The research aimed to find out whether telephone support from pharmacists and providing financial incentives (known as contingency management) would help people who were prescribed the medication acamprosate to adhere to their treatment. Acamprosate reduces alcohol cravings and helps prevent relapse in people who have stopped drinking. Contingency management is highly beneficial in treatment of drug dependence but has been rarely studied in relation to alcohol dependence.

This randomised controlled trial included people across England who had alcohol dependence and were taking acamprosate. Their average age was 46 and most (61%) were male. They were alcohol-free following detoxification at the start of the study.

All participants received standard support. 372 people received no other help, but 182 received telephone support in addition. A further 185 people received telephone support plus incentives (up to £120 in shopping vouchers over six months).

The researchers found that:

  • with standard support alone, well under half (38%) took their medication as prescribed
  • with extra telephone support, numbers rose slightly (41%) but the difference was not meaningful
  • with extra telephone support plus financial incentives, more (49%) took their medication as prescribed; this was a meaningful increase over standard support alone.

We found that contingency management was the critical ingredient in the cost effectiveness of delivering pharmacist support to improve uptake of acamprosate. We also found that this approach was possible to implement with people attending typical NHS and third sector addiction treatment services in England. We recommend wider implementation of this approach to improve outcomes for people with alcohol dependence while at the same time reducing overall costs

Professor Colin Drummond

Prof Colin Drummond, professor of addiction psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London and ARC South London alcohol theme lead