Read This Before Emailing Me Regarding Acamprosate
by Alexander DeLuca, 8/21/2004.
Harm Reduction and Individually Focused Alcohol Prevention
Neighbors et al.; IJDP; 17(4); 2006
brief overview of harm reduction and individually focused alcohol
prevention strategies. Universal, selective, and indicated prevention
strategies are described...
Zero-tolerance approaches continue to be the norm in... the US, despite
research suggesting that harm reduction approaches can be effective. [E]xisting
evidence supports that harm reduction shows considerable promise in
universal prevention and have become best practices..."
The MM Programme in 2004: What Type of Drinker Seeks Controlled Drinking?
Kosok, MM Program Director; IJDP;
Overview of HR Treatments for Alcohol Problems -
Witkiewitza, and Marlatt;
IJDP; 17(4); 285-294; 2006
Are Alcoholism Treatments Effective? The Project Match Data
- Cutler and Fishbain; 2005
Kern, Rotgers, and DeLuca; 109th
A Combined Behavioral Intervention for Treating Alcohol Dependence
[for the COMBINE Study]
from: Miller (Ed): Combined Behavioral Intervention Therapist Manual (COMBINE); 2005.
is a modular, manual-guided, semi-structured therapy integrating
evidence based behavioral methods developed as the state of the art
psychotherapy to be tested in the COMBINE Study. Structured around
Motivational Interviewing, CBI includes assessment, feedback, and highly
individualized treatment plan development that is flexible regarding
This Poster Presentation is a sneak preview of the CBI Therapist
Manual (in press). CBI is probably the most thoughtfully
designed, research based substance abuse therapy ever created. Clinicians, especially, will want to study this.
Group Motivational Treatment for Chemical Dependency
DeLuca, Magura, Warner, Grand, Rosenblum and Stahl; J. Substance Abuse
Treatment; 17(3); 1999
Naltrexone for the Treatment of Alcoholism - a Meta Analysis of Randomized,
Controlled Trials -
Long-Acting Injectable Naltrexone [Vivitrol] for Alcohol Dependence
A Randomized Controlled Trial
Garbutt et al; JAMA; 293; 2005-04-06
Design and Analysis of Trials of Combination Therapies
[in the COMBINE Study]
Hoskings et. al;
J Stud. Alcohol; 2005
Pharmacotherapies for the
Study - Process and Procedures
Swift and Pettinati;
J Stud. Alcohol; 2005
When Worlds Collide:
[The COMBINE Study] Blending
Pharmacotherapy and Psychotherapy Research
W.R. Miller, et al.; J Stud. Alcohol; 2005
COMBINE trial is designed to study the efficacy (alone and combined) of
naltrexone and acamprosate with 'medical management' and a
psychotherapy treatment known as the Combined Behavioral Intervention.
The Study is in progress. I will post more interim articles soon.
Disulfiram collection ;
Abstinence and Harm Reduction for Alcohol - Academic Literature archives
Comparing and Combining Naltrexone and Acamprosate - A Double-blind,
Kiefer, et. al.; Archives of General Psychiatry; 60(1); 2003
Efficacy and Safety of Naltrexone and Acamprosate in the Treatment Of
Alcohol Dependence: A Systematic Review
et al.; Addiction; 99(7):811-828; 2004
1-Year Pragmatic Trial of Naltrexone vs. Disulfiram in the Tx of Alcohol
- deSouza and deSouza; Alcohol and Alcoholism;
Harm Reduction: Meeting Clients Where They Are -
Kate Jackson, Social Work Today, 4(6), 2004.
Naltrexone Cause Permanent Liver Disease? (No) - Can Naltrexone be Used
in the Presence of Liver Disease (Carefully)
[References with Abstract from Medline Search for 'naltrexone' and
Alex DeLuca, M.D.; 2001-06-16; Updated: 2005-12-30
"A review of the literature indicates that even
when given at much higher doses than are needed for treating heroin or alcohol
abusers, there is no evidence that naltrexone causes clinically significant liver
disease or exacerbates, even at high doses, serious pre-existing liver disease."
[Brewer et al.; Addiction .Biology; 2004]
Can Campral Cure Alcohol Abuse? -
Anderson; Journal of Addictive Disorders; 2004
serious concern is the challenge of getting the new treatments to the
addicts. Our health and social policies coupled with financial
priorities seem to work to keep addicts from receiving treatment.
