Brain imaging of alcohol craving and the role of acamprosat: a fMRI-study

Neurophysiological correlates of craving were analysed in a placebo controlled study within abstinent alcoholics using acamprosat for relapse prevention. Craving behaviour was tested in a fMRI scanner while patients went through a cue exposure design. Full screening was done with SKID, history of alcoholism, and a craving questionnaire. Patients went through the fMRI trail twice: at T0 three weeks after 'detoxication' without medication and at T1 after a fortnight intake of acamprosat or placebo. 31 patients completed T0 and 28 T1. Patients were exposed to pictures of their favourite alcoholic drinks, to neutral stimuli and to scrambled patterns during each trail. During picture presentation, changes in regional brain activity were measured. At T0 we found different activated brain areas comparing alcoholic versus neutral or scrambled stimuli. Craving associated brain areas were identified within the Posterior Cingulate Cortex (PCC). After the following drug treatment (T1) an activation of the PCC was found only in the acamprosat group, not with placebo. In conclusion,this is the first study showing effects of acamprosat on neuroanatomic correlates after alcohol-specific cue exposure. The results indicate, that the reactivity and sensitivity for alcohol-specific cues is still activated during medication. The PCC was identified as the involved brain region. Probably acamprosat facilitates the awareness of alcohol-specific cues and subsequently prevents a relapse.