAS  Google Scholar 

  26. Lerner AG, Oyffe I, Isaacs G, et al. Naltrexone treatment of hallucinogen persisting perception disorder. Am J Psychiatry 1997; 154: 437

    PubMed  CAS  Google Scholar 

  27. Roth AS, Ostroff RB, Hoffman RE. Naltrexone as a treatment for repetitive self-injurious behavior: an open-label trial. J Clin Psychiatry 1996; 57: 233–7

    PubMed  CAS  Google Scholar 

  28. van den Brink W. Epidemiologie en classificatie van alcoholproblemen. In: Geerlings PJ, van den Brink W, Schippers GM, editors. Behandelstrategieën bij alcoholproblemen. Houten: Bohn Stafleu Van Loghum, 1996: 1–10

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Ziekenhuis Rivierenland, P.O. Box 6024, NL, 4000HA, Tiel, The Netherlands

    Melchior J. A. J. M. Hoes

Authors
  1. Melchior J. A. J. M. Hoes
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoes, M.J.A.J.M. Relapse Prevention in Alcoholics. Clin. Drug Investig. 17, 211–216 (1999). https://doi.org/10.2165/00044011-199917030-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00044011-199917030-00005

Keywords

Search

Navigation