The effects of acamprosate on alcohol-cue reactivity and alcohol priming in dependent patients: a randomized controlled trial.

Author(s): Hammarberg A, Jayaram-Lindstrom N, Beck O, Franck J, Reid MS

Affiliation(s): Department of Clinical Neuroscience, Division of Psychiatry, Karolinska University Hospital, M4: 02SE-17176, Stockholm, Sweden. anders.hammarberg@ki.se

Publication date & source: 2009-07, Psychopharmacology (Berl)., 205(1):53-62. Epub 2009 Mar 25.

Publication type: Clinical Trial; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

RATIONALE: Acamprosate is a widely utilized, efficacious treatment for relapse prevention in alcohol-dependent patients; yet, little is known regarding its therapeutic mechanism of action. OBJECTIVES: The aim of the present study was to examine the effect of acamprosate on cue reactivity and alcohol priming in alcohol-dependent patients. METHODS: In a double-blind design, 56 treatment seeking patients were randomized to 21 days of either acamprosate or placebo treatment and then participated in a series of cue- and alcohol-priming sessions. Alcohol cues consisted of a mixture of alcohol related visual, tactile, olfactory, and auditory stimuli. Non-alcohol-related cues were contextually similar but had no connection to alcohol. In the alcohol-priming procedure, patients were provided with an alcohol drink of their own choice at a dose corresponding to 0.20 gr. EtOH/kg bodyweight. Subjective, physiological, and biological measurements were recorded before and after each test session. Following study completion, all patients were referred to formal treatment. RESULTS: The results showed that acamprosate attenuated the subjective craving induced by alcohol priming in comparison to placebo-treated patients. Furthermore, acamprosate reduced alcohol-induced elevation in blood-cortisol levels. Lastly, there was a negative correlation between acamprosate plasma levels and alcohol craving following a priming drink. No effects of acamprosate on cue reactivity, or on the acute rewarding and sedating effects of the priming drink, were observed. CONCLUSION: These results suggest a potential mechanism by which acamprosate mediates its therapeutic effect in the treatment of alcoholism, by attenuating the urge to drink following an alcohol slip.