Naltrexone and acamprosate both modestly curtail drinking among alcohol-dependent patients, but which is best in which circumstances and for which treatment goals? To find out this review compared the medications’ performance when separately benchmarked against a placebo, bringing to bear much more data than is available from the few trials which directly compared the two drugs.

Key points From summary and commentary
• The medications naltrexone and acamprosate both modestly curtail drinking among alcohol-dependent patients, but it is unclear which is best in which circumstances and for which treatment goals.
• Rather than confining itself to direct comparisons of the drugs, the featured analysis addressed these issues by comparing the two medications’ performance when separately benchmarked against a placebo.
• Findings suggested naltrexone is best for patients who want to control their heavy drinking, acamprosate for those seeking abstinence. Both seem more effective when patients have detoxified and/or stopped drinking in the run-up to treatment.