OBJECTIVE: In a cost-effectiveness analysis we compared the socioeconomic relevance of adjuvant treatment of alcoholic patients with acamprosate with different other possible treatments but acamprosate. The main objective was to reveal whether this adjuvant treatment is more cost-effective compared to the control group considering direct and indirect costs. Further objectives were to compare the abstinence rate one year after the onset of the study, the duration of abstinence until the next relapse and the number of abstinent days during the observational period. METHODS: In a prospective multicentre cohort study we observed 1200 alcohol dependent patients over a period of 12 month per patient, 800 patients in the acamprosate cohort, 400 in the control group. RESULTS: At the end of the study data of 766 patients could be considered in the statistical analysis (510 of the acamprosate cohort, 256 of the control group). The two groups of the study population were comparable in terms of sociodemographic variables. The number of abstinent patients treated with acamprosate was 41.2 % (per protocol analysis), only 25.4 % (per protocol analysis) of all patients in the control group were abstinent during the study period. Although the drug costs are three times higher in the acamprosate cohort the cost analysis resulted in total costs of DM 3,026 ($1,593) per patient/year for the acamprosate group compared to DM 4,199 ($2,210) per patient/year in the control group, a significant cost saving potential of DM 1,173 ($617). Hospitalization could be identified as the most cost driving factor, which was significant higher in the control group. CONCLUSION: Based on the results of this study, it is suggested that an initial expensive adjuvant treatment of alcoholism leads to less cost than any other single therapy.