Acamprosate for Treating Alcohol Dependence

Indication and Mechanism

The American College of Physicians recommends acamprosate as the only intervention with sufficient high-quality evidence to be recommended for maintaining abstinence in detoxified alcohol-dependent patients 1, 2, 3

Acamprosate demonstrates superior efficacy compared to placebo with moderate certainty evidence, increasing the absolute probability of abstinence from 25% to 38% in patients with alcohol dependence 4, 3
The National Institute for Health and Care Excellence suggests that acamprosate is more effective in maintaining abstinence rather than inducing remission, making it most appropriate for patients who have already completed detoxification 5
Acamprosate shows better patient retention than placebo with moderate certainty evidence, reducing dropout rates from 50% to 42% in patients with alcohol dependence 2, 6
Weak evidence suggests acamprosate might be effective in the longer term, though more research is needed, according to the British Medical Journal 2

The British Medical Journal states that while naltrexone and disulfiram are also approved for alcohol dependence, there is insufficient high-quality evidence to conclude they improve abstinence in detoxified patients 2

The Hepatology society notes that treatment should be initiated only after the patient has achieved abstinence, as acamprosate has not been shown to have significant impact on alcoholics who have not been detoxified 5
Complete abstinence should be the goal, as there is a significant risk of recidivism in patients who attempt to cut back but not stop drinking altogether, according to the Hepatology society 5