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Review: in alcohol use disorders, acamprosate is more effective for inducing abstinence while naltrexone is more effective for reducing heavy drinking and craving

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Question: When are oral naltrexone and acamprosate most beneficial for treating alcohol use disorders, and what methods of implementation are most effective?

Outcomes: Abstinence (including abstinence rate, percentage days abstinent and time to first drink) and heavy drinking (including heavy drinking rate, percentage days heavy drinking, time to first heavy drink and quantity). Craving (measured on the Obsessive Compulsive Drinking Scale) was considered as a secondary outcome.


Design: Systematic review and meta-analysis.

Data sources: PubMed, EBMASE and PsycInfo were searched for English language studies, published between 1970 and 2009. Reference lists of included studies and other relevant reviews were hand-searched.

Study selection and analysis: Randomised controlled trial (RCTs) investigating the use of naltrexone or acamprosate to treat alcohol misuse/alcohol substance disorder in people aged ≥18 years were included. Studies had to include ≥5 participants in each treatment arm, assess one or more drinking outcomes and provide at least part of treatment in a community setting, to be eligible for inclusion. Effect sizes were calculated for each individual abstinence and heavy drinking outcome, and an aggregate effect size for …

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  • Sources of funding US National Institute on Alcohol Abuse and Alcoholism, and the US Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service and Substance Use Disorder Quality Enhancement Research Initiative.


  • Competing interests For the past 5 years, MS has received grants or has worked as a consultant for Reckitt Benckiser, Lilly, Astra Zeneca, Roche, Essex, Lundbeck, Sanofi and Aventis.