Mental health

Preventing relapse in alcohol dependent patients

Question 4: Are acamprosate, disulfiram and, naltrexone safe and effective in preventing relapse in alcohol dependence in non-specialized health care settings?

Management of alcohol use disorder

  • Population: alcohol dependence
  • Interventions:
    • acamprosate
    • naltrexone
    • disulfiram
  • Comparison:
    • placebo
    • one medication versus other
  • Outcomes:
    • proportion relapsed to heavy alcohol drinking
    • alcohol consumption: proportion abstinent and proportion drinking days
    • alcohol related health outcomes (including psychosocial functioning)
    • adverse events
    • mortality.


Acamprosate, disulfiram or naltrexone should be offered as part of treatment to reduce relapse to heavy alcohol use in alcohol dependent patients. The decision to use of acamprosate, disulfiram or naltrexone should be made taking into consideration patient preferences and availability.
Strength of recommendation: STRONG

Disulfiram should be offered to motivated patients in whom medication adherence can be monitored by treatment personnel, carers or family members, and when non-specialist health care providers are alert to potential adverse effects, including the disulfiram-alcohol reaction.
Strength of recommendation: STRONG

Evidence profile