Acamprosate is the most recent of three FDA approved medications for treating alcohol use disorder. Also known by the brand name Campral, it is often used to help people maintain abstinence once they’ve stopped drinking.
Acamprosate is best for:
- Establishing abstinence
- Controlling drinking urges and cravings
- Preventing relapse
- Long-term maintenance
Is it right for you? Skip to pros and cons
How Does Acamprosate Work?
Rather than blocking the pleasurable effects of alcohol, as naltrexone does, acamprosate appears to work by restoring a chemical imbalance in your brain caused by chronic drinking. This can make it easier for you to avoid alcohol, and eliminates a lot of common drinking triggers.
Here’s how the science works (in brief):
When you drink alcohol, it mimics certain neurotransmitters1 that control the activity of your nervous system. This can have a calming effect, which is part of why alcohol is often referred to as a central nervous system depressant.
There is a flipside to this, however: When you drink frequently and heavily, your body begins to compensate for always having a depressed nervous system. This means that, ironically, the more you drink, the more hyperactive your nervous system becomes.
This can result in symptoms like increased anxiety, depression, and insomnia. It can also cause your body to crave alcohol, as it seeks to rebalance itself.
When you take acamprosate, it appears to stimulate the receptors that reign your nervous system in (known as GABA receptors), and block the ones that ramp it up, evening things out.
While this doesn’t appear to help with acute withdrawal symptoms, or detox, it seems to make a big difference with what happens afterwards. As you strive to establish a new normal, it is common to fight with urges and cravings that might cause you to relapse. For many, acamprosate eliminates those urges and cravings, rebalancing their brain chemistry to move beyond alcohol dependence.
Medication for Abstinence
Acamprosate appears to work best in a specific situation: people who have quit drinking, are already past detox, and wish to remain abstinent from alcohol.
While the medication doesn’t appear to cause problems when mixed with alcohol, it doesn’t seem to have much effect if you continue to drink2, or if you are still in acute withdrawal. For this reason, acamprosate is considered an abstinence maintenance medication. People who wish to pursue moderation or cut back gradually may want to consider naltrexone instead.
If abstinence is your preferred path, however, acamprosate has some unique strengths. It has been shown to be more effective than naltrexone at maintaining total abstinence in some studies3. It is also processed through the kidneys, not the liver, so it can be safer for people with a long history of alcohol abuse. This is especially true for those with conditions such as cirrhosis and hepatitis. And because acamprosate (like naltrexone) is non-habit forming, and has no demonstrated withdrawal effects, you can start or stop taking it easily. It is safe to take this medication indefinitely, and you can begin using it immediately upon finishing detox, without having to gradually ramp up.
Side Effects of Acamprosate
- Upset Stomach
- Tingling Sensation
Of these, diarrhea is the most common—the others are fairly rare. Allergic reaction is possible, but also rare. Because acamprosate is processed through the kidneys, people with kidney disease may want to avoid it. Pregnant or nursing mothers should check with their doctor first. The medication may contain trace amounts of sulfites, which should be avoided if you have a hypersensitivity. Finally, if you are taking any other drugs, or struggling with other addictions at the same time, acamprosate may not work.
Depression and Acamprosate
One important issue to look out for with acamprosate is how it affects your mood. Because it works by rebalancing neurochemicals, this medication can relieve broader issues with anxiety and depression in some people. However, not everyone reacts the same way, and some acamprosate users report a sense of emotional numbness, or reduced concentration.
On the more extreme end of the spectrum, the medication can cause deep depression and even suicidal thoughts5 for some people. If a person has a history of suicide attempts or depression, it is important to have others monitor their mood while they are taking acamprosate. If you struggle emotionally on this medication, there are other options that may be less risky.
Acamprosate Combined With Therapy
Acamprosate is best taken in combination with behavioral therapy or other support. Like most medications for alcoholism, acamprosate can only help with the body’s physical and chemical reactions to alcohol. For people who drink to deal with difficult emotions, or underlying psychological distress, the addition of therapy or coaching can be crucial. Acamprosate is therefore best as a support medication—it cannot solve the issue of alcohol dependency on its own.
Is Acamprosate For You?
Acamprosate May Help If:
- You want to quit alcohol completely
- You have already completed detox
- You want to maintain long term abstinence
Acamprosate May Not Be Best If:
- You want to continue to drink on occasion
- You have kidney disease
- You have a history of depression or suicidal thoughts
Acamprosate can be a great choice for a person who has already stopped drinking alcohol and wishes to keep it that way. The medication has shown stronger results than naltrexone for maintaining abstinence, and can be taken indefinitely without chemical dependency or adverse effects. On the other hand, it has little effect if a person is still drinking, doesn’t seem to help with detox, and can have a negative effect on some people’s mood.
Because it is easy to keep drinking on this medication with little consequence, acamprosate is best for people who are already determined to quit alcohol, and want help avoiding urges and cravings. If you’ve recently completed a rehabilitation program, or have used naltrexone for a while and have decided on abstinence, acamprosate can be a great way to maintain long-term sobriety.
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