title: Varenicline effects on drinking, craving and neural reward processing among non-treatment-seeking alcohol-dependent individuals.
abstract: BACKGROUND
  The α4β2 nicotinic acetylcholine receptor partial agonist varenicline has been reported to reduce drinking among both heavy-drinking smokers and primary alcoholics, and this effect may be related to varenicline-mediated reduction of alcohol craving. Among smokers, varenicline has been reported to modulate cigarette cue-elicited brain activation in several reward-related areas.
  
  
  OBJECTIVE
  This pilot study tested varenicline's effects on drinking, alcohol craving, and alcohol cue-elicited activation of reward-related brain areas among non-treatment-seeking alcohol-dependent individuals.
  
  
  METHODS
  Thirty-five such individuals (mean age = 30, 57 % male, 76 % heavy drinking days in the past month, 15 smokers) were randomized to either varenicline (titrated to 2 mg) or placebo for 14 days, and were administered an alcohol cue reactivity fMRI task on day 14. A priori regions of interest (ROIs) were bilateral and medial orbitofrontal cortex (OFC), right ventral striatum (VS), and medial prefrontal cortex (mPFC).
  
  
  RESULTS
  Despite good medication adherence, varenicline did not reduce heavy drinking days or other drinking parameters. It did, however, increase self-reported control over alcohol-related thoughts and reduced cue-elicited activation bilaterally in the OFC, but not in other brain areas.
  
  
  CONCLUSIONS
  These data indicate that varenicline reduces alcohol craving and some of the neural substrates of alcohol cue reactivity. However, varenicline effects on drinking mediated by cue-elicited brain activation and craving might be best observed among treatment-seekers motivated to reduce their alcohol consumption.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA, schacht@musc.edu.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Schacht
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Anton
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Randall
authors.forename: Xingbao
authors.initials: X
authors.lastname: Li
authors.forename: Scott
authors.initials: S
authors.lastname: Henderson
authors.forename: Hugh
authors.initials: H
authors.lastname: Myrick
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D000437:Alcoholism / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D001552:Benzazepines / Q000494:pharmacology* / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology; D001931:Brain Mapping; D066249:Craving / Q000187:drug effects*; D003463:Cues; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009042:Motivation; D018722:Nicotinic Agonists / Q000494:pharmacology* / Q000627:therapeutic use; D010865:Pilot Projects; D011810:Quinoxalines / Q000494:pharmacology* / Q000627:therapeutic use; D012201:Reward; D000068580:Varenicline; D055815:Young Adult
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D000068580:Varenicline