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Kerry Nenn

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Medication-Assisted Treatment for Alcoholism

Acamprosate (known by the brand name Campral) is an FDA-approved medication for use in the treatment of alcoholism. It is one of the most used medications for alcohol addiction as part of a medication-assisted treatment (MAT) plan.

While other medications work by either reducing the pleasurable impacts of alcohol or creating unpleasant side effects when you drink alcohol, acamprosate works by reducing the brain’s dependence on alcohol. This medication is meant to help prevent future drinking episodes, rather than curbing the physical symptoms of withdrawal. Specifically, acamprosate works on the brain’s glutamate and gamma-aminobutyric acid (GABA) systems, restoring balance to these brain chemicals to lower alcohol cravings.

A History of  Acamprosate

Acamprosate was approved for the treatment of alcohol addiction in 2004, and it became available for use in rehab facilities, clinics, and pharmacies a year later. It is available in tablet form and typically administered two to three times a day.

Acamprosate is only given after a person has completed the detox process. For alcohol, the detox phase generally lasts one to two weeks; however, it varies depending on the amount and frequency of alcohol use. And unlike other MAT medications used to treat addiction, acamprosate is non-habit forming.

While other alcohol addiction treatment medications are broken down by the liver, acamprosate is broken down by the digestive tract. This makes it extremely useful for people who are experiencing liver-related problems caused by alcoholism.

MAT and the Tools That Help Treat Addiction

Medications that are used to treat addiction, like acamprosate, are not intended to cure substance use disorders. Instead, medications used in MAT are just one part of a whole comprehensive recovery plan.

Comprehensive treatment plans tend to include one or more of the following levels of care:

• Detox
• Inpatient rehab
• Outpatient rehab
• Mental health treatments
• Behavioral health treatments
• Support groups
• Aftercare

How Does Acamprosate Treat Alcoholism?

Within the first few days and weeks after you stop drinking, you’re likely to experience withdrawal symptoms. Since alcohol withdrawal symptoms can be severe and even life-threatening, it’s recommended to undergo detox in an inpatient rehab facility. As a result, many people start acamprosate while in a rehab setting. And they continue taking it after completing the program. In the event of a relapse, the medication will not cause an adverse reaction or exacerbate withdrawal symptoms.

The amount of time it takes for the brain to function normally again depends on several factors. These include how much and how often you drank, as well as if there are any other underlying medical conditions. Acamprosate is commonly prescribed for one year, although it’s being studied to determine the potential benefits of long-term use.

Before you stop taking this medication, a treatment provider will evaluate your:

• Length of time in recovery
• Cravings experienced on a weekly/monthly basis
• Short- and long-term goals for recovery
• Efforts to establish a support system
• Participation in aftercare programs
• Attending counseling and support group sessions

Side Effects of Acamprosate

Most side effects of acamprosate are mild and subside the longer you take the medication. It is this lack of side effects that make the drug a more popular choice than alternatives. This is especially true when it comes to liver related side effects. However, there are a number of side effects, including:

• Diarrhea
• Insomnia
• Anxiety and nervousness
• Muscle weakness
• Nausea
• Vomiting
• Flatulence
• Itchiness
• Headaches
• Dizziness
• Depression
• Suicidal thoughts
• Irregular heartbeat
• Vision problems
• Hearing changes
• Fainting
• Reduced urination
• Potential fetal risk
• Severe renal impairment
• Irritability
• Loss of appetite
• Difficulty concentrating
• Loss of strength
• Anhedonia

Who Should Take Acamprosate?

The ideal candidate for acamprosate is someone who has completed alcohol detox, is highly motivated to stop all alcohol use, and has a solid support system.

Other people who may benefit from acamprosate include:

• People who have a history of opioid addiction. (Unlike other medications for alcohol addiction – naltrexone, for example – acamprosate does not impact the brain’s opioid receptors. This makes it an ideal choice for those undergoing opioid maintenance treatment with methadone or Suboxone or those who consistently use opioid medications for pain control.)
• People who take many different medications due to complicated medical histories (because drug interactions with acamprosate are rare).
• People with liver damage.

Who Shouldn’t Take Acamprosate?

Acamprosate isn’t the right MAT medication for everyone. This medication shouldn’t be taken if:

• You have kidney problems or decreased kidney function. This drug is not processed in the liver like most medications. Instead, the kidneys excrete the drug, which puts strain on them.
• You are pregnant or breastfeeding. It is not known whether acamprosate is transferred to the baby through the mother’s breast milk, but most experts say it’s not worth the risk.
• You can’t take the medication on a consistent basis. Taking a medication up to three times a day can be too difficult for some people, but acamprosate is only effective when taken as prescribed. Only those who are committed to taking the medication consistently should start taking it.
• You are not an adult. Acamprosate has not been evaluated or approved for use in children or adolescents.

Fast Facts About the Benefits of Acamprosate

• It is absorbed through the digestive tract instead of the liver, which improves the effectiveness of the medication and reduces side effects for those who have alcohol-related liver damage.
• It poses fewer, and generally less severe, side effects than other MAT medications for alcoholism.
• There are no known drug interactions with other medications or substances.
• It actively reduces alcohol-related cravings and dependence by balancing neurotransmitters in the brain, instead of creating negative side effects from alcohol use.

Resources

1. S. National Library of Medicine: DailyMed. (2017). Acamprosate Calcium.
2. Substance Abuse and Mental Health Services Administration. (2009). Incorporating Alcohol Pharmacotherapies Into Medical Practice.
3. Witkiewitz, K., Saville, K., & Hamreus, K. (2012). Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility.
4. Substance Abuse and Mental Health Services Administration. (n.d.). Medications for the Treatment of Alcohol Use Disorder: A Brief Guide.