Temporally-Resolved Electrophysiology of Acamprosate Treatment of Alcohol Use Disorder

Summary

Background: Chronic heavy drinking can cause alcohol use disorder (AUD). AUD changes how the brain works. People with AUD may drink compulsively or feel like they cannot control their alcohol use. Acamprosate is an FDA-approved drug that reduces anxiety and craving in some, but not all, people with AUD. Objective: To learn more about how acamprosate affects brain function in people with AUD. Eligibility: People aged 21 to 65 years with moderate to severe AUD. Design: Participants will stay in the clinic for 21 days after a detoxification period of approximately 7 days. Acamprosate is a capsule taken by mouth. Half of participants will take this drug 3 times a day with meals. The other half will take a placebo. The placebo looks like the study drug but does not contain any medicine. Participants will not know which capsules they are taking. Participants will have a procedure called electroencephalography (EEG): A gel will be applied to certain locations on their scalp, and a snug cap will be placed on their head. The cap has sensors with wires. The sensors detect electrical activity in the brain. Participants will lie still and perform 2 tasks: they will look at different shapes and press a button when they see a specific one; and they will listen to tones and press dedicated buttons when they hear the corresponding tones. Participants will have 2 EEGs: 1 on day 2 and 1 on day 23 of their study participation. They may opt to have up to 4 more EEG studies (one on day 13 and one on each of the three follow-up visits) and 2 sleep studies, in which they would have sensors attached to their scalp while they sleep. Participants may have up to three follow-up visits for 6 months.

