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Neurocognitive Functioning Following The PROMETA® Treatment Protocol In Subjects With Alcohol Dependence

Information source: Institute of Addiction Medicine
Information obtained from ClinicalTrials.gov on October 19, 2009
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Alcohol Dependence

Intervention: Prometa Treatment Program (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: Institute of Addiction Medicine

Official(s) and/or principal investigator(s):
Jenny J Starosta, PhD, Principal Investigator, Affiliation: Institute of Addiction Medicine
Joseph Volpicelli, MD, PhD, Principal Investigator, Affiliation: Institute of Addiction Medicine

Overall contact:
Jenny J Starosta, PhD, Phone: 215-248-6025, Email: 2evolve@gmail.com

Summary

This study will test the safety and efficacy of the PROMETA® Treatment Protocol (which includes the benzodiazepine antagonist flumazenil) in reversing the neurocognitive impairment and this in turn will lead to improved ability to resist alcohol related cues and enhance involvement in psychosocial treatment.

Clinical Details

Official title: Neurocognitive Functioning Following The PROMETA® Treatment Protocol In Subjects With Alcohol Dependence

Study design: Treatment, Randomized, Double Blind (Subject, Investigator), Placebo Control, Parallel Assignment, Safety/Efficacy Study

Primary outcome: The primary outcome measure is neurocognitive functioning as assessed by a battery of standardized neurocognitive tests that assess, executive functioning, verbal memory, general intelligence, and attention.

Secondary outcome: Secondary outcome measures include, alcohol craving, subject retention, percent of abstinent days, percent of heavy drinking days, time to first heavy drinking day, and blood chemistries including liver enzymes, reports of side effects.

Detailed description: The principal aim of this study is to extend our evaluation of the PROMETA® Treatment Protocol as a means to improve neurocognitive functioning in recently detoxified alcohol dependent subjects. For many alcohol dependent patients entering treatment, a range of neurocognitive deficits are present that not only had adverse effects on the patient's ability to function and think clearly but these deficits also impair the process of addiction treatment. For example, alcohol dependent subjects typically experience high levels of alcohol craving in the early stages of treatment. The patient is left with the choice of relieving craving by drinking alcohol to provide immediate relief of craving symptoms or abstaining from alcohol to obtain long-term benefits from recovery of the complications from excessive drinking. We have previously shown in open label trials that the PROMETA® Treatment Protocol helps stimulant abusers in the early stages of recovery, have relatively low rates of relapse to stimulant use. It is not clear if the Protocol is effective because of less urges to use stimulants or the ability to resist these urges is improved from a recovery of Neurocognitive functioning. The present proposal extends our previous research by comparing the efficacy of the PROMETA® Treatment Protocol in a double blind placebo controlled trial using a new population of substance abusers (alcohol dependent subjects) and assessing the effects of the PROMETA® Treatment Protocol on neurocognitive functioning, particularly those aspects of functioning that affect the ability to make decisions that have important long-term benefits.

Eligibility

Minimum age: 18 Years. Maximum age: 75 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Patient must meet DSM-IV criteria for current diagnosis of alcohol dependence.

- In the past 30 days, patient had an average of >15 standard alcohol drinks/week with

at least one day of five or more drinks.

- Patient must have successfully completed detoxification from alcohol (abstinent for

three consecutive days). As evidenced by self-report or three negative breathalyzer reading and a CIWA-Ar score less than 6.

- Patient understands and signs the consent.

Exclusion Criteria:

- Patients with a current DSM-IV diagnosis of any substance dependence other than

alcohol, nicotine, or cannabis.

- Patients with a current or past history of DSM-IV diagnosis of Panic Disorder

- Evidence of benzodiazepine use in the past 15 days, determined by self-report and/or

by a urine drug screen

- Patients with a seizure disorder being managed with a benzodiazepine or for whom a

benzodiazepine is being considered

- Patients who are currently being treated with psychotropic medications, including

disulfiram, naltrexone, or acamprosate at the time of study entry.

