Case report: Acamprosate for treatment of volatile hydrocarbon (VHC) inhalant use disorder with comorbid alcohol use disorder.

Introduction: Inhalant use disorder is a substance use disorder that involves the inhalation of volatile hydrocarbons (VHCs) to experience intoxication. Despite its prevalence and potential for adverse events, pharmacotherapy research for inhalant use disorder is limited. Acamprosate is a medication used for alcohol use disorder (AUD) that may provide benefit for inhalant use disorder. Acamprosate, alcohol, and inhalants all modulate glutamatergic and GABAergic pathways to produce their effects. Reported is a case of inhalant use disorder with comorbid AUD treated successfully with acamprosate. Case Report: Patient A is a 39-year-old male consuming 16 cans of computer duster per day, having escalated use over the course of 2 weeks following a period of sobriety. He has been abstaining from alcohol with the help of disulfiram therapy. Following medical management, chronic inhalant use disorder pharmacotherapy was established with acamprosate 666 mg twice a day and later increased to 999 mg twice a day. Discussion: Similarities in effect may lead to the comorbid use pattern of inhalants and alcohol for our patient. As disulfiram did not address the inhalant use, acamprosate was chosen in hopes of reducing cravings and encouraging abstinence in the long term. Conclusion: Inhalant use disorder represents an understudied substance use disorder, and acamprosate may be a promising medication to investigate for broader safety and efficacy. Patients with comorbid AUD may be an especially likely population to benefit from acamprosate therapy due to the possibility of dual benefit from the FDA-approved AUD indication.