Timeline

Start

2025-05-07

Primary completion

2026-12-31

Completion

2026-12-31

Publications

• Background Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014 May 14;311(18):1889-900. doi: 10.1001/jama.2014.3628.
• Background Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 National and State Costs of Excessive Alcohol Consumption. Am J Prev Med. 2015 Nov;49(5):e73-e79. doi: 10.1016/j.amepre.2015.05.031. Epub 2015 Oct 1.
• Background Bauer LO. Predicting relapse to alcohol and drug abuse via quantitative electroencephalography. Neuropsychopharmacology. 2001 Sep;25(3):332-40. doi: 10.1016/S0893-133X(01)00236-6.
• Background Rangaswamy M, Porjesz B, Chorlian DB, Wang K, Jones KA, Bauer LO, Rohrbaugh J, O'Connor SJ, Kuperman S, Reich T, Begleiter H. Beta power in the EEG of alcoholics. Biol Psychiatry. 2002 Oct 15;52(8):831-42. doi: 10.1016/s0006-3223(02)01362-8.
• Background Rangaswamy M, Porjesz B, Chorlian DB, Wang K, Jones KA, Kuperman S, Rohrbaugh J, O'Connor SJ, Bauer LO, Reich T, Begleiter H. Resting EEG in offspring of male alcoholics: beta frequencies. Int J Psychophysiol. 2004 Feb;51(3):239-51. doi: 10.1016/j.ijpsycho.2003.09.003.
• Background Sullivan PF, Daly MJ, O'Donovan M. Genetic architectures of psychiatric disorders: the emerging picture and its implications. Nat Rev Genet. 2012 Jul 10;13(8):537-51. doi: 10.1038/nrg3240.
• Background Davies M. The role of GABAA receptors in mediating the effects of alcohol in the central nervous system. J Psychiatry Neurosci. 2003 Jul;28(4):263-74.
• Background Kalk NJ, Lingford-Hughes AR. The clinical pharmacology of acamprosate. Br J Clin Pharmacol. 2014 Feb;77(2):315-23. doi: 10.1111/bcp.12070.
• Background Naassila M, Hammoumi S, Legrand E, Durbin P, Daoust M. Mechanism of action of acamprosate. Part I. Characterization of spermidine-sensitive acamprosate binding site in rat brain. Alcohol Clin Exp Res. 1998 Jun;22(4):802-9.
• Background Umhau JC, Momenan R, Schwandt ML, Singley E, Lifshitz M, Doty L, Adams LJ, Vengeliene V, Spanagel R, Zhang Y, Shen J, George DT, Hommer D, Heilig M. Effect of acamprosate on magnetic resonance spectroscopy measures of central glutamate in detoxified alcohol-dependent individuals: a randomized controlled experimental medicine study. Arch Gen Psychiatry. 2010 Oct;67(10):1069-77. doi: 10.1001/archgenpsychiatry.2010.125.
• Background Harris BR, Prendergast MA, Gibson DA, Rogers DT, Blanchard JA, Holley RC, Fu MC, Hart SR, Pedigo NW, Littleton JM. Acamprosate inhibits the binding and neurotoxic effects of trans-ACPD, suggesting a novel site of action at metabotropic glutamate receptors. Alcohol Clin Exp Res. 2002 Dec;26(12):1779-93. doi: 10.1097/01.ALC.0000042011.99580.98.
• Background Dahchour A, De Witte P. Effects of acamprosate on excitatory amino acids during multiple ethanol withdrawal periods. Alcohol Clin Exp Res. 2003 Mar;27(3):465-70. doi: 10.1097/01.ALC.0000056617.68874.18.
• Background Spanagel R, Pendyala G, Abarca C, Zghoul T, Sanchis-Segura C, Magnone MC, Lascorz J, Depner M, Holzberg D, Soyka M, Schreiber S, Matsuda F, Lathrop M, Schumann G, Albrecht U. The clock gene Per2 influences the glutamatergic system and modulates alcohol consumption. Nat Med. 2005 Jan;11(1):35-42. doi: 10.1038/nm1163. Epub 2004 Dec 19.
• Background Mason BJ, Ownby RL. Acamprosate for the treatment of alcohol dependence: a review of double-blind, placebo-controlled trials. CNS Spectr. 2000 Feb;5(2):58-69. doi: 10.1017/s1092852900012827.
• Background Witkiewitz K, Saville K, Hamreus K. Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Ther Clin Risk Manag. 2012;8:45-53. doi: 10.2147/TCRM.S23184. Epub 2012 Feb 1.
• Background Propping P, Kruger J, Mark N. Genetic disposition to alcoholism. An EEG study in alcoholics and their relatives. Hum Genet. 1981;59(1):51-9. doi: 10.1007/BF00278854.
• Background Bauer LO. Electroencephalographic and autonomic predictors of relapse in alcohol-dependent patients. Alcohol Clin Exp Res. 1994 Jun;18(3):755-60. doi: 10.1111/j.1530-0277.1994.tb00942.x.
• Background Bauer LO, Gross JB, Meyer RE, Greenblatt DJ. Chronic alcohol abuse and the acute sedative and neurophysiologic effects of midazolam. Psychopharmacology (Berl). 1997 Oct;133(3):293-9. doi: 10.1007/s002130050404.
• Background Costa L, Bauer L. Quantitative electroencephalographic differences associated with alcohol, cocaine, heroin and dual-substance dependence. Drug Alcohol Depend. 1997 Jun 6;46(1-2):87-93. doi: 10.1016/s0376-8716(97)00058-6.
• Background Winterer G, Kloppel B, Heinz A, Ziller M, Dufeu P, Schmidt LG, Herrmann WM. Quantitative EEG (QEEG) predicts relapse in patients with chronic alcoholism and points to a frontally pronounced cerebral disturbance. Psychiatry Res. 1998 Mar 20;78(1-2):101-13. doi: 10.1016/s0165-1781(97)00148-0.
