Published October 26, 2012
Two drugs commonly used to treat alcoholism may be appropriate for people in different stages of recovery, a new analysis confirms - likely because they work differently in the brain.
The drugs, acamprosate (marketed as Campral) and naltrexone (ReVia), are both non-addictive themselves and don't make users sick when mixed with alcohol. So they're a good first option for people struggling with alcohol dependence who are motivated to stop drinking but would like to avoid an inpatient program, researchers said.
In a new analysis of 64 trials evaluating the two medications, researchers from California found acamprosate was more effective at helping people who were not currently drinking stay sober. Naltrexone had the advantage when it came to cutting back on heavy drinking and helping recovering alcoholics avoid cravings.
All of the trials randomly assigned participants to take one of the drugs or a placebo pill, with drinkers typically also attending therapy sessions. They included about 11,000 people in total.
Both acamprosate and naltrexone tended to work better when study subjects had stayed away from alcohol for at least a few days before starting the drug trials, or had been through a detox program.
Natalya Maisel from the VA Palo Alto Health Care System in Menlo Park, California, and her colleagues calculated that eight people dependent on alcohol would need to be treated with acamprosate for one additional person to quit drinking. Nine would need to take naltrexone to keep one from returning to heavy drinking, the researchers reported in the journal Addiction.
The findings make sense to addiction specialists given how each drug acts on the brain, according to Dr. Raymond Anton, head of the Center for Drug & Alcohol Programs at the Medical University of South Carolina in Charleston.
Acamprosate is known to calm brain activity in general, so it can stabilize a brain that gets out of sorts when an alcoholic stops drinking. But if people start drinking again while on acamprosate, it probably won't help keep their cravings down, he added.
Naltrexone, Anton said, works on the brain's reward and reinforcement system - so if people were to drink while on the drug, it would block some of the positive feelings produced by alcohol and keep them from overdoing it.
"It stops a slip from becoming a relapse," he said. Naltrexone can also help alcoholics in recovery avoid giving in to cues, like when they drive past a liquor store, according to Anton, who wasn't involved in the new study.
Maisel's team noted that most of the trials of both acamprosate and naltrexone used in the analysis were only a few months long - and there is "a paucity of information in the literature regarding how long the benefits of these medications last after treatment," the researchers said.
Anton said both drugs could be a useful "first step" in addressing problem drinking when paired with therapy - especially for people who are hesitant to seek care because of the time and money involved in intensive treatment. They should talk with their doctors about medication options, he said.
Generic acamprosate costs $40 to $90 for a one-month supply. Naltrexone runs closer to $100 per month.
"People should realize that there are alternative treatments that are useful for them while they continue in their normal work and family, that they don't necessarily have to go into a 30-day treatment center to get treatment for alcohol," Anton told Reuters Health.
"If it doesn't work, you can always think about rehab or inpatient treatment later on."