Addiction. 2006 Oct;101(10):1451-62.
Morley KC, Teesson M, Reid SC, Sannibale C, Thomson C, Phung N, Weltman
M, Bell JR, Richardson K, Haber PS.
Central Clinical School of Medicine, University of Sydney, NSW, Australia.
Naltrexone versus acamprosate in the treatment of alcohol dependence:
A multi-centre, randomized, double-blind, placebo-controlled trial.
AIM: To compare the efficacy of acamprosate and naltrexone in the treatment
of alcohol dependence. DESIGN: A double-blind, placebo-controlled trial.
SETTING: Three treatment centres in Australia. PARTICIPANTS: A total of
169 alcohol dependent subjects were given naltrexone (50 mg/day), acamprosate
(1998 mg/day) or placebo for 12 weeks. INTERVENTION: All subjects were
offered manualized compliance therapy, a brief intervention that targets
problems that may affect treatment compliance such as ambivalence and
misperceptions about medication. MEASUREMENTS: Time to the first drink,
time to first relapse, drinks per drinking day and cumulative abstinence.
FINDINGS: In intention-to-treat analyses, there were no differences between
groups on outcome measures of drinking, craving or biochemical markers.
Similarly, analyses of the 94 subjects that completed the study in full
and demonstrated 80% compliance, revealed no significant treatment effects.
Differential treatment effects were identified after stratification according
to scores on the Alcohol Dependence Scale (ADS) and Depression Anxiety
and Stress Scale (DASS). A significant beneficial treatment effect on
time to first relapse was revealed for subjects with 'no depression' allocated
to naltrexone (n = 56; P < 0.01). In addition, a significant beneficial
treatment effect was revealed in subjects with 'low dependence' allocated
to naltrexone (n = 34; P < 0.05). CONCLUSIONS: The results of this
study support the efficacy of naltrexone in the relapse prevention of
alcoholism amongst those with low levels of clinical depression and alcohol
dependence severity. No effect of acamprosate was found in our sample.
