Pharmacogenomics and Pharmacometabolomics of Acamprosate Treatment Outcome

Inclusion criteria

• Age 18 to85; DSM-5 diagnosis of AUD determined by PRISM;
• Completion of alcohol detoxification (CIWA score < 5) and no alcohol for at least 7 days (but no more than 35 days);
• Ability to provide informed consent
• Ability to speak English
• Willingness to use the study medications for 3 months and attend follow-up visits.
• No chronic/daily use of benzodiazepines, opioids, or stimulants for a period of time which is determined by 3 x the medication half-life value (see addendum A) to be completed before the initiation of study medication (acamprosate or placebo).
• Willingness to discontinue previously prescribed acamprosate for a period of at least 3 days before randomization to study medication (acamprosate or placebo).

Exclusion criteria

• Hypersensitivity or allergy to acamprosate
• Current use of wellbutrin and not willing to switch to an acceptable antidepressant medication
• Renal impairment (creatinine level >1.5 mg/dL);
• Diagnosis of advanced liver disease indicated in the medical record or by a MELD score of above 10;
• Women who are pregnant, breastfeeding, or planning to become pregnant during the next year;
• Primary diagnosis of substance use disorder other than alcohol as determined by PRISM or in medical record review or secondary diagnosis of active (within the past year) benzo/sedative dependence, opioid dependence, stimulant dependence, heroin dependence, and/or cocaine dependence
• Refusal to abstain from any chronic/daily use of prescribed benzodiazepines, opioids, stimulants, cannabis related medication such as CBD or medical marijuana, during the course of participation.
• Current use of Naltrexone and not willing to stop and switch to Acamprosate/Placebo
• Current use of Antabuse.
• Active suicidal ideation or any unstable medical or psychiatric condition as determined by responses to PRISM or by the investigator.
• Status of involuntary or court-ordered admission at time of consent.