Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?
Open accessAbstract
Aims: Although debates over the efficacy of oral naltrexone and acamprosate in treating alcohol use disorders tend to focus on their global efficacy relative to placebo or their efficacy relative to each other, the underlying reality may be more nuanced. This meta‐analysis examined when naltrexone and acamprosate are most helpful by testing: (i) the relative efficacy of each medication given its presumed mechanism of action (reducing heavy drinking versus fostering abstinence) and (ii) whether different ways of implementing each medication (required abstinence before treatment, detoxification before treatment, goal of treatment, length of treatment, dosage) moderate its effects. Methods: A systematic literature search identified 64 randomized, placebo‐controlled, E nglish‐language clinical trials completed between 1970 and 2009 focused on acamprosate or naltrexone. Results: Acamprosate had a significantly larger effect size than naltrexone on the maintenance of abstinence, and naltrexone had a larger effect size than acamprosate on the reduction of heavy drinking and craving. For naltrexone, requiring abstinence before the trial was associated with larger effect sizes for abstinence maintenance and reduced heavy drinking compared with placebo. For acamprosate, detoxification before medication administration was associated with better abstinence outcomes compared with placebo. Conclusions: In treatment for alcohol use disorders, acamprosate has been found to be slightly more efficacious in promoting abstinence and naltrexone slightly more efficacious in reducing heavy drinking and craving. Detoxification before treatment or a longer period of required abstinence before treatment is associated with larger medication effects for acamprosate and naltrexone respectively.
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Acamprosate is one of three FDA-approved medications for AUD and has an effect size similar to SSRIs for depression.
“With regard to non-alcohol-like drugs, acamprosate is one of three Food and Drug Administration-approved medications for the treatment of AUD that is widely prescribed worldwide, and it has an effect size (Mason, 2003;Maisel et al., 2013;Jonas et al., 2014) that is similar to selective serotonin reuptake inhibitors for depression (Schalkwijk et al., 2014).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Maisel et al., 2013
The Results (End-of-Treatment Outcomes; page unavailable) report effect sizes for acamprosate in treating alcohol use disorders, supporting the part of the sentence for which Maisel et al. is cited. The copy does not establish that acamprosate is one of three FDA-approved medications; the Discussion (Concluding Comments; page unavailable) says its effects are somewhat smaller than those of medications for depression, rather than establishing similarity to SSRIs. The SSRI comparison is separately cited to Schalkwijk et al. (LLM, conf=0.87)
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- Authors
- Maisel, N. C., Blodgett, J. C., Wilbourne, P. L., Humphreys, K., & Finney, J. W.
- Affiliations
- VA Palo Alto Health Care System (US)
- Corresponding author
- Maisel, Natalya C.
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2012-10-17
- Volume
- 108
- Issue
- 2
- Pages
- 275-293
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC3970823
- OpenAlex
- W1910982087
- Cited by
- 470
- References
- 115
- Citations by year
- 2026: 19 · 2025: 32 · 2024: 38 · 2023: 52 · 2022: 27 · 2021: 35 · 2020: 51 · 2019: 33 · 2018: 38 · 2017: 27 · 2016: 34 · 2015: 38 · 2014: 26 · 2013: 19
- FWCI
- 19.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (AA008689, R01AA008689)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- naltrexone, acamprosate, alcoholism, alcoholism treatment, abstinence maintenance, alcohol craving, alcohol detoxification, treatment duration, drug dosing, treatment moderators
- MeSH terms
- Acamprosate, Alcohol Deterrents, Ethanol, Humans, Inactivation, Metabolic, Naltrexone, Narcotic Antagonists, Taurine, Time Factors, Randomized Controlled Trials as Topic, Treatment Outcome, Alcohol-Related Disorders
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