Relapse prevention for alcohol use disorders: combined acamprosate and cue exposure therapy as aftercare.

Abstract

AIMS\nMany patients with alcohol use disorders are challenged by cravings leading to repeated relapses. Both cue exposure therapy (CET) and acamprosate target alcohol cravings and are often combined (CET\u2009+\u2009acamprosate). The main aim of this study was to investigate whether aftercare treatment consisting of CET combined with acamprosate is equivalent to (A) CET as monotherapy, (B) aftercare as usual (AAU) as monotherapy or (C) AAU combined with acamprosate.\n\n\nMETHODS\nPatients were randomized to receive either CET with urge-specific coping skills (USCS) as aftercare or AAU. Acamprosate prescription data were extracted from patient case records. Alcohol consumption, cravings, and USCS were assessed at pre-aftercare, post-aftercare, and 6-month follow-up.\n\n\nRESULTS\nOverall, patients increased their alcohol consumption during and following aftercare treatment, thereby relapsing despite any treatment. However, CET\u2009+\u2009acamprosate achieved greater abstinence compared to AAU\u2009+\u2009acamprosate at follow-up (p=.047). CET\u2009+\u2009acamprosate also reduced number of drinking days (p=.020) and number of days with excessive drinking (p=.020) at post-aftercare, when compared to AAU monotherapy. CET monotherapy increased sensible drinking at post-aftercare compared to AAU monotherapy (p=.045) and AAU\u2009+\u2009acamprosate (p=.047). Only CET monotherapy showed improvement in cravings, when compared to AAU at follow-up (mean urge level: p=.032; peak urge level: p=.014).\n\n\nCONCLUSION\nThe study showed that CET both as monotherapy and combined with acamprosate was superior to AAU monotherapy and AAU\u2009+\u2009acamprosate in reducing alcohol consumption. Only CET\u2009+\u2009acamprosate was capable of reducing alcohol consumption in the longer term, indicating that anti-craving medication may not impede CET from exerting an effect on alcohol consumption. Trial registration: ClinicalTrials.gov ID: NCT02298751 (24/11-2014).