1. A novel way of enhancing adherence to acamprosate for alcohol dependence: The Alcohol Dependence and Adherence to Medicine (ADAM) trial

Acamprosate is a safe, effective medication that can help support people with alcohol dependence to remain abstinent. However, poor adherence to the medication can hamper its effectiveness. This trial aimed to determine the effectiveness of delivering Medication Management (MM) and Contingency Management (CM) via telephone by trained pharmacists.

A 3-arm, multicentre randomised controlled trial took place in specialist alcohol treatment services in England. Participants were adults with alcohol dependence who were abstinent from alcohol on trial entry and prescribed acamprosate. Participants were randomised in a ratio of 2:1:1 using a stratified random permuted block method to; 1. Standard Support (SS), 2. SS with telephone delivered MM, provided by pharmacists, 3. SS with MM plus CM (vouchers up to £120) to reinforce engagement with MM. The primary outcome was self-reported percentage of medication taken in the previous 28 days at 6 months post-randomisation.

A total of 739 participants were recruited into the trial and 518 (70%) participants were followed up at 6-months post randomisation. The mean difference of percent adherence to acamprosate was higher for those who received MM plus CM (10.6%, 95% Confidence Interval (CI) 19.6% to 1.6%) compared to SS alone. The mean difference in percent adherence was not significantly different for those in the MM group compared to SS alone (3.1%, 95% CI 12.8% to – 6.5%).

This trial adds to the evidence base for the potential role of CM in the treatment of alcohol dependence and utilising the clinical skills of pharmacists to deliver interventions by telephone.