Biobehavioral mechanisms of topiramate's effects on alcohol use: an investigation pairing laboratory and ecological momentary assessments

被引:46
作者
Miranda, Robert, Jr. [1 ]
MacKillop, James [1 ,3 ]
Treloar, Hayley [1 ]
Blanchard, Alexander [1 ]
Tidey, Jennifer W. [1 ]
Swift, Robert M. [1 ,2 ]
Chun, Thomas [1 ]
Rohsenow, Damaris J. [1 ]
Monti, Peter M. [1 ]
机构
[1] Brown Univ, Ctr Alcohol & Addict Studies, Box S121-5, Providence, RI 02912 USA
[2] Prov Vet Affairs Med Ctr, Providence, RI 02908 USA
[3] Univ Georgia, Dept Psychol, Athens, GA 30602 USA
基金
美国国家卫生研究院;
关键词
Craving; medication action; topiramate; SUBJECTIVE RESPONSES; HEAVY DRINKERS; DRINKING; CONSUMPTION; DEPENDENCE; PROGRAMS; URGE;
D O I
10.1111/adb.12192
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
Topiramate reduces drinking, but little is known about the mechanisms that precipitate this effect. This double-blind randomized placebo-controlled study assessed the putative mechanisms by which topiramate reduces alcohol use among 96 adult non-treatment-seeking heavy drinkers in a laboratory-based alcohol cue reactivity assessment and in the natural environment using ecological momentary assessment methods. Topiramate reduced the quantity of alcohol heavy drinkers consumed on drinking days and reduced craving while participants were drinking but did not affect craving outside of drinking episodes in either the laboratory or in the natural environment. Topiramate did not alter the stimulant or sedative effects of alcohol ingestion during the ascending limb of the blood alcohol curve. A direct test of putative mechanisms of action using multilevel structural equation mediation models showed that topiramate reduced drinking indirectly by blunting alcohol-induced craving. These findings provide the first real-time prospective evidence that topiramate reduces drinking by reducing alcohol's priming effects on craving and highlight the importance of craving as an important treatment target of pharmacotherapy for alcoholism.
引用
收藏
页码:171 / 182
页数:12
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