Acamprosate to Treat Alcohol Addiction

The treatment options best suited for alcohol addiction depend on the addiction itself.

Whether you are trying to cut down, drink in moderation, or detox and go sober, there is a treatment option for you. [1] [2]

If you are worried or feel yourself becoming increasingly concerned about your own drinking habits or those of a loved one, you may want to consider intervention.

Intervention is where people encourage the addict to get help and enter treatment. Getting someone to admit they have an alcohol dependency or alcohol abuse problem will always be a challenge, but intervention is there to help.

The Different Types of Intervention

It is often easier for everyone except the addict to notice and acknowledge addiction. However, gone are the days of confrontation, and we now practice different types of intervention.

Before actually staging an intervention, you ought to educate yourself on how to plan and carry it out. This cannot be arranged in a day and takes careful planning.

The closest people to the addict are the most likely to know what they will be motivated by. There is no guarantee that the intervention will work, and it is not only successful if they enter treatment.

Even getting people to talk about treatment or acknowledge addiction should be regarded as a success.

There are different types of intervention, based on what you have tried and what motivates the person themselves: [3]

1. Simple Intervention: sometimes it only takes a quick chat for people to start their recovery journey. Often a one-to-one is enough to bring about a positive change rather than surrounding them with a group of people. This can be carried out either on your own or with a medical professional.
2. Classical Intervention: also called the ‘Johnson Model of Intervention’, a classical intervention is a planned task. Everyone except the addict is present at the meeting, providing counselling and addiction education for all involved. During the intervention, members involved should discuss how the addictive behaviour has affected them, and how it made them feel.
3. Family System Intervention: Family system frameworks abide by the family framework hypothesis. This type of intervention focuses on family bonds, connections, and strains on relationships. All relatives of the addict are asked to take part in guidance and training. A prime example of family intervention is the CRAFT approach, short for ‘community reinforcement and family training approach’. During CRAFT, families are asked to positively reward pro-social and anti-using behaviour. In doing so, they are told to let the negative consequences of drinking alcohol play out, such as missing important events or forgetting responsibilities. [4]
4. Crisis Intervention: at certain times such as depressive episodes, addicts need immediate help, classed as an impromptu intervention. This usually occurs when the addict has become a danger to themselves or others.

Sometimes all that is needed is a brief intervention. A brief intervention may only last about 10 minutes; you will most likely discuss patterns of drinking, how to reduce the amount you drink, and the emotional impact your drinking has had on you and your loved ones.

If intervention is not possible, then you will have to start with the basics. Keeping a drinking or substance use diary records when and how much you consume daily.

This might also highlight why you are drinking, or what triggers your heavy drinking episodes, like certain people or places.

Treatment for moderation or abstinence is usually available for those who drink over 14 units of alcohol per week, experience health challenges linked to this level of consumption, and are unable to function without it.

However, going sober and cutting yourself off from alcohol completely has maximum health benefits, but sometimes this is not a realistic goal for those who are severely addicted. Matching treatment with the nature of someone’s addiction will provide the best chance of success.

If the intervention has been successful, then you will need to cover the topic of alcohol detoxification if their addiction has become physical, not just mental.

First Steps: Detoxing

Do I Require a Detox?

If you have become physically addicted to a substance, you are required to finish a detox before you enter treatment or as a part of treatment.

There are different signs of alcoholism depending on the person, but the most common signs of alcoholism or alcohol use disorder are:

• Alcohol cravings followed by heavy drinking
• Unsociable drinking, such as drinking alone or in the mornings
• Lying about intake, drug use, or theft
• Lack of interest in activities you loved before
• Built up alcohol tolerance
• Lethargic and always tired
• Headaches and constant sweating
• Change in appetite and weight
• Trouble sleeping
• Withdrawal symptoms

If you are exhibiting some or all of these behaviours, you may be struggling with an alcohol dependency or alcohol addiction.

It may prove helpful to fill out some self-help questionnaires to give yourself a better idea. The CAGE questionnaire is commonly used as an alcohol screening tool: [5]

CAGE Questions:

1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticising your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

This questionnaire has also been adapted to apply to substance abuse.

CAGE Questions Adapted to Include Drug Use (CAGE-AID):

1. Have you ever felt you ought to cut down on your drinking or drug use?
2. Have people annoyed you by criticizing your drinking or drug use?
3. Have you felt bad or guilty about your drinking or drug use?
4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

A ‘yes’ answer will give you a score of 1, and a ‘no’ answer will give you a score of 0. If you score 2 or more out of 4, then your behaviour is deemed ‘clinically significant’. This means you are showing signs of alcohol addiction.

People who struggle with alcohol addiction become both mentally and physically dependent on it. Alcohol changes the brain’s reward pathways, increasing tolerance and leaving you more exposed to mental health disorders and physical health challenges.

When you drink ‘heavily’, your body will become accustomed to the new levels of euphoria, and it will require more alcohol more often to achieve the desired effects it once had.

Most people feel quite apprehensive or nervous about cutting down or stopping drinking, this is mostly attributed to wanting to avoid withdrawal symptoms.

Alcohol detox is the first phase of the road to recovery. During alcohol detox, all the alcohol is completely flushed out of your system.

A detox can last up to around 2 weeks and usually starts 6 hours after your last drink. The true time the detox takes and whether it is successful depends on the severity and nature of your addiction.

Detox is best when accompanied by therapy, counselling, and support options.

Sometimes when the addiction is mild and not severe, you may attempt detox at home with the support of our medical professionals. This usually doesn’t require medication, as the withdrawal symptoms should not be life-threatening.

However, if your alcohol consumption is high and your addiction is severe, it is advised that you do not carry out a home detox. This is usually more than 20 units a week and will require medication to help with the withdrawal symptoms.

Withdrawal Symptoms of Alcohol Abuse

Alcohol detox leaves you with mild to extreme withdrawal symptoms. The signs and symptoms of withdrawal vary according to the severity of the addiction, and the substance being abused.

Your withdrawal symptoms will depend on how addicted you are to alcohol, concerning how much and how often you drank before. [6]

Symptoms can be physical, or they can manifest mentally as a result of the damaged pathways in the brain, leaving it hyperactive.

Withdrawal symptoms are the worst in the first 48 hours but will improve as your mind and body adjust to the lack of alcohol.

Mild/common withdrawal symptoms:

• Sickness, nausea and vomiting
• Headaches and high temperature
• Excessive sweats or chills
• Vivid dreams or insomnia
• Anxiety
• Depression

The most severe symptoms of withdrawals:

• Severe mental illness
• Disorientation and confusion
• Hallucinations
• Delirium tremens
• Seizures and tremors
• High blood pressure
• Abnormal heartbeat
• Rapid heart rate
• Fever

The American Society of Addiction Medicine put forward 3 main goals of the detoxification process for alcohol addiction: [7]

1. To provide a safe withdrawal from the drug(s) of dependence and enable the patient to become drug-free.
2. To provide a withdrawal that is humane and thus protects the patient’s dignity.
3. To prepare the patient for ongoing treatment of his or her dependence on alcohol or other drugs.

Everyone will have their own unique withdrawal symptoms depending on their addiction. What they suffer from the most can also be affected by family history, genetics, and environmental influence. Not only can these vary, but these symptoms may also be life-threatening. [8]

That’s why it is advised that people detox at an inpatient or outpatient clinic or allow supervision for home detox.

It is important that during your detox you drink at least 3 litres of water every day. You should avoid caffeinated drinks such as tea, coffee, and energy drinks.

Caffeine can alter your levels of anxiety, which is already a severe symptom of withdrawal. Water, squash, and juice are the best choices to make. Try to eat regular meals, 2-3 times a day to keep your body full and energised.

Detox Medication

The National Institute for Health and Care Excellence (NICE) has recommended numerous medications to treat alcohol abuse. These include: [9] [10]

1. Acamprosate

Acamprosate aids in the prevention of relapse in those that have successfully detoxed from alcohol. Acamprosate works against the areas of the brain that crave alcohol.

2. Disulfiram

Similar to acamprosate, disulfiram causes unpleasant side effects and reactions if you ingest alcohol. This is meant to deter you from drinking. The reactions can range from nausea to dizziness.

3. Naltrexone

Naltrexone is used primarily to prevent relapse and/or limit the amount of alcohol consumed. This directly blocks the receptors in the brain, stopping the effects of alcohol.

4. Nalmefene

Nalmefene also stops relapse and prevents the intake of alcohol. This works by reducing alcohol cravings, which will work if you do not have physical withdrawal symptoms, you are still drinking quite a lot, but it is not medically necessary for you to go ‘cold-turkey’.

Why Acamprosate is Prescribed

Managing detox is possible through prescription medications, therapy, and support. Once detox has begun, you are already changing your relationship with alcohol.

To prevent or reduce the impact of life-threatening withdrawal symptoms such as delirium tremens, rehab centres provide medication.

Acamprosate (a-kam-pro-sate) is prescribed to help avoid relapse. The brains of addicts have been destroyed by alcoholism, changing its reward pathways. Acamprosate works to fix this, by helping the brain return back to its functional self.

This does not prevent withdrawal symptoms from happening, nor does it reduce their impact. Acamprosate does, however, stop people from drinking and breaking the detox or relapsing. This medication is taken in tablet form around 3 times a day.