- Patients with a history of unstable or serious medical illness, including need for

benzodiazepines.

- Known severe physical or medical illnesses such as AIDS, active hepatitis,

- Current severe psychiatric symptoms, e. g., psychosis, dementia, acute suicidal or

homicidal ideation, mania or depression requiring newly initiated antidepressant or psychotropic therapy, or which would make it unsafe for the patient to participate in the opinion of the primary investigator.

- Patients who have used investigational medication in the past 30 days.

- Female patients who are pregnant, nursing, or not using a reliable method of

contraception.

- Patients with a condition that would make intravenous administration of medications

difficult (e. g. absence of suitable peripheral veins).

- Have a known or hypersensitivity to medication components of PROMETA®TM

- Have been treated with PROMETA® for any reason currently or in the past year

Locations and Contacts

Jenny J Starosta, PhD, Phone: 215-248-6025, Email: 2evolve@gmail.com

Institute of Addiction Medicine, Philadelphia, Pennsylvania 19118, United States; Recruiting
Jenny J Starosta, PhD, Phone: 215-248-6025, Email: 2evolve@gmail.com
Joseph Volpicelli, MD, PhD, Phone: 215-248-6025, Email: volpj@aol.com
Jenny J Starosta, PhD, Principal Investigator
Joseph Volpicelli, MD, PhD, Principal Investigator
Additional Information

Related publications:

[No authors listed] Matching alcoholism treatments to client heterogeneity: treatment main effects and matching effects on drinking during treatment. Project MATCH Research Group. J Stud Alcohol. 1998 Nov;59(6):631-9.

Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs. 2004;18(1):37-48.

Bates ME, Pawlak AP, Tonigan JS, Buckman JF. Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change. Psychol Addict Behav. 2006 Sep;20(3):241-53.

Girdler NM, Lyne JP, Wallace R, Neave N, Scholey A, Wesnes KA, Herman C. A randomised, controlled trial of cognitive and psychomotor recovery from midazolam sedation following reversal with oral flumazenil. Anaesthesia. 2002 Sep;57(9):868-76.

Mason BJ. Treatment of alcohol-dependent outpatients with acamprosate: a clinical review. J Clin Psychiatry. 2001;62 Suppl 20:42-8. Review.

Mason BJ, Goodman AM, Chabac S, Lehert P. Effect of oral acamprosate on abstinence in patients with alcohol dependence in a double-blind, placebo-controlled trial: the role of patient motivation. J Psychiatr Res. 2006 Aug;40(5):383-93. Epub 2006 Mar 20.

Rupp CI, Fleischhacker WW, Drexler A, Hausmann A, Hinterhuber H, Kurz M. Executive function and memory in relation to olfactory deficits in alcohol-dependent patients. Alcohol Clin Exp Res. 2006 Aug;30(8):1355-62.

Singh N, Sharma A, Singh M. Possible mechanism of alprazolam-induced amnesia in mice. Pharmacology. 1998 Jan;56(1):46-50.

Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001867. Review.

Stewart SA. The effects of benzodiazepines on cognition. J Clin Psychiatry. 2005;66 Suppl 2:9-13. Review.

Tapert SF, Ozyurt SS, Myers MG, Brown SA. Neurocognitive ability in adults coping with alcohol and drug relapse temptations. Am J Drug Alcohol Abuse. 2004 May;30(2):445-60.

Uekermann J, Daum I, Schlebusch P, Wiebel B, Trenckmann U. Depression and cognitive functioning in alcoholism. Addiction. 2003 Nov;98(11):1521-9.

Zinn S, Stein R, Swartzwelder HS. Executive functioning early in abstinence from alcohol. Alcohol Clin Exp Res. 2004 Sep;28(9):1338-46.

Starting date: March 2007
Ending date: September 2008
Last updated: January 15, 2008

Page last updated: October 19, 2009

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