Due to the modest effect of current pharmacotherapies, more effective treatments must be developed to optimally treat alcohol dependent patients. Treatments combining pharmacotherapies with different mechanisms of action may better address the diverse neurobiology of alcohol and the heterogeneity of alcoholics. Aripiprazole (APZ), a partial dopamine agonist, effects dopamine and serotonin receptors without the limiting side effects seen with other atypical antipsychotics. Dopamine medicate reward based drinking and craving. Topi ram ate (TPMT), an antiepileptic, affects glutamate and GABA-A receptors and shows promise in reducing heavy drinking. Glutamate and GABA may mediate relief-based drinking and protracted withdrawal. Despite strong evidence that multiple neurotransmitters contribute to alcoholism, few studies have used two medications with such a diverse combination of actions to examine a potential synergistic effect on reducing alcohol consumption. The primary aims are to: (1) determine if APZ and TPMT are each more effective than placebo, and the combination of APZ and TPMT is more effective than either drug alone or placebo, in reducing alcohol use in non-treatment seeking alcohol dependent subjects in an alcohol selfadministration experiment (ASAE);(2) examine a hypothesized dose-response for two doses of APZ (20mg/d and 30 mg/d) and an established dose TPMT (300mg/d);(3) examine the putative mechanisms of action of APZ, TPMT alone and together on craving, subjective stimulation, candidate gene influences and other behavioral effects associated with alcohol consumption;and (4) establish the safety of giving APZ and TPMT together. We will use of a 3 X 2 drug (20mg, 30mg APZ vs. placebo) by drug (SOOmg TPMT vs. placebo) between-subjects factorial design. Nonabstinent, non-treatment seeking, alcohol dependent persons (N=216) will be recruited from the community and randomly assigned to one of 6 cells. Subjects drinking and safety is monitored over a 5-week titration to their target dose, leading to an in-laboratory alcohol self administration session, during which clinical and behavioral effects are assessed during access to alcohol. A 1 month follow-up assesses adverse events and drinking. The long term objectives of this research are to improve medications available for alcoholism treatment and inform research and theory on the mechanisms of action of such medications.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA015753-05
Application #
8102027
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Roach, Deidra
Project Start
2007-09-15
Project End
2014-03-31
Budget Start
2011-07-01
Budget End
2014-03-31
Support Year
5
Fiscal Year
2011
Total Cost
$457,950
Indirect Cost
Name
Brown University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912
Haass-Koffler, Carolina L; Goodyear, Kimberly; Zywiak, William H et al. (2018) Corrigendum: Comparing and Combining Topiramate and Aripiprazole on Alcohol-Related Outcomes in a Human Laboratory Study. Alcohol Alcohol 53:500
Swift, Robert M; Aston, Elizabeth R (2015) Pharmacotherapy for alcohol use disorder: current and emerging therapies. Harv Rev Psychiatry 23:122-33
Vuittonet, Cynthia L; Halse, Michael; Leggio, Lorenzo et al. (2014) Pharmacotherapy for alcoholic patients with alcoholic liver disease. Am J Health Syst Pharm 71:1265-76
Haass-Koffler, Carolina L; Leggio, Lorenzo; Kenna, George A (2014) Pharmacological approaches to reducing craving in patients with alcohol use disorders. CNS Drugs 28:343-60