The effect of naltrexone and acamprosate on cue-induced craving, autonomic nervous system and neuroendocrine reactions to alcohol-related cues in alcoholics.
BACKGROUND
Acamprosate and naltrexone have been shown to be effective in relapse prevention of alcoholism. It is hypothesized that naltrexone exerts its effects primarily on cue-induced craving and neuroendocrine cue reactivity, whereas acamprosate exerts its effect primarily on autonomic nervous system reactions to alcohol-related cues.


METHODS
In a randomized double-blind experiment, 131 abstinent alcoholics received either acamprosate (n=56), naltrexone (n=52) or placebo (n=23) for three weeks and participated in two cue-exposure sessions: the first the day before and the second at the last day of medication.


RESULTS
Consistent with the hypotheses, naltrexone reduced craving more than acamprosate, and acamprosate reduced heart rate more than naltrexone. No medication effect was found on cue-induced cortisol.


CONCLUSIONS
The findings provide some evidence for differential effects of naltrexone and acamprosate: naltrexone may exert its effect, at least partly, by the reduction of cue-induced craving, whereas acamprosate may exert its effect, at least partly, by the reduction of autonomic nervous system reactions to alcohol-related cues.
Ooteman
Wendy
W
Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands. w.ooteman@amc.uva.nl
Koeter
Maarten W J
MW
Verheul
Roel
R
Schippers
Gerard M
GM
van den Brink
Wim
W
D000077443:Acamprosate; D000339:Affect; D000427:Alcohol Deterrents / Q000494:pharmacology*; D000437:Alcoholism / Q000523:psychology*; D001341:Autonomic Nervous System / Q000502:physiology*; D003463:Cues; D004311:Double-Blind Method; D005712:Galvanic Skin Response / Q000187:drug effects; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D009271:Naltrexone / Q000494:pharmacology*; D009292:Narcotic Antagonists / Q000494:pharmacology*; D009490:Neurosecretory Systems / Q000502:physiology*; D010349:Patient Compliance; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D013654:Taurine / Q000031:analogs & derivatives* / Q000494:pharmacology
D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate; D006854:Hydrocortisone