As long as you are taking acamprosate, it helps prevent you from drinking even if you think you won’t touch alcohol again. If you do consume alcohol whilst taking acamprosate, this will not harm you or cause unpleasant side effects, but you must call your doctor.

Acamprosate seems to work by promoting balance between neurotransmitters, which helps withdrawal-associated distress. This does not curb physical withdrawals but is directly intended to help the urges that people have to drink.

This has been labelled as safe with excellent tolerability. If you are prescribed acamprosate, this will be most likely when you start having withdrawal symptoms and you may be prescribed this medicine for 6 months.

Does Acamprosate Work?

Acamprosate was approved in 2004 and became readily available in rehabilitation facilities in 2005. A recent Cochrane review trialled almost 7000 patients with alcohol abuse disorder.

Through 24 randomised trials, the review looks at two outcomes:

1. Duration of abstinence
2. Return to heavy drinking

The review concluded that receiving acamprosate dramatically reduced the risk of relapsing and returning to alcohol by 86%. Acamprosate also increased abstinence by 11%. [11]

Despite being prescribed on the first day of alcohol withdrawal, it can take several days for acamprosate to be in full effect. Like any medication, this has some adverse effects, such as diarrhoea, disorientation and dizziness, and muscle weakness.

Acamprosate is absorbed directly through the digestive system rather than the liver. Alcohol has already damaged and reduced the functioning of this organ, so this improves effectiveness, reducing side effects for those that already suffer from liver damage or liver failure.

Although acamprosate has been proven to remain effective at preventing relapse, it is rarely enough on its own. Acamprosate is most effective when paired with therapy and counselling, both available at inpatient and outpatient rehabilitation.

Treatment of alcohol dependence and treatment of alcoholism aim to increase their abstinence rates in patients with alcohol dependence through:

• Managing their cravings for alcohol
• Managing alcohol consumption
• Medicating withdrawals from alcohol
• Providing medication for relapse

Acamprosate works on relapse rates and abstinence from alcohol. Maintenance of abstinence is then attributed to both medication and therapy, both provided by medical professionals.

These inpatient and outpatient treatment centres offer a range of therapies such as:

• Cognitive behavioural therapy
• Drug therapy
• Behavioural therapy
• Motivational interviewing
• Family guidance
• Pharmacological treatment

Once you pair acamprosate with one of these therapies in a rehab facility, you have started your recovery journey.

Get Help Today

Please contact our dedicated helpline at Rehab 4 Alcoholism on 0800 111 4108 for more information and advice. 

References

[1] Kessler RC, Nelson CB, McGonagle KA, Liu J, Scwartz M, Blazer DG. Co-morbidity of DSM- III- R major depressive disorder in the general population: Results from the US National Co-morbidity Survey. Br J Psychiatry. 1996;168:17–30.

[2] https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder

[3] Miller, W.R., Meyers, R.J. and Tonigan, J.S., 1999. Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. Journal of consulting and clinical psychology, 67(5), p.688.

[4] Kirby KC, Versek B, Kerwin ME, Meyers K, Benishek LA, Bresani E, Washio Y, Arria A, Meyers RJ. Developing Community Reinforcement and Family Training (CRAFT) for Parents of Treatment-Resistant Adolescents. J Child Adolesc Subst Abuse. 2015 May 4;24(3):155-165. doi: 10.1080/1067828X.2013.777379. PMID: 25883523; PMCID: PMC4394369.

[5] https://www.mdcalc.com/calc/1729/cage-questions-alcohol-use

[6] Saitz R. Introduction to alcohol withdrawal. Alcohol Health Res World. 1998;22(1):5-12. PMID: 15706727; PMCID: PMC6761824.

[7]  Miller NS, Gold MS. Management of withdrawal syndromes and relapse prevention in drug and alcohol dependence. Am Fam Physician. 1998;58:139–46.

[6]  American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000.

[7] Kasser C, Geller A, Howell E, Wartenberg A. Detoxification: principles and protocols. American Society of Addiction and Medicine. [cited 2010 Sept 7] Available from: http://www.asam.org/pub1/detoxification.htm

[8] Sachdeva A, Choudhary M, Chandra M. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. J Clin Diagn Res. 2015 Sep;9(9):VE01-VE07. doi: 10.7860/JCDR/2015/13407.6538. Epub 2015 Sep 1. PMID: 26500991; PMCID: PMC4606320.

[9] Johnson, Bankole A., and Nassima Ait-Daoud. “Medications to treat alcoholism.” Alcohol Research & Health 23, no. 2 (1999): 99.

[10] https://www.nhs.uk/conditions/alcohol-misuse/treatment/

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277871/