Blaming the alcoholic is still a prevalent attitude."
accessible to the non-scientist reader than most of the articles on this
site about acamprosate, this article reviews the history of the
development of Campral and covers most of the major studies along the
way, and discusses some problems with treatment.
A pretty good review.
Appears Safe, Well-Tolerated in Long-Term Treatment
Doctor’s Guide; 4/15/2005
Yes, but is there
any there, there?
Predictors of Acamprosate Efficacy:
Results from a Pooled Analysis of Seven European Trials
by R. Verheul et al; Psychopharmacology (Berlin); 2005.
"Acamprosate efficacy was not differentially associated with any of the
predictor variables. Importantly, the hypotheses were rejected despite
the large sample size and sufficient statistical power."
Another underwhelming acamprosate study. Hypotheses Re: who might
benefit most based on presumed pharmacological mechanism failed. All one
can say is acamprosate may help some, but there is currently no way to
|United Kingdom Multicentre Acamprosate Study (UKMAS): A
6-Month Prospective Study Of Acamprosate Versus Placebo In Preventing
Relapse After Withdrawal From Alcohol
Chick et. al.;
Alcohol and Alcoholism
35(2); 176-187; 2000.
"In comparison with
other published trials of acamprosate, patients started study
medication after a longer time following detoxification, had
more often recommenced drinking before medication was started
and had a higher drop-out rate, and this might have contributed
to the lack of a treatment effect
in this study. [emphasis mine
Versus Acamprosate - One Year Follow Up of Alcohol Dependence Treatment
(PDF) by Rubio et. al.; Alcohol & Alcoholism;
"At the end of one
year, 41% receiving naltrexone and 17% receiving acamprosate had not
relapsed. The cumulative number of days of abstinence was significantly
greater, and the number of drinks consumed at one time and the severity
of craving were significantly less in the naltrexone group... as was the
percentage of drinking days."
and Combining Naltrexone and Acamprosate in Relapse Prevention of
Alcoholism by Kiefer et. al.; Arch Gen
Psychiatry; 60(1); 2003.
combined medication was most effective with significantly
lower relapse rates than placebo and acamprosate but not
acamprosate, especially in combination, considerably enhance
the potential of relapse prevention."
of the combination of naltrexone and acamprosate on alcohol intake in
mice by Kim et. al; Psychiatry
Clin. Neurosci.; 58(1); 2004.
results demonstrate that naltrexone, at the higher dose... significantly
reduced alcohol consumption. When combined with naltrexone, acamprosate
reduced alcohol consumption across both doses of naltrexone."
Comparison of Two Intensities of Psychosocial Intervention for Alcohol
Dependent Patients Treated with Acamprosate by
Hammarberg et. al.; Alcohol & Alcoholism; 39(3); 2004.
more intensive individual treatments appears to add no extra improvement
beyond that obtained by prescribing acamprosate and offering an
infrequent consultation with a physician"
& Safety of Naltrexone and Acamprosate in the Treatment of Alcohol
Dependence - A Systematic Review
by Carmen et. al.; Addiction; 99(7); 811 - 828; 2004.
"Acamprosate appears to be especially
useful in a therapeutic approach targeted at achieving abstinence,
whereas naltrexone seems more indicated in programmes geared to
controlled consumption. Both drugs are safe and acceptably
Effects During Acamprosate Treatment by Brasser
et. al.; Alcoholism: Clin. Exp. Res.; 28(7); 2004.
"RESULTS: Acamprosate alone did not substantially
affect subjective, physiological, or psychomotor performance measures.
Acamprosate did not alter alcohol pharmacokinetics, or alcohol-induced
behavioral impairment or tachycardia, and most subjective alcohol
effects were also unaltered by acamprosate as well."
Press Release Announcing FDA Approval of acamprosate calcium
(Campral) in PDF format -- from
mechanism of action of Campral in maintenance of alcohol abstinence is
not completely understood. Chronic alcohol exposure is hypothesized to
alter the normal balance between neuronal excitation and inhibition.
