A Double-Blind, Placebo-Controlled Pilot Trial of Quetiapine for the Treatment of Type A and Type B Alcoholism

Kampman, Kyle M.; Pettinati, Helen M.; Lynch, Kevin G.; Whittingham, Tom; Macfadden, Wayne; Dackis, Charles A.; Tirado, Carlos; Oslin, David W.; Sparkman, Thorne; O’Brien, Charles P.

doi:10.1097/jcp.0b013e3180ca86e5

Cited by 80 publications

(90 citation statements)

References 42 publications

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“…Although our data did not support an expected baseline difference between typology groups in negative reinforcement smoking expectancies, the mediated moderation results suggest that stronger effects of topiramate on relief-related craving for the Type B group were implicated in suppressing their long-term increases in smoking. Consistent with prior literature on alcohol use (Kampman et al, 2007), these data support the goal of targeting negative reinforcement mechanisms of smoking in Type B alcoholic smokers.…”

Section: Discussionsupporting

confidence: 76%

“…Babor's typology has since been applied in multiple studies to evaluate its usefulness in matching patients to treatments and determining treatment outcomes (Bogenschutz et al, 2009;Kranzler et al, 1996). Although preferential pharmacological treatment outcomes by medication and type are mixed, the majority of the studies indicate that Type B alcoholics are, in general, more difficult to treat (Kampman et al, 2007).…”

mentioning

confidence: 99%

“…Whether alcoholic typology affects smoking outcomes has not been previously evaluated. We tested the hypothesis that topiramate's effects on smoking would be moderated by alcohol-dependence subtype, such that Type A alcoholics would demonstrate a preferential drug treatment response as compared to the Type B group, based on the hypothesized differences in nicotine dependence and previous studies indicating that Type B alcoholics are more generally resistant to treatment (Kampman et al, 2007). Last, we explored differences in smoking outcome expectancies between the two typologies and whether the hypothesized subtype differences in response to topiramate were mediated by craving.…”

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confidence: 99%

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Type A/Type B Alcoholism Predicts Differential Response to Topiramate in a Smoking Cessation Trial in Dually Diagnosed Men

Isgro

Doran

Heffner

et al. 2017

J. Stud. Alcohol Drugs

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ABSTRACT. Objective:Babor's A/B typology characterizes alcoholdependence subtypes, which differ across multiple defining variables; however, differences in cigarette smoking and cessation between these subtypes have not been previously investigated. Topiramate reduces heavy drinking and has separately been found to help non-alcoholdependent individuals quit smoking. This study tested the hypothesis that topiramate's effects on smoking would be moderated by alcohol-dependence subtype, and explored craving as a mediator of this response. Method: One hundred twenty-nine abstinent alcohol-dependent outpatient male smokers participated in this 12-week, randomized controlled trial comparing topiramate (maximum dosage 200 mg/day) with placebo, both with brief counseling, for smoking cessation. Participants were followed for 24 weeks following end of treatment. Results: Of the 125 participants with sufficient subtyping data, k-means cluster analysis categorized 52 (42%) as Type A alcoholics and 73 (58%) as Type B. Types A and B did not differ on baseline smoking characteristics, urges to smoke, or smoking consequence scores. Longitudinal mixed-effects regression indicated that the effect of treatment on smoking was moderated by the Type × Time interaction. Specifically, during the nontreatment follow-up phase, Type B's treated with topiramate had relative suppressed levels of smoking compared with placebo-treated Type B's. This moderating effect of the Type × Time interaction was mediated by intention to smoke and craving related to relief of negative affect. Conclusions: Type B alcoholics demonstrated suppressed levels of smoking in response to topiramate treatment as compared with placebo, but only during the nontreatment follow-up phase. This effect was mediated, in part, through intention to smoke and craving to smoke to relieve negative affect. Our findings extend other studies demonstrating a differential medication response by alcoholism subtype. (J. Stud. Alcohol Drugs, 78, 232-240, 2017)

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Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Type A/Type B Alcoholism Predicts Differential Response to Topiramate in a Smoking Cessation Trial in Dually Diagnosed Men

Isgro

Doran

Heffner

et al. 2017

J. Stud. Alcohol Drugs

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“…El anticonvulsivante topiramato, un regulador gabaérgico / glutamatérgico, ha obtenido evidencias de eficacia a través de dos estudios controlados 6,7 . Varios agentes antipsicóticos, moduladores de las vías dopaminérgicas, también han sido ensayados con resultados dispares y con poca evidencia de eficacia hasta la fecha 8,9 .…”

