Galantamine and Computerized Cognitive Behavioral Therapy for Cocaine Dependence

Carroll, Kathleen M.; Nich, Charla; DeVito, Elise E.; Shi, Julia; Sofuoglu, Mehmet

doi:10.4088/jcp.17m11669

Cited by 51 publications

(41 citation statements)

References 57 publications

(60 reference statements)

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“…In addition to seeking treatment for cocaine, all participants were currently enrolled in methadone maintenance treatment for opioid-use disorder. Consistent with the parent trial (20), the fMRI sample was predominantly male (63.5%) and unemployed (73.0%), with multiple prior treatment attempts (outpatient: 2.97± 3.63, inpatient: 3.16±5.24) and legal problems (lifetime arrests: 5.46±6.29). Following exclusion of individuals with incomplete data (n=4) or excessive motion during scanning (n=17; further details below), the final sample used for CPM analyses consisted of 53 individuals (73.6% male).…”

Section: Participants and Recruitmentmentioning

confidence: 63%

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Connectome-Based Prediction of Cocaine Abstinence

Yip

Scheinost

Potenza³

et al. 2019

AJP

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153

127

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Objective: To identify a brain-based predictor of cocaine abstinence using a recently developed machine learning approach, connectome-based predictive modeling (CPM). CPM is a predictive tool and a method of identifying networks that underlie specific behaviors ('neural fingerprints'). Methods: Fifty-three individuals participated in neuroimaging protocols at the start of treatment for cocaine-use disorder, and again at the end of 12-week treatment. CPM with leave-one-out cross-validation was run to identify pre-treatment networks that predicted abstinence (percent cocaine-negative urines during treatment). Networks were applied to post-treatment fMRI data to assess changes over time and ability to predict abstinence during follow-up. The predictive ability of identified networks was then tested in separate, heterogeneous sample of individuals scanned prior to treatment for cocaine use disorder (n=45). Results: CPM predicted abstinence during treatment, as indicated by a high correspondence between predicted and actual abstinence values (r (df=52) =0.42, p=0.001). Identified networks included connections within and between canonical networks implicated in cognitive/ executive control (frontoparietal, medial frontal) and in reward responsiveness (subcortical, salience, motor/ sensory). Connectivity strength did not change with treatment, and strength at post-treatment also predicted abstinence during follow-up (r (df=39) =0.34, p=0.03). Network strength in the independent sample predicted treatment response with 64% accuracy by itself, and with 71% accuracy when combined with baseline cocaine-use.

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Section: Participants and Recruitmentmentioning

confidence: 63%

“…Participants (n=74) were recruited from a randomized controlled trial of behavioral therapy plus galantamine or placebo treatment for cocaine-use disorder (20). Demographic and clinical characteristics are shown in Table 1.…”

Section: Participants and Recruitmentmentioning

confidence: 99%

Connectome-Based Prediction of Cocaine Abstinence

Yip

Scheinost

Potenza³

et al. 2019

AJP

Self Cite

153

127

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“…Data used for these analyses was composed of a sample of 474 individuals pooled from five RCTs designed to evaluate pharmacological and/or behavioral treatments for CUD in different outpatient settings. Primary outcome results and CONSORT diagrams for each study have been published (Carroll et al, 2008;Carroll et al, 2014b;Carroll et al, 2018;Carroll et al, 2016;Carroll et al, 2012). All five trials shared common characteristics such as similar inclusion/exclusion criteria, identical assessment battery and similar treatment duration (8 or 12 weeks).…”

Section: Participant and Study Designmentioning

confidence: 99%

Short and long-term improvements in psychiatric symptomatology to validate clinically meaningful treatment outcomes for cocaine use disorders

Miguel

Kiluk

Babuscio

et al. 2019

Drug and Alcohol Dependence

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Background: Substantial efforts have been made to identify clinically meaningful nonabstinence cocaine use outcomes by establishing associations between targeted drug use outcomes and long-term functional improvements. Psychiatric symptomatology is prevalent among those seeking treatment for cocaine use disorder (CUD). Establishing an association between cocaine use outcomes and improvements in psychiatric symptomatology would support clinical validity to these outcome measures. Method: With data pooled from 5 clinical trials evaluating treatment for CUD (n= 474) multiple linear mixed models were conducted to determine how five specific cocaine use outcome measures performed in terms of improvements in psychiatric symptomatology assessed with the Brief Symptom Inventory (BSI) at baseline, end-of-treatment and 6-month follow-up. Results: Three outcome measures performed comparably well (maximum days of consecutive abstinence, 3 or more weeks of abstinence and end-of-treatment abstinence), in that they consistently predicted improvements in several BSI composite scores at the end-of-treatment and follow-up. The poorer-performing outcome measures were complete abstinence during treatment, percentage of negative urinalysis results and percentage of days abstinent. Improvements in the BSI's global index of distress, positive symptom total, as well as depression, interpersonal sensitivity, obsessive-compulsion, phobic-anxiety and psychoticism dimensions were consistently

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“…In human studies, galantamine showed promising results as a treatment for alcohol or tobacco use disorder [160, 161]. In a recent randomized clinical trial, galantamine, compared to placebo, reduced cocaine use among cocaine and opioid addictive individuals that were stabilized on methadone [162]. AChE inhibitors have not been examined for the treatment of OUD in humans.…”

Section: Future Directions For Medication Developmentmentioning

confidence: 99%

The Cholinergic System as a Treatment Target for Opioid Use Disorder

et al. 2018

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Opioid overdoses recently became the leading cause of accidental death in the United States, marking an increase in the severity of the opioid use disorder (OUD) epidemic that is impacting global health. Current treatment protocols for OUD are limited to opioid medications, including methadone, buprenorphine and naltrexone. While these medications are effective in many cases, new treatments are required to more effectively address the rising societal and interpersonal costs associated with OUD. Here we review the opioid and cholinergic systems, and we examine the potential of acetylcholine (ACh) as a treatment target for OUD. The cholinergic system includes enzymes that synthesize and degrade ACh and receptors that mediate ACh’s effects. ACh is involved in many central nervous system functions that are critical to the development and maintenance of OUD, such as reward and cognition. Medications that target the cholinergic system have been approved for the treatment of Alzheimer’s disease, tobacco use disorder and nausea. Clinical and preclinical studies suggest that medications such as cholinesterase inhibitors and scopolamine, which target components of the cholinergic system, show promise for the treatment of OUD and further investigations are warranted.

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Galantamine and Computerized Cognitive Behavioral Therapy for Cocaine Dependence

Abstract: ClinicalTrials.gov identifier: NCT00809835.

Cited by 51 publications

References 57 publications

Connectome-Based Prediction of Cocaine Abstinence

Connectome-Based Prediction of Cocaine Abstinence

Short and long-term improvements in psychiatric symptomatology to validate clinically meaningful treatment outcomes for cocaine use disorders

The Cholinergic System as a Treatment Target for Opioid Use Disorder

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