Recovering from an alcohol addiction can be a challenging process, and different tools are best for different people. Traditionally, addiction recovery has largely focused on psychotherapy and group support, such as Alcoholics Anonymous. But for many individuals, medication is a crucial piece of the puzzle, helping them to control alcohol cravings, stick with sobriety, and even relearn moderation. Two of the most common medications for this purpose are acamprosate (Campral) and naltrexone.
If you’re interested in trying medication treatment, or you have a loved one who is struggling with alcohol, you may be wondering, which of these two drugs is a better match? Is one more effective than the other? How are they different, and how are they similar?
Below, we’ll look at acamprosate vs naltrexone, explain how each of these FDA-approved medications work, the pros and cons, and how to decide which is a good fit for your unique situation.
Acamprosate: How It Works for Alcohol Use Disorder (AUD)
Acamprosate, commonly known by the brand name Campral, is one commonly prescribed FDA-approved medication to treat AUD. It is frequently used to help people who are already in recovery control alcohol cravings.
Campral works by helping to repair the damage alcohol causes to people’s brain chemistry. As a depressant, alcohol disrupts the neurochemicals that regulate feelings of anxiety. The longer a person uses alcohol excessively, the worse this imbalance becomes, which is one major reason why people crave alcohol. Campral restores this chemical balance, and can therefore reduce the urge to drink for some people.
Technically, acamprosate can be taken at any stage of the recovery process. However, it is generally used to help people who are already abstaining from alcohol stay sober. It is largely ineffective against cravings if you are still drinking.
Schedule a private call with a Ria Health team member and we can help you get started.
Naltrexone: A Different Pharmaceutical Approach
Naltrexone is also FDA-approved to treat AUD, but the science behind this medication is quite different. Rather than restoring brain chemicals related to anxiety, naltrexone is used to block the endorphin rush many people get from drinking alcohol. Without this endorphin kick, alcohol often becomes less appealing, causing people to lose interest in drinking. This is known as the extinction method.
Although naltrexone was initially approved to treat opioid addiction, it has now been successfully used to treat alcohol addiction for several decades. One of the benefits of naltrexone is that it can be prescribed while a person is still drinking. The effects of this medication can make it easier for a person to taper off alcohol, and can even allow some people to relearn moderate drinking.
Another benefit of naltrexone is that it can be delivered in a variety of ways to meet patients’ individual needs and lifestyles. For example, many people get naltrexone as a monthly injection (known as Vivitrol) which eliminates the risk of forgetting to take their medicine. Others prefer to take naltrexone as a daily pill, or simply one hour before they plan on drinking.
Campral vs. Naltrexone: Pros and Cons
Both naltrexone and acamprosate have a strong track record in treating AUD—especially among people who haven’t responded to more traditional approaches. However, each medication has its pros and cons.
Campral: Best Uses, and Side Effects
Campral is generally prescribed to patients who are already on the road to recovery, and have stopped actively drinking. Because of this, it is often referred to as an abstinence maintenance medication. This means that, on the downside, it likely won’t do much to help if you’re still drinking.
One benefit of taking Campral for many people is that it is processed in the kidneys rather than the liver. Many people in recovery from AUD have sustained liver damage, so this medication is safer. However, if you have trouble with your kidneys you should probably avoid this medication.
Then, as with any drug, there are certain side effects associated with Campral. The most common one is diarrhea, although for most patients this is tolerable. The most severe side effects connected with acamprosate tend to be psychiatric in nature. In a small number of people, the drug has been linked to deep depression and suicidal ideation. If you have a history of depression, tell your doctor before trying this medication.
Naltrexone: Upsides and Downsides
Unlike Campral, naltrexone is effective for people who are still actively drinking, which can be a life-saver for those who struggle to quit completely. As noted above, this drug acts to stop the endorphin rush from drinking, which can help people unlearn drinking behaviors. The downside is, if you need to quit immediately, this may not be as useful. Naltrexone often takes time to work. Many people see their biggest reduction in cravings if they start by drinking on the medication for a period of time.
As for side effects, naltrexone can also be difficult to tolerate for up to 10 percent of people. Among the worst side effects is what is sometimes termed a “nalover.” This is a hangover-like feeling associated with taking naltrexone, including severe fatigue, headache, and nausea. Other people feel a strange sense of intoxication, or frequent gastrointestinal distress. For these individuals, naltrexone may not be a workable solution.
Unlike Campral, naltrexone is processed through the liver. Though this isn’t a major risk for everyone, for some with long-term AUD this can be unsafe. Finally, there are some people for whom addiction to alcohol is not linked to the opioid system. For these individuals, naltrexone will likely be ineffective.
Which AUD Medication Is Right For You?
Ultimately, both naltrexone and acamprosate are useful medications that can have life-changing impacts for those battling alcohol dependency. When sitting down with your doctor to make a medication decision, consider what your personal goals are, as well as your existing body chemistry and overall health. The best fit ultimately depends on the individual.
In brief, here is a quick summary of naltrexone vs acamprosate:
|Acamprosate (Campral)||Naltrexone (Vivitrol, ReVia)|
|Most effective if you have already quit alcohol||Most effective if you are still drinking|
|Used to help people remain abstinent from drinking and avoid relapse||Used to help people unlearn drinking behaviors, leading to either abstinence or moderation|
|Processed through the kidneys, safer if you have liver disease||Processed through the liver, riskier if you have liver disease|
|Worst side effects include diarrhea, and for a small number of people, severe depression||Worst side effects include hangover-like symptoms, a sense of intoxication, and gastrointestinal issues|
If you are unsure which is the best choice for you, or aren’t certain whether medication will be useful, schedule a no-obligation call with a member of our team for more information. At Ria Health, we prescribe both acamprosate and naltrexone, as well as several other AUD medications, based on each person’s unique needs and history. We also provide coaching support to help you stick with medication treatment—all from an app on your phone.