Campral interacts with neurotransmitter systems and is hypothesized to
restore the normal balance. This mechanism of action is different from
that ascribed to currently available medications, which either block the
'high' associated with alcohol or induce vomiting if alcohol is
Comment: Ahh, OK; 'restores normal balance,' but not well
understood. Is anybody else feeling decidedly underwhelmed?
(Campral) Prescribing Information in
from Forest Laboratories,
fourth study, the efficacy of CAMPRAL was evaluated in alcoholics,
including patients with... polysubstance abuse and patients who had not
undergone detoxification and who were not required to be abstinent at
baseline. This study failed to demonstrate superiority of CAMPRAL over
Acamprosate Enhances N-Methyl-D-Apartate Receptor-Mediated
Neurotransmission But Inhibits Presynaptic GABA Receptors in Nucleus
Accumbens Neurons [Abstract] -- by
Fulvia Berton, et. al.; Alcoholism: Clinical & Experimental Research; 22
(calcium acetylhomotaurine) is used therapeutically in Europe to reduce
relapse in weaned alcoholics. However, the mechanisms of acamprosate
action in the central nervous system are still obscure, although early
studies suggested an action on GABA receptors."
Acamprosate (Campral) Summary
by Mary Elchisak, 2001.
Month after month this document is one of the most
viewed on this website; which completely baffles me <g>.
Now reformatted for easier reading and HTML Print
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- by James
Moderation Management; 2004 --
"Taking Antabuse is a
proactive way of achieving abstinence for whatever timeframe... seems
appropriate... It removed the alcohol factor from my emotional life. The
results were useful and unexpected. "
Motives of Problem Drinkers Seeking Help from Moderation Management
survey data on the characteristics and help-seeking motives of 467
Pragmatic Trial of Naltrexone vs. Disulfiram in the Treatment of Alcohol
Dependence by deSouza & deSouza; Alcohol &
Alcoholism; 39(6); pages 528-531;
2004 -- "[T]he
number of patients that remained abstinent with Disulfiram were twice
that with Naltrexone. The survival time till the first relapse was
greater with Disulfiram [and the] number who were abstaining at the end
of one year was [much greater]. Naltrexone patients had significantly
lower [craving] scores..."
Disulfiram Have a Role in Alcoholism Treatment Today? by Fuller & Gordis; Addiction 99(1); 21-24; 2004.
Excellent, recent review of the issues surrounding disulfiram
(Antabuse) therapy making the point that supervised administration is
both safe and effective.
Commentaries about the above article from other expert clinicians and
regarding safety and psychological aspects of disulfiram therapy:
Addiction; 99(1); 2004.
Randomized Controlled Trial of Family-Supervised Disulfiram vs.
Family-Supervised Naltrexone* (Abstract)
by deSouza & deSouza; Alcohol & Alcoholism (in press)
"[T]he number of
patients that remained abstinent with Disulfiram were twice that with
Naltrexone. The survival time till the first relapse was greater with
Disulfiram... The number who were abstaining at the end of one year was
86% with Disulfiram compared to 56% with Naltrexone. However, the
Naltrexone patients had significantly lower [craving] scores..."
Disulfiram for alcohol abuse:
Why is such an effective drug so
under-prescribed? by Colin Brewer,
Primary Care in the New NHS ;
"[Looking at] only those studies in which disulfiram was [supervised]
as part of the treatment programme, we find that out of 13 controlled
and 5 uncontrolled studies, all but one are positive, and often very
Medications that can help us avoid relapse
in early recovery. Alex DeLuca; 1996.
A patient hand-out regarding the use of Antabuse (disulfiram) and
naltrexone (ReVia) as pharmacologic aids in early recovery from
alcohol, cocaine, or opiate dependence. I just can't say this stuff
Medications that might help problem drinkers achieve moderation goals
Alex DeLuca; 2001.
A patient hand-out regarding the use of naltrexone (ReVia) as an aid
to early recovery for people with a goal of moderation rather than
|Antabuse Plus Buprenorphine May Help Treat Those Addicted To
Doctor's Guide to the Internet; June 14,
"[M]ore than 50
percent of individuals addicted to opiates such as heroin also are
addicted to cocaine. A study in the Spring 2000 issue of Biological
Psychiatry reports that combining buprenorphine... with disulfiram
(Antabuse) was more effective than buprenorphine alone in reducing
cocaine use in persons with this dual addiction."
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