Acamprosate vs Naltrexone: What to Know

What Are Acamprosate and Naltrexone?

Acamprosate and naltrexone are both FDA-approved medications used in the treatment of alcohol dependence. They don’t cure alcohol use disorder, but they can support recovery by reducing urges to drink and helping prevent relapse.

• Acamprosate (brand name Campral) helps restore balance in the brain disrupted by chronic alcohol use. It’s commonly used after detox to support long-term abstinence.
• Naltrexone works differently. It blocks the brain’s pleasure response to alcohol, reducing the urge to drink and making alcohol less rewarding.

Both are valuable alcohol treatment medications, but choosing between them depends on individual needs, medical history, and treatment goals.

How Acamprosate Works?

Acamprosate is often chosen for people who have already stopped drinking and want to maintain sobriety. It helps manage the chemical imbalances in the brain caused by long-term alcohol use, especially during early recovery.

By stabilizing the brain’s neurotransmitters, acamprosate reduces withdrawal symptoms like restlessness, insomnia, or mood swings—making it easier to stay sober.

Many find it eases anxiety and emotional discomfort during their first months of sobriety.

Acamprosate for Alcohol Cravings

One of acamprosate’s primary roles is managing persistent cravings after someone stops drinking. Alcohol cravings can linger long after detox, increasing the risk of relapse. By targeting neurotransmitters involved in anxiety and stress, acamprosate for alcohol cravings helps reduce the mental and emotional urges that often drive someone back to drinking.

Many people report that acamprosate worked best for them when used as part of a broader plan—including therapy and peer support—to maintain sobriety.

How Naltrexone Works?

Naltrexone interferes with alcohol’s effects in the brain—especially its ability to trigger dopamine, the chemical linked to feelings of pleasure and reward. When someone drinks while on this medication, the typical “buzz” is greatly reduced, making alcohol feel less rewarding over time.

This medication is often prescribed to individuals who are still drinking but want to reduce their intake or quit altogether. It’s especially effective in lowering the frequency of heavy drinking episodes and supporting progress toward sobriety.

Unlike acamprosate, which must be taken three times a day, naltrexone is more convenient—it’s typically prescribed as a once-daily pill (50 mg) or a long-acting monthly injection.

The Effects of Naltrexone

The effects of naltrexone extend beyond reducing alcohol’s pleasure. This medication may also help improve overall focus and reduce impulsive behaviors that often lead to relapse. Over time, those using naltrexone may notice fewer cravings and a decrease in drinking triggers.

By reducing the dopamine spike that normally follows drinking, naltrexone helps retrain the brain’s reward system. This can lead to lasting changes in behavior and decision-making.

Choosing the Right Medication for You

When comparing acamprosate vs naltrexone, your treatment plan should consider a few key factors:

• Drinking status: Acamprosate is best for people who have already detoxed and stopped drinking. Naltrexone may be used earlier—even if the person hasn’t fully quit yet.
• Craving vs reward: Acamprosate helps reduce internal cravings. Naltrexone blocks the external reward of drinking.
• Adherence: Naltrexone’s once-daily pill or monthly injection may be easier to stick with than acamprosate’s three-times-a-day dosing.
• Medical conditions: Acamprosate is not ideal for people with kidney issues. Naltrexone should be avoided in people with liver disease.

Always consult a medical provider before starting any medication for alcohol use disorder to determine the safest and most effective approach.

Naltrexone and Alcohol Withdrawal

It’s important to note that naltrexone is not designed to treat alcohol withdrawal symptoms. Alcohol withdrawal can be dangerous and should be managed by a medical provider—often with different medications like benzodiazepines or supervised detox protocols.

Naltrexone is introduced only after withdrawal is complete and the patient is medically stable. This helps reduce complications and increases the effectiveness of the medication.

Effectiveness and Clinical Studies

Research from randomized controlled trials supports both medications:

• Naltrexone has shown strong results in reducing heavy drinking and increasing the number of days without alcohol.
• Acamprosate is more effective in helping individuals maintain long-term abstinence once detoxed.

In placebo-controlled studies, both medications outperformed non-medicated groups—but work best when combined with counseling and behavioral therapies.

Side Effects and Considerations

Both acamprosate and naltrexone have potential side effects. Knowing them can help you prepare and manage expectations.

• Acamprosate side effects may include:
  • Diarrhea
  • Nausea
  • Headaches
  • Anxiety or sleep problems
• Naltrexone side effects may include:
  • Nausea or stomach upset
  • Drowsiness
  • Headaches
  • Liver enzyme changes (requires monitoring)

In rare cases, both may cause allergic reactions. Regular follow-ups with your provider ensure safety and early detection of side effects.

When to Talk to Your Primary Care Provider

If you’re exploring alcohol treatment medications, starting with your primary care provider is a smart step. They can assess your health, review your alcohol use history, and guide you to appropriate treatment. Many primary care doctors are now trained to prescribe acamprosate or naltrexone, especially when part of a team-based approach to recovery.

Early conversations with your provider can also help rule out contraindications, such as liver or kidney concerns, and ensure the medication aligns with your broader care plan.

Cost of Acamprosate vs Naltrexone

The cost of acamprosate vs naltrexone can vary based on insurance, dosage, and whether you’re using a generic or brand-name version. Generally:

• Acamprosate (Campral) tends to be slightly more expensive due to the number of doses required per day.
• Naltrexone is often affordable in pill form, but the monthly injection (Vivitrol) may cost more if not covered by insurance.

Speak to your healthcare provider or case manager to explore options for financial support or coverage through treatment programs.

Medication and Whole-Person Treatment

Medication alone isn’t a cure. The best outcomes happen when medication is combined with other treatment of alcohol use disorder, including:

• Therapy (like CBT or motivational interviewing)
• Peer support groups
• Mental health care
• Lifestyle changes and family support

Treatment includes more than just managing symptoms—it’s about addressing the root causes of alcohol dependence and building healthier coping skills.

Is One Medication Better Than the Other?

There’s no one-size-fits-all answer. Some people respond better to acamprosate, especially those focused on staying completely alcohol-free. Others find success with naltrexone for alcohol dependence, particularly when trying to reduce heavy drinking.

The choice depends on individual goals, medical background, and support systems. Some individuals may even switch between or combine medications based on progress.

Finding Medication Support Near You

If you’re deciding between acamprosate vs naltrexone, know that both are proven tools in the journey to recovery. Whether you’re managing cravings, addressing the effects of alcohol on your brain, or trying to prevent relapse, the right medication—along with therapy and support—can make a major difference.

At Scottsdale Treatment Facilities, personalized plans often include alcohol treatment medications, counseling, and care for co-occurring mental health conditions. If you’re looking for co-occurring disorders treatment near you, help is available—and recovery is possible with the right support system in place.