New research suggests a medication originally designed to increase wakefulness may help some people reduce drinking by improving their impulse control.
Poor impulse control can lead to a person’s inability to moderate consumption of substances such as food, alcohol and other drugs. This behavioral flaw can lead to the development of addiction.
Existing FDA approved medications for alcoholism — including naltrexone (Revia) and disulfiram (Antabuse) — are thought to reduce alcohol consumption by curbing cravings and creating unpleasant reactions to alcohol.
A new study suggests a third medication — modafinil (Provigil) — may also help some people to reduce drinking by improving their impulse control.
Although modafinil is already approved solely for the treatment of several sleep disorders, it has been shown to enhance a person’s ability to think and to think more clearly. Such beneficial effects have been observed in healthy individuals and in patients with schizophrenia and attention-deficit hyperactivity disorder.
Modafinil has also been shown to reduce impulsivity in some individuals with addictions, but these effects had not yet been studied in non-stimulant addictions — like alcohol dependence.
Lianne Schmaal, Ph.D., at the University of Amsterdam and colleagues investigated the effects of modafinil on impulsivity in alcohol-dependent patients and healthy controls. The researchers also measured participants’ underlying brain activity while they completed a stop signal task designed to measure impulsive behavior.
“This line of research adopts a strategy from the attention deficit disorder playbook. Modafinil has effects that resemble amphetamine. This interesting new study suggests that, if you are impulsive, modafinil may help your self-control,” commented Dr. John Krystal, editor of Biological Psychiatry.
Researchers discovered modafinil improved response inhibition in alcohol-dependent participants with initially poor response inhibition, but response inhibition was diminished in those who initially performed better.
Modafinil also curbed brain activation in key brain regions associated with response inhibition, but again, only in those patients with poor baseline response inhibition.
Schmaal explained further, “Most importantly, the study showed that modafinil had a positive effect in patients with high initial levels of impulsivity, whereas modafinil had a detrimental effect in patients with low initial levels of impulsivity.
Positive effects of modafinil were associated with normalization of brain activation and connectivity patterns during the stop signal task.”
These findings indicate that baseline levels of impulsivity should be taken into account when considering treatment with modafinil.
“The current observation of ‘one size does not fit all’ (i.e., that a pharmacotherapy may constitute a useful adjunct therapy for some individuals but not for others) calls for caution when prescribing modafinil and strongly supports the potential of and the need for personalized medicine,” added Schmaal.