July 19, 2013
Epilepsy Drug May Help Addicts Kick The Habit
Several past studies have shown the drug to be effective for those addicted to either cocaine or alcohol, but no clinical trials have been performed on people addicted to both. Since cocaine and alcohol addictions often come together, it may be useful to research therapies that target both problems.
The study included 170 participants addicted to both alcohol and cocaine who were part of a 13-week trial in which some received topiramate and others a placebo. Addicts had an average age of 45 and were comprised of predominantly African American males using crack cocaine.
The study found the drug reduced alcohol cravings, but participants continued to drink the same amount. And while topiramate appeared to have no affect on cocaine cravings, addicts who were on topiramate were more likely to cease cocaine use and continue the trial in the last three weeks than those who took the placebo. Those with the most intense cocaine withdrawal symptoms such as agitation, restless behavior and mood aggression seemed to benefit the greatest from topiramate.
Kyle M. Kampman, MD, professor of Psychiatry at the Perelman School of Medicine said, "Cocaine dependence continues to be a significant public health concern in the United States and Europe. Drug counseling remains the treatment of choice, but many patients do not respond completely to it, so developing effective medications for treatment is a research priority. Based on the study's results, this drug, plus cognitive behavioral therapy, may be a good option for people addicted to both alcohol and cocaine to help reduce their cocaine use."
Topiramate is an FDA approved anti-convulsant medication that works by increasing the brain's levels of gamma-Aminobutyric acid (GABA), which is the nervous system's primary inhibitory neurotransmitter.
For the combination of drug and alcohol addiction, it is hypothesized that GABA may lessen the amount of dopamine released from drug and alcohol use which would lower the feelings of euphoria that encourage the habit. In 2005, Dr. Kampman performed a small pilot study that found topiramate to help participants stay away from cocaine for three weeks or more.
Due to previous studies with topiramate, it was surprising participants did not experience reduced alcohol dependence. These results may be explained by the severity of the participants' addiction. In this trial, the average days on which participants drank "heavily" was only 12 percent versus other studies that were closer to 50 percent. Thus topiramate may have greater benefits for people who drink more heavily.
In the last three weeks of the trial, 20 percent of addicts on topiramate tested negative for cocaine compared to only 7 percent who took the placebo. Significantly, 17.6 percent of heavy users abstained from cocaine altogether by the end of the trial compared to only 8.8 percent who were on the placebo. Dr. Kampman explained the results, saying the drug likely had a more positive impact on heavy users because they experience higher levels of cocaine euphoria.
Of participants receiving topiramate, 65 percent stayed in the trial to the end while only 59 percent of those on the placebo continued.
Dr. Kampman said, "This study further supports topiramate as a promising medication for people who are both alcohol and cocaine dependent. Future studies are planned in which topiramate will be combined with other promising medications for the treatment of cocaine dependence in the hope of achieving even higher levels of cocaine abstinence than were achieved with topiramate alone."
This study was published in the journal Drug and Alcohol Dependence.