title: Effect of modafinil on impulsivity and relapse in alcohol dependent patients: a randomized, placebo-controlled trial.
abstract: Poor impulse control plays an important role in the development, course and relapse of substance use disorders. Therefore, improving impulse control may represent a promising approach in the treatment of alcohol dependence. This study aimed to test the effect of modafinil on impulse control and alcohol use in alcohol dependent patients (ADP) in a randomized, double-blind, placebo-controlled trial. Eighty-three abstinent ADP were randomized to 10 weeks modafinil (300 mg/d) or placebo. Alcohol use was quantified using the timeline follow-back method and was assessed until 6 months after treatment discontinuation. Impulsivity was assessed using self-report questionnaires (Barratt Impulsiveness Scale; State Impulsivity questionnaire) and neurocognitive tasks (Stop Signal Task; Delay Discounting Task) administered before, during and after treatment. Modafinil significantly improved self-report measures of state impulsivity, but had no effect on percentage of abstinent days or percentage of heavy drinking days, nor on the behavioral measures of impulsivity. However, subgroup analysis revealed that modafinil prolonged the time to relapse (p=.022) and tended to increase the percentage of abstinent days (p=.066) in ADP with poor response inhibition at baseline, whereas modafinil increased the percentage of heavy drinking days (p=.003) and reduced the percentage of abstinent days (p=.002) in patients with better baseline response inhibition. Overall results do not favor the use of modafinil in order to reduce relapse or relapse severity in ADP, and caution is required in prescribing modafinil to a non-selected sample of ADP. Further research on the effect of modafinil in ADP with poor baseline response inhibition is warranted.
authors.affiliation: Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium. leen_joos@hotmail.com
authors.forename: Leen
authors.initials: L
authors.lastname: Joos
authors.forename: Anna E
authors.initials: AE
authors.lastname: Goudriaan
authors.forename: Lianne
authors.initials: L
authors.lastname: Schmaal
authors.forename: Erik
authors.initials: E
authors.lastname: Fransen
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
authors.forename: Bernard G C
authors.initials: BG
authors.lastname: Sabbe
authors.forename: Geert
authors.initials: G
authors.lastname: Dom
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000503:physiopathology / Q000517:prevention & control*; D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007175:Impulsive Behavior / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D000077408:Modafinil; D010352:Patient Dropouts; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D057566:Self Report
chemical_list: D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil
keywords: Alcohol dependence; Impulse control; Modafinil; Relapse; Response inhibition; State impulsivity