When Nikki Wake recently celebrated her 54th birthday there was no wine, no champagne and no beer. Instead, she met with friends to do ‘bongo’s bingo’ – a mix of bingo and dancing – and left the party sober and joyful.
It’s a remarkable turnaround for Nikki who, to the outside world, might have seemed like a capable high-flier holding down a demanding job and caring for her son, but was in fact in danger of drinking herself to death.
‘I’d always liked a drink,’ says Nikki, who has a 17-year-old son. It was after her husband Andy developed a brain injury in 2017 and subsequently died in 2020, that her habit ‘spiralled out of control’.
‘I threw myself into work and drinking,’ says Nikki, from Manchester, who works in event planning and app development. ‘I’d start at breakfast with a bottle of wine, get my son to school, come home and drink another bottle through the day – then a third bottle that evening.’
It was in November last year, after a seizure caused by boozing, that she realised she needed help and checked herself into rehab.
While that helped her stop drinking, the ‘miracle’ she credits with keeping her off alcohol is a little white pill she takes every day called acamprosate.
The drug, which was developed in the 1980s, stops alcohol cravings – and for those, like Nikki, who fear they may be tempted to drink again, it can be lifesaving.
She started taking the daily pills shortly before the end of a month in rehab, in case she got the urge to buy alcohol on the way home.
After Nikki Wake’s husband Andy developed a brain injury in 2017 and subsequently died in 2020 her drinking habit ‘spiralled out of control’
‘But I didn’t,’ she says. ‘I went straight home. I didn’t drink the next day or the next. And soon, weeks just passed.’ She has been sober ever since.
Alcohol-related health problems are at a record high in the UK, with around 600,000 people in England alone alcohol dependent (and may suffer physical withdrawal without it), according to estimates from the University of Sheffield.
Alcohol directly claimed the lives of more than 10,000 people in 2023, according to data from the Office for National Statistics.
However, while acamprosate has been around for more than 30 years, experts say awareness of it and other drugs designed to tackle problem drinking remains very low.
Acamprosate works by restoring the balance of brain chemicals – glutamate, which makes brain cells more excitable and active, and GABA, which calms brain activity – that are disrupted by long-term alcohol use, explains Dr Syed Omair Ahmed, a consultant psychiatrist at Black Country Partnership Foundation NHS Trust and the Priory Hospital Woodbourne, in Birmingham.
‘In those with alcohol dependence, the brain adapts to constant alcohol intake by increasing glutamate activity and reducing GABA to compensate for alcohol’s depressant effect,’ he says.
‘When a person initially stops drinking, this chemical imbalance can lead to withdrawal symptoms such as anxiety, restlessness and cravings. Acamprosate helps to minimise these.’
How quickly people feel the effects varies; some experience reduced cravings ‘within days, whereas others may need several weeks’, he adds.
The ‘miracle’ that Nikki credits with keeping her off alcohol is a little white pill she takes every day called acamprosate
Thorunn Govind, a pharmacist based in Manchester and Chair of the Royal Pharmaceutical Society, adds: ‘It works best in those who are already abstinent and motivated to stay sober. ‘Studies suggest it increases the chances of maintaining abstinence, especially when combined with therapy or support groups.’
But it can come at a cost – side-effects include diarrhoea, nausea, headache and fatigue.
Patients remain on the drug for up to a year, although some may need it for longer ‘if the risk of relapse is high’, says Dr Ahmed.
Acamprosate is in fact just one of the medications that can help people struggling with alcohol problems.
Another, naltrexone, works in an entirely different way. ‘Essentially, it stops alcohol from giving you that high or euphoric feeling,’ says Dr Ahmed.
While acamprosate appears to be more effective in maintaining abstinence, naltrexone helps people reduce their overall consumption, as it ‘blocks the receptors in the brain that are linked to the pleasurable effects of alcohol’, he explains.
Both drugs are effective in most people yet lack of awareness about them means they’re not used more widely, suggests Dr Ahmed. ‘Most people have heard of rehabilitation programmes or support meetings, but medications such as acamprosate and naltrexone aren’t as widely publicised.
‘This could be because of stigma or lack of doctor awareness and treatment preference.
‘A lot of alcohol-dependent patients might feel more optimistic if they knew there was something they could take that could genuinely help reduce these cravings. So they don’t just have to rely on willpower or therapy.’
That said, acamprosate does not work for everyone.
‘Some studies have shown that it may work better in people with strong cravings rather than in people who drink out of habit,’ says Dr Ahmed.
Those with co-existing conditions, such as depression or anxiety, could also find such drugs work less well.
What is clear, says Dr Ahmed, is that anti-drinking medication is more effective when combined with therapy or counselling.
Nikki says: ‘I started drinking young, as many women did in the late 80s and 90s’ “ladette” culture,’ she says.
‘I married Andy and we liked a drink but I wasn’t a problem drinker.’
It was only in 2017 when Andy had a heart attack which led to a brain injury that Nikki began to spiral.
‘It was so sudden and he was my soulmate,’ she says. ‘He was kept alive in ICU but there was really nothing anyone could do. The consultant took me aside and said gently: “this will not have a happy ending”.
‘I used to bring bottles of vodka and diet coke mixed and hidden in a coke bottle into intensive care to visit him. It was my crutch.’
Andy was eventually allowed home but needed nursing care, which Nikki juggled with running her own business and caring for their son.
‘I was a functioning alcoholic,’ she says. ‘I’d manage to juggle ensuring Andy was cared for, get our son to school, drink; run my business, drink more; I’d fly business class and drink; go to meetings and drink. It was acceptable.
‘But I never ever missed a meeting or got my son to school late. No one knew.’
Then in 2020 Andy tragically died. ‘I had pre-grieved for three years as he slowly died,’ she says. ‘But losing him was still immensely difficult.’
Nikki’s drinking worsened and by 2021 she could ‘barely walk the length of my street without feeling unwell’, she says. She carried on but in 2023, after a particularly bad binge, she woke in immense pain.
‘I don’t know if it was my liver or something else but I felt so, so unwell,’ recalls Nikki.
‘I knew I had to stop drinking but couldn’t get through the day without alcohol.
‘I was already taking mirtazapine for depression, so [feeling so ill] I took two instead of one. Something happened and I think I may have had a seizure. I called a friend who took me to A&E.’
She was told mixing alcohol and the antidepressant had triggered a seizure. ‘I was kept in for three days and told I needed to stop drinking. I agreed, left – and bought wine on the way home.’
In November last year – a day before her son’s 17th birthday – something in Nikki changed.
‘There was no rock bottom, no lightbulb moment but I just felt generally dreadful,’ she says.
‘I felt like if I picked up one more glass, I’d be dead. I told my son I was checking myself into rehab. He hugged me and said “that would be the best birthday present ever”.’
Nikki had private health insurance which covered her admission to The Priory hospital, where she did a 28-day detox, which included counselling.
‘It was hard,’ she says. ‘But I felt looked after. It was there that a doctor recommended acamprosate to help my recovery.’
Seven months on, Nikki is still sober and has launched an app called Sober Love to help sober people date.
‘So many dates are about drinking, it’s hard to find a sober match. I thought of this new idea during my rehab. It was another good thing to come from getting sober.
‘Acamprosate saved my life,’ she says. ‘I plan to stay sober now in Andy’s honour and for our son.’
