The overarching goal of this study is to build on the results of our pre-clinical and clinical screening experiments of anticonvulsant efficacy and toxicity to guide the development of safer and more effective medications for the treatment of alcohol dependence. This investigation will examine the effects of representative anticonvulsants from three chemical classes: a sugar sulfamate, topiramate;a heterocyclic sulfonamide, zonisamide;and a pyrrolidine, levetiracetam on ethanol consumption and neurotoxicity in alcohol dependent subjects. These medications share some common pharmacologic effects, but also have different actions that are relevant to regulation of ethanol consumption, tolerability, and safety in humans. The primary aim of this proposal is to conduct a double blind placebo controlled parallel group design study with 4 treatment groups (N=40 in each group) in alcohol dependent subjects assigned to receive one of the active study medications or placebo for 14 weeks. We hypothesize that: during the expected period of maximal steady state plasma concentrations, (treatment weeks 10-12), the mean number of drinks per day in each active treatment arm will be significantly lower than in the placebo arm. Furthermore we hypothesize that secondary measures of alcohol consumption and positive clinical outcome in each active treatment arm will show significantly greater efficacy compared to the placebo group. We also hypothesize that subjects in the topiramate group will show greater impairment on a composite measure of neurotoxicity, and tests of verbal fluency and attention than do the other active drug or placebo groups. The immediate benefits of this study will be to help determine if novel anticonvulsants offer safer and more effective alternatives to agents currently approved for the treatment of alcoholism. The broader implications of the study are to guide the selection of existing compounds and the synthesis of new agents for alcoholism treatment based on the chemical classes of the study medications. In turn, this will advance the development of innovative pharmacotherapies for alcohol dependence.

Public Health Relevance

Currently approved medications for the treatment of alcoholism are associated with limited effectiveness and their adoption in clinical practice has been slow. The goal of the current study is to find more effective and safer medications for alcoholism by studying agents that differ in chemical structure and pharmacologic actions from those currently available.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Health Services Research Review Subcommittee (AA)
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Fertig, Joanne
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Boston Medical Center
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Devine, Eric G; Knapp, Clifford M; Sarid-Segal, Ofra et al. (2015) Payment expectations for research participation among subjects who tell the truth, subjects who conceal information, and subjects who fabricate information. Contemp Clin Trials 41:55-61
Knapp, Clifford M; Ciraulo, Domenic A; Sarid-Segal, Ofra et al. (2015) Zonisamide, topiramate, and levetiracetam: efficacy and neuropsychological effects in alcohol use disorders. J Clin Psychopharmacol 35:34-42
Oldham, Mark A; Ciraulo, Domenic A (2014) Bright light therapy for depression: a review of its effects on chronobiology and the autonomic nervous system. Chronobiol Int 31:305-19
Knapp, Clifford M; Ciraulo, Domenic A; Datta, Subimal (2014) Mechanisms underlying sleep-wake disturbances in alcoholism: focus on the cholinergic pedunculopontine tegmentum. Behav Brain Res 274:291-301
Knapp, Clifford M; O'Malley, Matthew; Datta, Subimal et al. (2014) The Kv7 potassium channel activator retigabine decreases alcohol consumption in rats. Am J Drug Alcohol Abuse 40:244-50
Devine, Eric G; Waters, Megan E; Putnam, Megan et al. (2013) Concealment and fabrication by experienced research subjects. Clin Trials 10:935-48
Ciraulo, Domenic A; Barlow, David H; Gulliver, Suzy Bird et al. (2013) The effects of venlafaxine and cognitive behavioral therapy alone and combined in the treatment of co-morbid alcohol use-anxiety disorders. Behav Res Ther 51:729-35
Afshar, Maryam; Knapp, Clifford M; Sarid-Segal, Ofra et al. (2012) The efficacy of mirtazapine in the treatment of cocaine dependence with comorbid depression. Am J Drug Alcohol Abuse 38:181-6
Streeter, Chris C; Whitfield, Theodore H; Owen, Liz et al. (2010) Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. J Altern Complement Med 16:1145-52
Knapp, Clifford M; Sarid-Segal, Ofra; Richardson, Mark A et al. (2010) Open label trial of the tolerability and efficacy of zonisamide in the treatment of alcohol dependence. Am J Drug Alcohol Abuse 36:102-5

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