A comparative study evaluating the efficacy of naltrexone versus acamprosate as anticraving agents in alcohol use disorder

Background: Alcohol use disorders (AUDs) are characterized by excessive alcohol consumption, negatively impacting health, social life, and economic status. Globally, AUD contributes to significant disease burden, causing millions deaths annually. Despite the availability of treatments, relapse rates remain high. Naltrexone and acamprosate, two FDA-approved anticraving agents, are widely used to prevent relapse. However, comparative studies in Indian populations are limited, prompting this study to assess the efficacy of these drugs in treating AUD. Aim: This study aimed to compare the effectiveness of naltrexone and acamprosate as anticraving agents in treating AUD, evaluating the time to first drink (lapse) and time to relapse among patients using either medication at 1 and 3 months. It also assessed the correlation between baseline severity of AUD and the efficacy of naltrexone and acamprosate as anticraving agents, as well as compared demographic and clinical variables between the two treatment groups. Materials and Methods: A prospective observational study was conducted on 70 patients diagnosed with AUD, divided into two groups: naltrexone (n = 35) and acamprosate (n = 35). Patients were assessed using the Obsessive Compulsive Drinking Scale (OCDS) and followed for 3 months to evaluate craving intensity, time to first drink, and relapse rates. The Quality of Life Scale (QOLS) and Clinical Global Impression (CGI) were used to assess treatment impact. Results: Both groups were comparable at baseline. At 3 months, naltrexone patients had higher abstinence rates (63.64%) compared with acamprosate (34.68%, P = 0.018). Naltrexone also significantly extended the time to first drink and relapse compared to acamprosate. Conclusion: Naltrexone demonstrated superior efficacy in maintaining abstinence and reducing relapse rates in AUD patients compared to acamprosate. These findings suggest that naltrexone may be more effective for long-term treatment in the Indian context.