Type A/Type B Alcoholism Predicts Differential Response to Topiramate in a Smoking Cessation Trial in Dually Diagnosed Men.
Babor's A/B typology characterizes alcohol-dependence subtypes, which differ across multiple defining variables; however, differences in cigarette smoking and cessation between these subtypes have not been previously investigated. Topiramate reduces heavy drinking and has separately been found to help non-alcohol-dependent individuals quit smoking. This study tested the hypothesis that topiramate's effects on smoking would be moderated by alcohol-dependence subtype, and explored craving as a mediator of this response.



One hundred twenty-nine abstinent alcohol-dependent outpatient male smokers participated in this 12-week, randomized controlled trial comparing topiramate (maximum dosage 200 mg/day) with placebo, both with brief counseling, for smoking cessation. Participants were followed for 24 weeks following end of treatment.



Of the 125 participants with sufficient subtyping data, k-means cluster analysis categorized 52 (42%) as Type A alcoholics and 73 (58%) as Type B. Types A and B did not differ on baseline smoking characteristics, urges to smoke, or smoking consequence scores. Longitudinal mixed-effects regression indicated that the effect of treatment on smoking was moderated by the Type × Time interaction. Specifically, during the nontreatment follow-up phase, Type B's treated with topiramate had relative suppressed levels of smoking compared with placebo-treated Type B's. This moderating effect of the Type × Time interaction was mediated by intention to smoke and craving related to relief of negative affect.



Type B alcoholics demonstrated suppressed levels of smoking in response to topiramate treatment as compared with placebo, but only during the nontreatment follow-up phase. This effect was mediated, in part, through intention to smoke and craving to smoke to relieve negative affect. Our findings extend other studies demonstrating a differential medication response by alcoholism subtype.
Pacific Treatment and Research Center (Pac-TARC), San Diego Veterans Affairs Healthcare System, San Diego, California.|Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Melodie
M
Isgro
Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Neal
N
Doran
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Jaimee L
JL
Heffner
Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Esther
E
Wong
Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Elizabeth
E
Dinh
Pacific Treatment and Research Center (Pac-TARC), San Diego Veterans Affairs Healthcare System, San Diego, California.
Jessie
J
Tibbs
Pacific Treatment and Research Center (Pac-TARC), San Diego Veterans Affairs Healthcare System, San Diego, California.|Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Katie
K
Russell
Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Tracy
T
Bittner
Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Chris
C
Wehrle
Pacific Treatment and Research Center (Pac-TARC), San Diego Veterans Affairs Healthcare System, San Diego, California.|Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Matthew J
MJ
Worley
Pacific Treatment and Research Center (Pac-TARC), San Diego Veterans Affairs Healthcare System, San Diego, California.|Department of Psychiatry, University of California, San Diego, Health Sciences, La Jolla, California.
Robert M
RM
Anthenelli
D000328:Adult; D000437:Alcoholism / Q000523:psychology*; D066249:Craving; D017831:Diagnosis, Dual (Psychiatry); D004311:Double-Blind Method; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D014029:Tobacco Use Disorder / Q000523:psychology; D000077236:Topiramate
D000077236:Topiramate; D005632:Fructose