One double-blind controlled study19 conducted in the United States evaluated days of cumulative abstinence but showed no significant benefit from acamprosate by this outcome measure. However, subanalysis of subjects with a treatment goal of abstinence did demonstrate significant efficacy compared with placebo. This study provided outpatient treatment for withdrawal symptoms for about 10% of its participants. Furthermore, half of the subjects were not abstinent from alcohol at the start of treatment drug administration, and only 41% had a treatment goal of abstinence. Patient choice is an important factor in assessing the potential benefits of acamprosate treatment, and subjects are likely to require a treatment goal of abstinence. In the present study, we confirmed potential participants’ desire to abstain completely before enrollment; we consider patient desire to have been a crucial factor in the efficacy demonstrated in our study, and we believe that this should inform future clinical practice.