title: A pilot study of the effectiveness of D-cycloserine during cue-exposure therapy in abstinent alcohol-dependent subjects.
abstract: BACKGROUND
  Cue-exposure therapy (CET) has been advocated as a potentially effective treatment of addictive behaviours. Strategies that enhance learning may improve the outcome of CET. D-cycloserine (DCS), a partial N-methyl-D-aspartate receptor agonist, has been shown to facilitate extinction of learned fear in rats and augment exposure-based treatment in some anxiety disorders in man.
  
  
  OBJECTIVE
  This double-blind placebo-controlled pilot study used a cue-exposure paradigm, salient for an individual's alcohol drinking, to see if DCS would reduce cue-reactivity compared with placebo.
  
  
  METHODS
  Sixteen abstinent, alcohol-dependent individuals were randomised to receive either a single-dose (250 mg) DCS or placebo before CET sessions, separated by at least 1 week. Subjective responses were assessed using the Alcohol Urge Questionnaire (AUQ) and visual analogue scales. Cardiovascular responses were assessed using Finapres©.
  
  
  RESULTS
  The cue-exposure paradigm significantly increased craving assessed with the AUQ during the first session. In subsequent sessions, the degree of craving was reduced. However, no significant difference was seen between the DCS and placebo groups in any outcome measure. The variability of responses between individuals was great with more than half the groups reporting no or very small changes in AUQ scores.
  
  
  CONCLUSIONS
  This is the first human study to our knowledge to assess the efficacy of DCS in facilitating CET in alcohol dependence. The high proportion of subjects with little or no response to cue-exposure would make any effect of DCS very difficult to detect. It is important that future studies carefully consider the criteria for inclusion.
authors.affiliation: Psychopharmacology Unit, Bristol University, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY, UK. ben.watson@bristol.ac.uk
authors.forename: B J
authors.initials: BJ
authors.lastname: Watson
authors.forename: S
authors.initials: S
authors.lastname: Wilson
authors.forename: L
authors.initials: L
authors.lastname: Griffin
authors.forename: N J
authors.initials: NJ
authors.lastname: Kalk
authors.forename: L G
authors.initials: LG
authors.lastname: Taylor
authors.forename: M R
authors.initials: MR
authors.lastname: Munafò
authors.forename: A R
authors.initials: AR
authors.lastname: Lingford-Hughes
authors.forename: D J
authors.initials: DJ
authors.lastname: Nutt
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D003463:Cues; D003523:Cycloserine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005108:Extinction, Psychological / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods*; D016194:Receptors, N-Methyl-D-Aspartate / Q000819:agonists; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D016194:Receptors, N-Methyl-D-Aspartate; D003523:Cycloserine