Philadelphia, PA, February 1, 2013 - Poor impulse control contributes to one's inability to control the consumption of rewarding substances, like food, alcohol, and other drugs. This can lead to the development of addiction. FDA-approved medications for alcoholism, like naltrexone (Revia) and disulfiram (Antabuse), are thought to reduce alcohol consumption by curbing cravings and creating unpleasant reactions to alcohol, effects which reduce the desire to drink alcohol.

New medications, however, might target the uncontrollable urges to consume drugs of abuse. The idea of treating problems of self-control by improving the ability to suppress impulses is not new. This approach is precisely what one is doing when counting to 10 before acting when one is upset. What is new, however, is the idea that medications might help with this process.

A new study by Lianne Schmaal at the University of Amsterdam and colleagues, published in Biological Psychiatry, suggests that modafinil (Provigil), a drug originally developed to increase wakefulness, may help some people to reduce drinking by improving their impulse control.

Although modafinil is formally approved solely for the treatment of several sleep disorders, it has been shown to enhance cognition. Such beneficial effects have been observed in healthy individuals and in patients with schizophrenia and attention-deficit/hyperactivity disorder. It has also been shown to reduce impulsivity in some individuals with addictions, but these effects had not yet been studied in non-stimulant addictions like alcohol dependence.

This background of potentially promising findings led Schmaal et al. to investigate the effects of modafinil on impulsivity in alcohol dependent patients and healthy controls. The researchers also measured participants' underlying brain activity while they completed a stop signal task designed to measure impulsive behavior.

"This line of research adopts a strategy from the attention deficit disorder 'playbook'. Modafinil has effects that resemble amphetamine. This interesting new study suggests that, if you are impulsive, modafinil may help your self-control," commented Dr. John Krystal, Editor of Biological Psychiatry.

They found that modafinil improved response inhibition in alcohol-dependent participants with initially poor response inhibition, but response inhibition was diminished in those who initially performed better. Modafinil also modulated brain activation in key brain regions directly involved response inhibition, but again, only in those patients with poor baseline response inhibition.

Schmaal explained further, "Most importantly, the study showed that modafinil had a positive effect in patients with high initial levels of impulsivity, whereas modafinil had a detrimental effect in patients with low initial levels of impulsivity. Positive effects of modafinil were associated with normalization of brain activation and connectivity patterns during the stop signal task."

These findings indicate that baseline levels of impulsivity should be taken into account when considering treatment with modafinil.

"The current observation of 'one size does not fit all' (i.e., that a pharmacotherapy may constitute a useful adjunct therapy for some individuals but not for others) calls for caution when prescribing modafinil and strongly supports the potential of and the need for personalized medicine," added Schmaal.

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The article is "Effects of Modafinil on Neural Correlates of Response Inhibition in Alcohol-Dependent Patients" by Lianne Schmaal, Leen Joos, Marte Koeleman, Dick J. Veltman, Wim van den Brink, and Anna E. Goudriaan (doi: 10.1016/j.biopsych.2012.06.032). The article appears in Biological Psychiatry, Volume 73, Issue 3 (February 1, 2013), published by Elsevier.

Notes for editors

Full text of the article is available to credentialed journalists upon request; contact Rhiannon Bugno at +1 214 648 0880 or Biol.Psych@utsouthwestern.edu. Journalists wishing to interview the authors may contact Lianne Schmaal at +31 (0) 20 89 13762 or lianschmaal@gmail.com.

The authors' affiliations, and disclosures of financial and conflicts of interests are available in the article.

John H. Krystal, M.D., is Chairman of the Department of Psychiatry at the Yale University School of Medicine and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.

About Biological Psychiatry

Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.

The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.

Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 5th out of 129 Psychiatry titles and 16th out of 243 Neurosciences titles in the Journal Citations Reports® published by Thomson Reuters. The 2011 Impact Factor score for Biological Psychiatry is 8.283.

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