r/Alcoholism_Medication • u/RaTheOrgygod • 3d ago

Acamprosate and alcohol

Doc adviced me to still take my naltrexone through my drinking, but what about campral? I've had two stints of sobriety on this drug, amd combined with naltrexone they seemed to reduce the number of times the thought of alcohol entered my brain. Major parts of the day I can just leave it or take it, I don't obsess like I would otherwise.

Now I'm drinking again, so what's the advice? Just continue taking the drugs as prescribed and try to stop?

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u/Thin_Situation_7934 3d ago

You have experience with using both together and it worked for you if I understand correctly. Have you brought that up with your current doctor. Sounds like a winning combo for you and definitely not unheard of either. It's been done successfully. Acamprosate tends to work better in abstinence, but we are all different and what works, works.

Here's more for you:

https://pubmed.ncbi.nlm.nih.gov/23075288/

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u/RaTheOrgygod 3d ago

my current phydivian isn't really well versed in addiction treatment. nal and campral was prescribed from a different doctor after I went throigh detox. when I told my current GP I was unhappy with Antabuse, her solution was to just up the dose

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u/Thin_Situation_7934 3d ago

All 3 of these medications are very different in terms of the working mechanisms.

Antabuse simply retards metabolism of alcohol so it's toxic version stays in the person longer and makes them sick (not to mention possible long term cell damage). So not for drinking.

Naltrexone (and nalmefene) work on blocking mu-opioid receptors so drinking is not rewarded with euphoria. Creates a surprise and "disappointment" in the drinker so over time alcohol is uninteresting. This can be targeted 60 - 90 minutes before drinking. However, many people very successfully use it to curb cravings in support of abstinence. (Per the paper whose link I sent above).

Acamprosate works in mysterious ways that even researchers haven't fully understood. It basically resets the GABA/glutamate imbalance caused by drinking. By upsetting this balance, alcohol causes the person to experience spikes in anxiety as the alcohol wears off which often leads to more drinking. This med is usually used in abstinence, but again the paper shows that this is not always the case.

Here is a link to a short version of a really good document about the 4 medications approved by the FDA for AUD. There is also a long version available.

https://store.samhsa.gov/product/advisory-prescribing-pharmacotherapies-patients-alcohol-use-disorder-based-tip-49/pep20-02

If your doctor isn't experienced in treating AUD, but willing and eager to learn then educate them. Lots of doctors don't care to learn about this because they think treating AUD is "too hard". If yours is like that then you are best served by a better doctor and they do exist.

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u/bafangfang TSM 3d ago edited 3d ago

If you're drinking again, stay on the Naltrexone. Try to take it 1 to 2 hours before your first drink. It makes alcohol less interesting/satisfying and over time you will develop a "meh" attitude toward it. 

I cannot advise in the Campral, but others here have advised you.

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u/Suspicious_Kale5009 3d ago

Agree with this. I don't think acamprosate will hurt you if you take it while drinking but the studies done on it have supported abstinence maintenance as an end goal, and so it's generally prescribed to people with the advice to stop drinking right then, because it eases withdrawal.

Naltrexone is a different sort of drug and many of us continue to drink while on it, thus allowing it to reset our level of interest in alcohol. To my mind, it works more to combat the core problem, which isn't craving, but actual addiction.

I don't think the combination will hurt you at all and might be more effective than either one by itself.

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u/Sobersynthesis0722 3d ago

How does naltrexone with continued alcohol use combat the root problem better? I keep trying to find actual published clinical trials where intentional continued drinking along with oral naltrexone was more successful. Or any that even tried that.

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u/Suspicious_Kale5009 3d ago edited 3d ago

You want to read about the Sinclair method. It's essentially reconditioning your brain to stop associating the addictive high with alcohol use by blocking the opioid receptors and robbing you of the part of the drinking experience that creates addiction. You begin to associate using alcohol with meh feelings which causes it to lose its addictive pull. Over time you just stop caring about alcohol.

You can't create these new, neutral to negative associations with alcohol if you don't drink it.

There are people who say that it curbs cravings even if you don't drink but it never did that for me. I stopped craving gradually, over time, when my brain got the message that drinking wasn't doing it for me anymore. But if using it as a craving reducer in abstinence works for others, that's great for them.

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u/Sobersynthesis0722 3d ago

Read about it where? We are talking about a therapeudic intervention in a high risk population. That requires a high standard showing the outcomes using this protocol.

Books and podcasts are not peer reviewed. Telling people with AUD they need to keep drinking in order to get better when naltrexone has only resulted in moderate improvements over placebo is a rather bold claim and it matters.

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u/Suspicious_Kale5009 3d ago

If you want lots of detail, you can start with this series of online lectures by one of the prominent researchers in the field.

This was an eight-week series but the Q&A sessions were not recorded to protect the privacy of the participants.

https://www.youtube.com/watch?v=PMckDG68PSE&ab_channel=TSMMeetups

If you are scientifically inclined, it should be fairly easy to move forward from here and find papers from this researcher as well as others in the field.

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u/Sobersynthesis0722 2d ago

I know about Dr Volpicelli. He is a top research scientist and clinician in field. His academic work was groundbreaking and does not contain some of the pitfalls being communicated about the nature of addiction and the benefits and limitations of naltrexone. His clinic utilizes a full range of treatments and a complete evaluation with an approach geared toward the individual.

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u/sciencebased 3d ago

I use both. Campral works (well, worked) excellent- the problem was you're supposed to take it daily, x3 per day. I'm sorry but that's frankly a battle liter per day alcoholics WILL lose. So I went and got on the vivitrol shot as well. Sooooooooo much better than depending on yourself to take pills daily. I can still drink/get drunk, but why would I? It now immediately makes me tired/hungover feeling. No euphoria. Honestly I had forgotten what a hangover even felt like in over a decade (I was either drunk or withdrawing).

I've been on the liver transplant for two years, dozens of ER visits, pancreatitus, AA, countless detoxes, seizures, rehabs, you name it. Combining vivitrol and campral is the only thing that's truly "worked." It's not all roses ofc, but I have been given a new lease on life.

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u/Sobersynthesis0722 3d ago edited 3d ago

If you want to commit to abstinence Acamprosate does help more with craving as you pointed out. If you are going to drink anyway naltrexone is more likely to decrease the amount you drink. Studies using both at the same time did not show any additional benefit.