Hypothalamic-Pituitary-Adrenal System Regulation in Recently Detoxified Alcoholics Is Not Altered by One Week of Treatment with Acamprosate

Background: Acamprosate decreases relapse rates in alcohol-dependent patients by approximately 10-20 % within the first year after detoxification. Psychological stress is a major risk factor for relapse and is associated with activation of the hypothalamic-pituitary-adrenocortical (HPA) system. In recently detoxified alcoholics, the HPA system is dysregulated with non-suppression of cortisol after dexamethasone administration. We therefore investigated whether acamprosate normalizes HPA hyperactivity in alcoholics within the first 3 weeks of abstinence, employing a combined dexamethasone/corticotropin-releasing hormone (Dex-CRH)-test. Methods: Thirty alcohol-dependent patients were tested one week after withdrawal signs had disappeared. In 15 patients, acamprosate, 1332-1998 mg/day, was administered orally and a second Dex-CRH test was performed 1 week later. In the other 15 patients, acamprosate treatment was offered only after the second test. Results: CRH-stimulated cortisol secretion was significantly increased in both the acamprosate group and the group receiving no anti-relapse medication compared to a control group of 15 healthy subjects. Acamprosate treatment had no effect on basal or CRH-stimulated ACTH or cortisol secretion. Conclusions: We conclude that 1 week of acamprosate treatment does not attenuate the HPA dysregulation observed during early abstinence.

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