Aripiprazole Suppression of Drinking in a Clinical Laboratory Paradigm: Influence of Impulsivity and Self-Control.

Autor: Anton RF; Alcohol Research Center, Addictions Science Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina., Schacht JP; Alcohol Research Center, Addictions Science Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina., Voronin KE; Alcohol Research Center, Addictions Science Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina., Randall PK; Alcohol Research Center, Addictions Science Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.
Jazyk: angličtina
Zdroj: Alcoholism, clinical and experimental research [Alcohol Clin Exp Res] 2017 Jul; Vol. 41 (7), pp. 1370-1380. Date of Electronic Publication: 2017 Jun 05.
DOI: 10.1111/acer.13417
Abstrakt: Background: Aspects of impulsivity have been implicated in the development, or maintenance, of alcohol use disorder (AUD). The brain dopamine system is implicated in both reward processing/memory (typically subcortical) and in brain inhibitory control mechanisms (typically cortical). Using a validated clinical laboratory paradigm, the dopamine/serotonin "stabilizing" drug, aripiprazole was evaluated in non-treatment-seeking AUD individuals based on their level of impulsivity/self-control.
Methods: Ninety-nine individuals (77% male; mean age 27; 7.5 drinks per day; 83% heavy drinking days) meeting DSM-IV criteria for alcohol dependence were randomized to aripiprazole (N = 47 evaluable) or placebo (N = 48 evaluable) based on their Barratt Impulsiveness Scale (BIS-11) score (above or below 68). Aripiprazole, or similar placebo, was titrated to 15 mg over 8 days. Drinking was recorded over 6 days under natural conditions. On Day 8, after 1 day of required abstinence, individuals participated in a bar laboratory paradigm that included a priming drink (breath alcohol concentration [BAC] target 0.02 to 0.03 g/dl) and free-choice consumption of up to 8 drinks (max BAC 0.1 g/dl) in exchange for a "bar credit" of $2 per drink (max $16). End points were drinks per day under natural conditions and drinks consumed in the bar laboratory after the priming drink.
Results: There was no significant main effect of aripiprazole or interaction with BIS-11 score during the natural drinking period. However, there was a main effect of aripiprazole on bar laboratory drinking (p = 0.04) and aripiprazole reduced the total number of drinks consumed more among individuals with low self-control (p = 0.034) and increased latency to consume those drinks (p = 0.045) more among those with high impulsivity. Relative to placebo, aripiprazole caused more side effects and increased alcohol-induced sedation, but neither significantly influenced its interaction with impulsivity/self-control scores on drinking.
Conclusions: This paradigm forced a choice between immediate drinking reward and delayed monetary reward. In those with high impulsivity and/or low self-control, aripiprazole shifts the balance away from immediate drinking toward a later reward. Medications targeting cortical dopamine/serotonin balance might show clinical benefit of reduced drinking, among individuals with impulsivity/low self-control.
(Copyright © 2017 by the Research Society on Alcoholism.)
Databáze: MEDLINE
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