While the exact mechanism of action is unknown, it’s believed that acamprosate helps by restoring the balance of two neurotransmitters in the brain (GABA and Glutamate) that get disrupted by long-term or chronic alcohol abuse. By doing this, it helps the brain to begin working normally again and allows patients in recovery to maintain sobriety from alcohol more easily.
GABA and glutamate are important neurotransmitters because they are responsible for controlling the inhibitory (GABA) and excitatory (glutamate) systems in our brains. As the names would suggest, the inhibitory system is the mechanism that tells the brain to calm down, and the excitatory system tells the brain to get energized or excited.
Another way to look at these two important systems is to take an analogy of a car. The GABA system is like the brakes and allows us to slow down, while the glutamate system acts like the accelerator. If you have a car with only one system or the other, it’s not a very functional car – you need both systems to balance each other out in order to be able to use the car effectively.
When a person drinks alcohol (not just an alcoholic, but anyone), it stimulates the GABA system in the brain and the person becomes sedated and relaxed (the brakes slow you down). At the same time, the glutamate system is suppressed (so the accelerator is not being pressed). When the alcohol wears off, your excitatory system “rebounds” and you feel more irritable, agitated, and may find it difficult to sleep (remember: the brakes are now off, and the accelerator is being pushed).
In an alcoholic, chronic drinking causes the body to develop a tolerance – meaning it takes more alcohol to achieve the same effect. This modifies the GABA/glutamate systems over time, which means alcoholics need to consume more and more alcohol to “put on the brakes” (slow down and relax).
When the alcohol eventually wears off, the glutamate system has become somewhat “turbocharged” and the result is that the accelerator seems to be “pressed to the floor” resulting in quite severe withdrawal symptoms in many cases. This can cause the person to crave alcohol to relieve these uncomfortable symptoms.
By restoring these chemicals in the brain to normal levels, Campral makes it easier for people in recovery to maintain their sobriety and participate fully in therapy and counseling.