Section: Introductionunclassified

Amisulpride en el tratamiento de la dependencia alcohólica

Flórez¹,

Sáiz²,

García‐Portilla³

et al. 2011

Adicciones

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Background: 6-month naturalistic, open-label trial to compare amisulpride versus topiramate and naltrexone as a treatment for patients with alcohol dependence, with assessments at enrolment and after 3 and 6 months of treatment. Methods: 274 alcohol-dependent patients who had been drinking heavily during the past month were included. Once detoxified, patients were assigned to one of three treatment groups (naltrexone 50 mgr per day, topiramate 200 mgr per day or amisulpride 100 mgr per day). Patients were assessed at baseline and after 3 and 6 months of follow-up. Outcome was measured using tools that assessed alcohol intake (EuropASI and Alcohol Timeline Followback), craving (OCDS), disability (WHO/DAS), and quality of life (EQ-5D); changes in biomarkers of alcohol intake were also noted. Results: at the 6-month follow-up patients taking amisulpride had poorer results than those taking topiramate in direct measures of alcohol intake (OCDS, alcohol intake, number of drinks per day and heavy drinking days), but no significant differences were found in these measures on comparing the amisulpride patients with those taking naltrexone. Conclusions: in this study, amisulpride, at a dose of 100 mgr per day, was less effective than topiramate, at a dose of 200 mg per day, but as effective as naltrexone, at a dose of 50 mg per day, for reducing alcohol intake and craving over the period of the study.

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“…Both studies demonstrated that quetiapine was well tolerated and in the latter study, the medication not only reduced alcohol consumption and overall psychiatric symptom intensity but also significantly reduced craving. A double-blind placebo-controlled study by Kampman and colleagues evaluated the effect of quetiapine and found that the medication was well tolerated and clinically effective in reducing drinking [162]. The effect of medication was found to be stronger in individuals with a more severe disease phenotype.…”

Section: Clinical Evidence For the Use Of Atypical Dopamine D2 Antagomentioning

confidence: 99%

Dopamine and Alcohol Dependence: From Bench to Clinic

Jayaram‐Lindström¹,

Ericson²,

Steensland³

et al. 2016

Recent Advances in Drug Addiction Research and Clinical Applications

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Alcohol dependence, a chronic relapsing psychiatric disorder, is a major cause of mortality and morbidity. The role of dopamine in alcohol-induced reward as well in the development of alcohol dependence is reviewed herein. Both preclinical and clinical studies have suggested that alcohol activates the mesolimbic dopamine system (defined as a dopamine projection from the ventral tegmental area (VTA) to the nucleus accumbens (NAc, i.e. ventral striatum)) leading to a euphoric sensation. Alcohol dependence is characterized by a disruption in the reward-related brain areas including fewer dopamine D2 receptors in ventral striatum. Investigations of the underlying dopaminergic mechanisms involved during the development and maintenance of alcohol dependence could identify novel targets. Human and rodent experimental studies show that dopamine receptor antagonists, agonists and partial agonists as well as dopamine stabilizers influencing dopamine transmission, alter alcohol-mediated behaviours and thus may be potential treatment targets for alcohol dependence. Although there exists promising preclinical results, the majority of placebo-controlled randomized clinical trials with traditional dopamine antagonists and agonists have so far have been discouraging. Furthermore, the severe side-effect profiles of many of these compounds may limit their clinical use. Newer dopamine agents, such as partial agonists and dopamine stabilizers, attenuate alcohol-mediated behaviours in rodents as well as humans. Preclinical as well as clinical studies have shown that substances indirectly targeting the mesolimbic dopamine system may be potential targets for attenuation of alcohol reward. Collectively, the data reviewed herein may contribute to further understanding the complex mechanisms involved in development of alcohol dependence and we suggest that the newer dopamine agents as well as indirect modulators of dopamine signalling deserve to be further evaluated for treatment of alcohol dependence.

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A Double-Blind, Placebo-Controlled Pilot Trial of Quetiapine for the Treatment of Type A and Type B Alcoholism

Abstract: Quetiapine may be effective for the treatment of alcohol dependence, particularly in the more complicated Type B, early-onset alcoholics.

Cited by 80 publications

References 42 publications

Type A/Type B Alcoholism Predicts Differential Response to Topiramate in a Smoking Cessation Trial in Dually Diagnosed Men

Type A/Type B Alcoholism Predicts Differential Response to Topiramate in a Smoking Cessation Trial in Dually Diagnosed Men

Amisulpride en el tratamiento de la dependencia alcohólica

Dopamine and Alcohol Dependence: From Bench to Clinic

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