title: Do acamprosate or naltrexone have an effect on daily drinking by reducing craving for alcohol?
abstract: OBJECTIVE
  To explore the effect of acamprosate and naltrexone on craving and alcohol consumption in the treatment of alcohol dependence.
  
  
  METHODS
  A randomized, double-blind, single-dummy, placebo-controlled trial.
  
  
  METHODS
  Three treatment centres in Sydney, Australia.
  
  
  METHODS
  A total of 169 alcohol-dependent subjects were given naltrexone (50 mg/day), acamprosate (1998 mg/day) or placebo for 12 weeks, in conjunction with manualized medication compliance therapy.
  
  
  METHODS
  During the course of the trial, participants kept a daily diary which included the number of standard drinks they consumed and their peak craving for alcohol that day rated on a 0-10 scale.
  
  
  METHODS
  Subjective ratings of daily craving and daily drinking for the first 6 weeks of treatment.
  
  
  RESULTS
  Mixed/hierarchical linear models were employed on an intention-to-treat basis. Analyses revealed that craving was a significant predictor of daily drinking and baseline levels of depression were the best predictor of daily craving. There was no significant improvement in model fit when treatment group was added both in models of daily craving and daily drinking. Daily alcohol consumption was best predicted by a model incorporating baseline dependence and depression scores, and daily craving, entered as a time-varying covariate. However, there was a significant craving x time x treatment interaction (t = -3.365, df = 4413.712, P < 0.001), suggesting that at higher levels of craving drinking was reduced at a significantly greater rate with naltrexone compared to acamprosate.
  
  
  CONCLUSIONS
  Naltrexone had a greater effect on drinking when craving was high. These results support the role of naltrexone in reducing craving when that craving is highly salient. The role of acamprosate in reducing craving was not supported by these findings.
authors.affiliation: Central Clinical School of Medicine, University of Sydney, NSW, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Richardson
authors.forename: Andrew
authors.initials: A
authors.lastname: Baillie
authors.forename: Sophie
authors.initials: S
authors.lastname: Reid
authors.forename: Kirsten
authors.initials: K
authors.lastname: Morley
authors.forename: Maree
authors.initials: M
authors.lastname: Teesson
authors.forename: Claudia
authors.initials: C
authors.lastname: Sannibale
authors.forename: Martin
authors.initials: M
authors.lastname: Weltman
authors.forename: Paul
authors.initials: P
authors.lastname: Haber
mesh_terms: D000077443:Acamprosate; D000328:Adult; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000188:drug therapy* / Q000523:psychology; D016739:Behavior, Addictive / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D010349:Patient Compliance; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate