The Actions of Acamprosate in Treating Alcohol Tolerance and Alcohol Dependency in Patients - Literature review Example

CRITICAL EVIDENTIAL REVIEW OF THE ACTIONS OF ACAMPROSATE IN TREATING ALCOHOL TOLERANCE AND ALCOHOL DEPENDENCY IN PATIENTS BACKGROUND Alcohol addiction is a major psychological and social issue that impacts on the help of a patient. “Alcohol addicts develop a tolerance for alcohol, they are dependent on alcohol and they develop withdrawal symptoms when alcohol use is terminated” (Bennett & Holloway, 2012, p. 10). Alcohol addiction therefore involves a situation where a person is so much addicted to alcohol and has to depend on alcohol as some kind of a compulsive behaviour. And where a person does not get access to alcohol, that individual tends to become somewhat jittery and behaves in an abnormal manner due to alcohol deprivation. Alcohol addiction is seen in the dimensions of tolerance and dependence. “Tolerance is a state of adaption in which more and more alcohol is needed to produce desired effect. Physical dependence means upon interruption of drinking, a characteristic withdrawal syndrome appears which is relieved by more alcohol intake” (Suillivan, 2012, p. 13). This implies that alcohol tolerance is a situation where a person has come to a point where his body and system desires specified volumes of alcohol to function. This means the person has gotten to a point where drinking is more of a norm and his body has come to terms with the fact that alcohol is essential to his wellbeing and continuous existence. Physical dependency on alcohol implies that a person seem to get social challenges like seeking to be away from other people when s/he does not get to consume alcohol. In other words, physical dependence or alcohol addiction implies that a person cannot socialize or relate to others when that individual does not consume an amount of alcohol that s/he is used to. Alcohol addiction is therefore a maladaptive pattern of alcohol consumption that involves alcohol abuse and dependence on alcohol (Shenton & Turetsky, 2010). Numerous treatments have been put forward for dealing with alcohol abuse and alcohol addiction. One of such treatments is the drug, Acamprosate. Acamprosate works to reduce dependency and desire for alcohol. It therefore helps to cut down on the volume of alcohol consumed and enables a person to become more independent of alcohol. Acamprosate is said to work best where there is a support from a group or an expert in order to enable the patient to get guidance and assistance in abstinence. Acamprosate can therefore be said to be a drug that works with the combination of an administrator or a medical professional as well as other behavioural scientists like psychologists and counsellors who provide various levels of guidance to enable a patient to live above his or her dependency on alcohol. AIMS AND OBJECTIVES OF THE STUDY The aim of this paper is to analyse the way Acamprosate works in helping patients to deal with their alcohol addiction challenges and to identify the most effective way of administering the drug to patient. In order to attain this end, the following objectives will be explored in the research: 1. A critical review of the drug, Acamprosate and how it operates in the normal sense; 2. Application of relevant tools and techniques in Randomised Clinical Trials (RCTs) to ascertain the operation and role of Acamprosate in preventing alcohol dependency; 3. An evaluation of other RCT results and other studies conducted by various authorities and technicians in analysing the effects and administration of Acamprosate; 4. A synthesis of the fundamental findings of RCTs relating to Acamprosate and how best t can be applied to human beings in practical situations. The research will be grouped into four main sections. The next section will be the first and it will identify the methodology that will be used to conduct the analysis and apply the results of other RCTs that were conducted in into alcohol abuse and the administration of Acamprosate. The second section will involve the presentation of key findings about the way Acamprosate operates and other RCT studies that were conducted. The third part will synthesise the findings and provide a critical review of the core findings of various studies. The final part of this research will delve into the significance and importance of Acamprosate and conclusions and inferences will be drawn on how the drug works in dealing with cases involving patients who have developed alcohol dependency. METHODOLOGY Fundamentally, the research will be concerned with the use of previously conducted Random Clinical Trials (RCTs) as the basis and yardstick for analysis. To this end, the researcher will use various peer reviewed journals and academic sources as basis for formulating an enquiry into the fundamental concepts and ideas under review. To this end, these peer reviewed journals that involved studies about Acamprosate will be critiqued and analysed for the identification of the actual effects and processes that the drug goes through in order to work and provide an improvement in the condition of patients. However, the research will not focus solely on the RCTs identified in journals and other academic sources. The research will commence with a literature review of Acamprosate and how it works. From there, the various studies conducted into the efficiency and efficacy will be analysed and reviewed. Afterwards, they will be critiqued and evaluated to find their essence and interpreted to formulate various forms of conclusions. Random Clinical Trials are rigorous methods of testing hypotheses (Committee for Indications for Waterborne Pathogens, 2010). This method of research often tests two groups where one receives treatment or intervention and another does not receive any kind of treatment. From there, the different groups are examined and critically and objectively evaluated in order to identify the way they operate. RCTs can also be viewed as a specific type of scientific environment used to test the effectiveness of medical intervention within a particular population (Esser, Smith, & Altman, 2012). This means that RCT involves various types of testing and analysis to find differences in populations and also assert how these differences interact to form trends and patters. This can be used for analysing and evaluating various products and treatment systems to ascertain their efficacies in specific pointers and issues. The process within which RCT works involve a system of gathering information about a given process and situation and from there, the researcher will scientifically identify possible trends and solutions to a given issue or problem (Chow & Liu, 2010). This can form a system through which deductions can be made after inducing a situation whereby variables are matched against each other and comparative analysis are made. These inductions involve the formation and maintenance of control groups that are made to go through specific processes which are closely observed and monitored (Gullo, 2013). The research findings will be critiqued in a format that will evaluate the various elements and aspects of Acamprosate and how it affects the human being who is dependent on alcohol. To this end, the research will try to evaluate the dominant findings and synthesise it in order to draw logical conclusions on how the drug operates as it was evaluated in various studies and its implications to the human mind and the human body. FINDINGS This section will be divided into two parts. The first section will evaluate the elements and aspects of Acamprosate and how it operates in the conventional sense. This will be somewhat a presentation various findings made from a critical literature review. From there, the research will proceed to analyse various dominant trends and dominant findings that were made in various RCTs and its related activities. The literature review will culminate in the formulation of various hypotheses. These hypotheses will form the main parameters within which the findings from the RCTs will be discussed and synthesised. Literature Review This section of the essay will examine Acamprosate and how it influences people who have developed alcohol tolerance and physical dependency. This will commence by discussing what is meant by Acamprosate and what it does to the human being. Acamprosate, acetyl homotaurine is used for treating alcohol dependency (Suillivan, Ekle, & Sibley, 2010). It is a product that is used in combination with counselling and lifestyle changes to maintain abstinence from alcohol (Bryant, Knights, & Salerno, 2013). Acamprosate is a medicine that gets a person to abstain from alcohol abuse and encourages the individual to be more sober and more normal even where that individual remains without alcohol in his or her system (Bryant, Knights, & Salerno, 2013). Acamprosate is clinically related to neurotransmitters, GABA, glutamate and taurine (Bryant, Knights, & Salerno, 2013). “The drug reduces the symptoms of withdrawal related to the lack of alcohol and this include amongst other things, anxiety, irritability and insomnia which is related to alcohol addicts’ lifestyle.” (Bryant, Knights, & Salerno, 2013, p. 424). Therefore it can be stated that the technical role of Acamprosate is to get people to overcome the symptoms of alcohol addicts. And this includes processes like anxiety, uneasiness and other feelings are exhibited when alcohol dependent persons do not consume their expected levels of alcohol. Acamprosate is seen by other authorities as a prototype of neuro-modulatory treatments that calms an addict down in times and situations that an individual is deprived of alcohol (Miller, 2013). This is because Acamprosate has an impact on the state of the brain and it deals with the condition of withdrawal and is used to deal with anti-craving and anti-relapse amongst alcohol addicts who need to get some kind of solution to their drinking problem. Therefore it can be said that Acamprosate has some impact on the human brain and this allows users to build a normal life and not desire or crave for alcohol when they are in a situation of deprivation. From here, the following deductions can be made about the drug, Acamprosate and this include amongst other things: 1. Acamprosate works on the human brain and prevents a person from becoming too desirous of consuming alcohol; 2. Acamprosate does not kill the desire to drink alcohol. Rather, it enables a person to build a life that will not depend on the consumption of alcohol and allows an addict to maintain a normal life without having to develop complications These two hypotheses will be tested in the RCTs that were conducted by other researchers. This will give an insight into how Acamprosate works and how it affects people in different people in order to deal with the situation. Some of the research involved various trials and tests that were done by different academics around the world. These are presented in peer-reviewed journals and provide an insight into various issues relating to the drug in question: Peer Reviewed Journals These peer reviewed journals were studied to identify the RCTs carried out by various academics and how they prove or disprove the work of Acamprosate and its utilisation as a tool for treating alcohol intake disorders. Acamprosate neither exerts its actions by nurturing alcohol’s reinforcing effects, nor does it alter indirect hypothermia, taste aversion or motor impairment (De Witte, Bachteler, & Spanagel, 2009). This implies that there is empirical evidence that point out that Acamprosate does not force the body to actually reject alcohol or impair the desire and expectations for alcohol consumption. Rather, it provides a system through which people can live without becoming disorganised or feeling unusual when they do not consume their normal levels of alcohol. “Acamprosate reduces craving and relapse that is associated with hyper-glutamatergic state in the brain and the phenomenon of conditioned withdraw and could be an anti-craving and anti-relapse drug” (De Witte, Bachteler, & Spanagel, 2009, p. 73). The implication is that Acamprosate helps to deal with the symptoms and pressures that are internally induced upon a person who does not get to drink a given level of alcohol. Rather, these desires and expectations are suppressed by the patient and this leads to better methods and ways of controlling addiction and desire. This breaks the cycle and with the proper attitudes and the proper activities, a person could live above addiction and become less dependent on alcohol. The side effect of Acamprosate is mild and transient in nature and the most common ones include headaches, diarrhoea, flatulence and abdominal pains and other skin reactions (Sadock, 2012). Studies that involved three years of evaluation of various Acamprosate products and its variants indicated that alcohol treatment through the use of Acamprosate reduces healthcare costs of patients and improved the quality of life amongst participants in the study and reduces social vices amongst users of the drug (Zarkin, et al., 2010). This shows that the treatment is a method of improving the quality of life amongst users and prevents people from either being pressured or less desirous of trying to use alcohol. Other studies identified that social isolation was a common problem with people who used to be addicted to alcohol. However, the use of Acamprosate reduced isolation and improved acceptance amongst wider society because people were not showing signs of difficulties in adjustments as the case was when they sought to quit alcoholism without taking the medication (Lozano, Domingo-Salvany, Martinez-Alonso, Brugal, Alonso, & De La Fuente, 2008) The molecular state of Acamprosate is not very well known. The action of the drug is therefore in doubt. Therefore, an empirical study was conducted to test the component of the drug that helps people to gain relieve from their addiction problem (Spanagel, Vengeliene, Jandeleint, & Fischer, 2014). The study placed participants into categories which included: 1. Excessive drinkers 2. Alcohol seekers 3. Relapsed-like drinking behaviours (Spanagel, Vengeliene, Jandeleint, & Fischer, 2014) Two categories were segregated for each category and one was given Acamprosate with Calcium whilst the other was given the drug without Calcium. It was identified that calcium is an active element of Acamprosate and patients with high plasma Calcium levels showed better efficacy and better responses to treatment and were more abstinent to alcohol than those who did not have such high levels (Spanagel, Vengeliene, Jandeleint, & Fischer, 2014). Another RCT conducted by Lido et al identified that the drug decreases brain glutamate and increases Beta-endorphins in human beings and this diminishes reinstatement in ethanol and promotes abstinence (Lido, Marston, Ericson, & Soderpalm, 2012). A related study identified that Acamprosate and many other anti-craving drugs are subjective and they do not inhibit intake, rather, they ought to be taken with a degree of attention from other therapists and behaviourist professionals to stay on the right track and avoid going back into the habit of alcohol abuse (Kalk & Lingford-Hughes, 2014). A study performed on rats also confirmed that it blocked the glumate signalling and this helped to reduce the drinking behaviour of rats (Oka, Hirouchi, Tamura, Sugahara, & Onyama, 2013). Other RCT studies were based on placebo responses. Placebo studies are mainly stimulated or medically ineffective treatments for a disease intended to deceive patients (Oken, 2010). A placebo study conducted by Litten et al studied 55 patients who were over 18 years old. Each of the respondents were classified into groupings and they were given varying doses of Acamprosate which either contained a little or no effective base for operation and action in the patients. The findings indicated that Acamprosate’s effect was strong and it could help in combination with counselling but where counselling was done without an effective dose of Acamprosate in their system, patients found it challenging to live their lives without Acamprosate (Litten, Castle, Falk, & Ryan, 2013). In another longitudinal study, evidence gathered indicated that Acamprosate treatment increased the percentage of abstinence days over placebo treatment (Berger, Fisher, & Bohn, 2013). The study examined how long patients could abstain. They were given deceptive drugs as medication for their alcohol dependency and afterwards, they were given Acamprosate and observed. The findings indicated that the participants in the study could abstain more with Acamprosate rather than those that did not get Acamprosate as treatment. DISCUSSIONS The findings indicate that there is scientific evidence that Acamprosate works more in relieving a person from his or her alcohol addiction. This is because the placebo studies that compared situation where a patient had Acamprosate as an aid to quitting alcoholism provided better results than those that did not get Acamprosate. Therefore, it can be said that Acamprosate is an effective and efficient tool in helping people to get over their addiction to alcohol. From the two placebo studies analysed, it is apparent that Acamprosate is a strong aid for people who really need to get of alcohol and get a better tendency towards abstinence. However, the placebo studies did not provide actual findings on how the drug works and how the drug deals with people’s craving and desires. It only confirms that there is a high tendency for people to abstain from alcohol when they take the drug. The main mode for the operation of Acamprosate involves blocking glutamate signalling. Glutamate receptors are membranes that are important for neural communication, memory formation, learning and regulation (Farooqui, 2010). It is responsible for controlling neurotransmitters and the central nervous system (CNS) and this plays a major role in helping in the functioning of the human brain (Dale & Vincent, 2012). Therefore, the main function of Acamprosate involves blocking that aspect of the human mind that becomes restless and induces a person to get into the habit of drinking again and again when that individual is not drinking alcohol. Therefore, with a diminished volume and desire for the consumption of alcohol, there is a strong tendency for a person to put his or her life back together and try to live a sober life that does not really depend on alcohol for calming down. Another important discovery of the RCTs studied indicates that Calcium is a major and important element in the effective functioning of Acamprosate. This is because Spanagel et al (2014) identify that where there is the use of Acamprosate in helping people to stay away from alcohol addiction, the volume of calcium in their blood and the possibility of getting Calcium substitutes helps a person to respond more to treatment than the situations where there is little or no Calcium in a person’s blood or system. Acamprosate mainly works on the brain of the patients. This enables patients to live above the various elements and aspects of craving and desiring the alcohol when they are not in a state of consuming them. This has several dimensions, which include psychological, behavioural and social in nature. The drug works on the mind of patients and it calms down patients’ compulsive desire and expectation to consume more and more alcohol. This means that their minds have to be calm and they will need to be receptive of the new trends and patterns of their lives. In terms of behaviour, people have to streamline their behaviour and deal with the processes and procedures required of this new experience and this demands some degree of guidance. Also, in the area of interacting with other people in society, there is a strong need for patients using Acamprosate to be given guidance by various specialists like psychologists and other experts in order to understand how these three elements interact and this can enable patients to rise above the compulsive nature of alcohol addiction. CONCLUSION Acamprosate works on the mind of the patient and gets to inhibit the glutamine that causes a person to be desirous of consuming alcohol. This enables the patient to stay calm and live above the disorders related to alcohol abstinence amongst persons addicted to alcohol and fond of alcohol abuse. The drug, Acamprosate reduces alcohol addiction, but it does not work in isolation. In other words, a person who relies solely on Acamprosate is likely to fail in overcoming addiction because there are psychological, behavioural and social implications for alcohol addicts. What the drug does is that it calms the mind and seeks to regulate the patient’s cravings and desires. However, in terms of behaviour and socialisation, if a patient makes the wrong choices, alcohol dependency is likely to continue. Hence, there is the need for some kind of therapeutic support and assistance to help patients to deal with the behavioural and social aspects of the operation of the Acamprosate drug. Also, empirical studies indicate that Calcium is important in facilitating the action of Acamprosate. This includes the fact that Calcium assists and accelerates the operation of Acamprosate and its impact on alcohol addiction. This means that medical professionals will be encouraged to provide Acamprosate alongside other doses of Calcium supplements that can enhance the impact of Acamprosate on a patient. From the study, it is confirmed that Acamprosate encourages a patient to control the impacts of social disorders and mental disorders that come with the desire to consume alcohol amongst alcohol dependent patients. This negates the first hypothesis since it shows that the drug does not operate independently. The findings also supports the second hypothesis which indicates that a person becomes more sober and less stressed if that individual uses Acamprosate in a situation where that person is heavily dependent on alcohol. This relieves the complications and difficulties that come with the attempt to abstain from alcohol. Bibliography Bennett, T., & Holloway, K. (2012). Understanding Drugs, Alcohol and Crime. New York: McGraw Hill. Berger, L., Fisher, M. B., & Bohn, N. G. (2013). Efficiency of Acamprosate for Alcohol Dependence in Family Medicine Setting in the United States: A Radicalized Double-Blined Placebo Controlled Study. Alcoholism, Clinical and Experimental Research , 668-674. Bryant, B. J., Knights, K. M., & Salerno, E. (2013). Pharmacology for Health Professionals. Sydney: Elsevier Australia. Chow, S. C., & Liu, J. P. (2010). Design and Analysis of Clinical Trials: Concepts and Methodologies. Hoboken, NJ: John Wiley & Sons. Committee for Indications for Waterborne Pathogens. (2010). Indicators for Waterborne Pathogens. Washington, DC: National Academic Press. Dale, R. C., & Vincent, A. (2012). Inflammatory and Autoimmune Disorders of the Nervous System in Children. Hoboken, NJ: John Wiley and Sons. De Witte, P., Bachteler, D., & Spanagel, R. (2009). Acamprosate: Predictive Data : Drugs for Relapse Prevention of Alcoholism. London: Springer. Esser, M., Smith, G. D., & Altman, D. (2012). Systematic Reviews in Health Care. Hoboken, NJ: John Wiley and Sons . Farooqui, A. A. (2010). Hot Topics in Neural Membrane Lipidology. London: Springer. Gullo, A. (2013). Anaesthesia, Pain, Intensive Care and Emergency Medicine. London: Springer. Kalk, J. J., & Lingford-Hughes, A. R. (2014). The Clinical Pharmacology of Acamprosate. British Journal of Clinical Pharmacology , 315-323. Lido, H. H., Marston, H., Ericson, M., & Soderpalm, B. (2012). The Glycine Renptalke Inhibitor Org24598 & Acamprosate Reduce Ethanol Intake: Tolerance Development to Acamprosate but not Org24598. Addiction Biology , 897-907. Litten, R. Z., Castle, I. J., Falk, D., & Ryan, M. (2013). The Placebo Effect in Clinical Trials for Alcohol Dependency: An Exploratory Analysis of SI Naltrexore and Acamprosate Studies. Alcoholism, Clinical and Experimental Research , 2178-2197. Lozano, O. M., Domingo-Salvany, A., Martinez-Alonso, M., Brugal, M. T., Alonso, J., & De La Fuente, A. C. (2008). Health Related Quality of Life in Young Concaine Users and Associated Factors. Quality of Life Research , 977 - 985. Miller, P. M. (2013). Interventions for Addiction: Comprehensive Addictive Behviours and Disorders. London: Academic Press. Oka, M., Hirouchi, M., Tamura, M., Sugahara, S., & Onyama, J. (2013). Acamprosate Reduces Alcohol Drinking Behaviour in Rats and Glumate-Induced Toxicity in Ethanol-Exposed Primary Rat Cortical Neuronal Cultures. European Journal of Pharmacology , 323-331. Oken, B. S. (2010). Placebo Effects: Clinical Aspects of Neurobiology. Brain , 2812-2823. Sadock, B. (2012). Kaplan and Sadocks Pocket Handbook of Psychiatric Drug Treatment. Amsterdam: Wolders Kluwer Health. Shenton, M. E., & Turetsky, B. I. (2010). Understanding Neuropsychiatric Disorders. Cambridge: Cambridge University Press. . Spanagel, R., Vengeliene, V., Jandeleint, B., & Fischer, W. N. (2014). Acamprosate Produces its Anti-Release Effect with Calcium. Neuropsycho-Pharmacology , 783 - 791. Suillivan, K., Ekle, E., & Sibley, A. (2010). 2010 Nurses Drug Handbook . London: Jones and Bartlett. Suillivan, L. (2012). Alcohol and Health. Darby, PA: DIANE Publishing. Zarkin, G. A., Bray, J. W., Aldridge, A., M., M., Cisler, R. A., Couper, D., et al. (2010). Effects of Alcohol Treatment on Social Costs of Alcohol Dependency. COMBINE Study , 396 - 401. Read More