A 52-year-old man with alcohol use disorder has been abstinent for 6 months after completing detoxification. He is motivated to maintain sobriety but continues to experience strong cravings. He has no liver disease. Which pharmacological agent reduces craving by modulating central glutamate and GABA transmission and is approved for maintaining alcohol abstinence?
- A Acamprosate ✓
- B Disulfiram
- C Naltrexone
- D Topiramate
Explanation
Acamprosate (calcium acetylhomotaurinate) is FDA-approved for maintenance of abstinence in alcohol use disorder. It modulates glutamatergic and GABAergic neurotransmission — thought to be disrupted during chronic alcohol withdrawal — thereby reducing protracted abstinence syndrome and craving. It has no hepatic metabolism, making it safe in liver disease. Naltrexone reduces the rewarding effects of alcohol via mu-opioid blockade and is effective for reducing relapse to heavy drinking. Disulfiram creates an aversive reaction with alcohol by inhibiting aldehyde dehydrogenase.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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