• Background Kopell N, Ermentrout GB, Whittington MA, Traub RD. Gamma rhythms and beta rhythms have different synchronization properties. Proc Natl Acad Sci U S A. 2000 Feb 15;97(4):1867-72. doi: 10.1073/pnas.97.4.1867.
• Background Coutin-Churchman P, Moreno R, Anez Y, Vergara F. Clinical correlates of quantitative EEG alterations in alcoholic patients. Clin Neurophysiol. 2006 Apr;117(4):740-51. doi: 10.1016/j.clinph.2005.12.021. Epub 2006 Feb 21.
• Background Nair Chaitanya M, Jayakkumar S, Chong E, Yeow CH. A wearable, EEG-based massage headband for anxiety alleviation. Annu Int Conf IEEE Eng Med Biol Soc. 2017 Jul;2017:3557-3560. doi: 10.1109/EMBC.2017.8037625.
• Background Chen C, Yu X, Belkacem AN, Lu L, Li P, Zhang Z, Wang X, Tan W, Gao Q, Shin D, Wang C, Sha S, Zhao X, Ming D. EEG-Based Anxious States Classification Using Affective BCI-Based Closed Neurofeedback System. J Med Biol Eng. 2021;41(2):155-164. doi: 10.1007/s40846-020-00596-7. Epub 2021 Feb 5.
• Background Muhammad F, Al-Ahmadi S. Human state anxiety classification framework using EEG signals in response to exposure therapy. PLoS One. 2022 Mar 18;17(3):e0265679. doi: 10.1371/journal.pone.0265679. eCollection 2022.
• Background Traub RD, Whittington MA, Colling SB, Buzsaki G, Jefferys JG. Analysis of gamma rhythms in the rat hippocampus in vitro and in vivo. J Physiol. 1996 Jun 1;493 ( Pt 2)(Pt 2):471-84. doi: 10.1113/jphysiol.1996.sp021397.
• Background Whittington MA, Jefferys JG, Traub RD. Effects of intravenous anaesthetic agents on fast inhibitory oscillations in the rat hippocampus in vitro. Br J Pharmacol. 1996 Aug;118(8):1977-86. doi: 10.1111/j.1476-5381.1996.tb15633.x.
• Background Porjesz B, Almasy L, Edenberg HJ, Wang K, Chorlian DB, Foroud T, Goate A, Rice JP, O'Connor SJ, Rohrbaugh J, Kuperman S, Bauer LO, Crowe RR, Schuckit MA, Hesselbrock V, Conneally PM, Tischfield JA, Li TK, Reich T, Begleiter H. Linkage disequilibrium between the beta frequency of the human EEG and a GABAA receptor gene locus. Proc Natl Acad Sci U S A. 2002 Mar 19;99(6):3729-33. doi: 10.1073/pnas.052716399. Epub 2002 Mar 12.
• Background Faulkner HJ, Traub RD, Whittington MA. Disruption of synchronous gamma oscillations in the rat hippocampal slice: a common mechanism of anaesthetic drug action. Br J Pharmacol. 1998 Oct;125(3):483-92. doi: 10.1038/sj.bjp.0702113.
• Background Saletu-Zyhlarz GM, Arnold O, Anderer P, Oberndorfer S, Walter H, Lesch OM, Boning J, Saletu B. Differences in brain function between relapsing and abstaining alcohol-dependent patients, evaluated by EEG mapping. Alcohol Alcohol. 2004 May-Jun;39(3):233-40. doi: 10.1093/alcalc/agh041.
• Background Klimesch W. EEG alpha and theta oscillations reflect cognitive and memory performance: a review and analysis. Brain Res Brain Res Rev. 1999 Apr;29(2-3):169-95. doi: 10.1016/s0165-0173(98)00056-3.
• Background Anderson NE, Baldridge RM, Stanford MS. P3a amplitude predicts successful treatment program completion in substance-dependent individuals. Subst Use Misuse. 2011;46(5):669-77. doi: 10.3109/10826084.2010.528123. Epub 2010 Nov 1.
• Background Wan L, Baldridge RM, Colby AM, Stanford MS. Association of P3 amplitude to treatment completion in substance dependent individuals. Psychiatry Res. 2010 May 15;177(1-2):223-7. doi: 10.1016/j.psychres.2009.01.033. Epub 2010 Apr 9.
• Background Costa L, Bauer L, Kuperman S, Porjesz B, O'Connor S, Hesselbrock V, Rohrbaugh J, Begleiter H. Frontal P300 decrements, alcohol dependence, and antisocial personality disorder. Biol Psychiatry. 2000 Jun 15;47(12):1064-71. doi: 10.1016/s0006-3223(99)00317-0.
• Background Hada M, Porjesz B, Begleiter H, Polich J. Auditory P3a assessment of male alcoholics. Biol Psychiatry. 2000 Aug 15;48(4):276-86. doi: 10.1016/s0006-3223(00)00236-5.
• Background Maurage P, Campanella S, Philippot P, de Timary P, Constant E, Gauthier S, Micciche ML, Kornreich C, Hanak C, Noel X, Verbanck P. Alcoholism leads to early perceptive alterations, independently of comorbid depressed state: an ERP study. Neurophysiol Clin. 2008 Apr;38(2):83-97. doi: 10.1016/j.neucli.2008.02.001. Epub 2008 Mar 3.
• Background Gilmore CS, Fein G. Theta event-related synchronization is a biomarker for a morbid effect of alcoholism on the brain that may partially resolve with extended abstinence. Brain Behav. 2012 Nov;2(6):796-805. doi: 10.1002/brb3.95. Epub 2012 Oct 5.
• Background Boeijinga PH, Parot P, Soufflet L, Landron F, Danel T, Gendre I, Muzet M, Demazieres A, Luthringer R. Pharmacodynamic effects of acamprosate on markers of cerebral function in alcohol-dependent subjects administered as pretreatment and during alcohol abstinence. Neuropsychobiology. 2004;50(1):71-7. doi: 10.1159/000077944.
• Background Bauer LO, Hesselbrock VM. Brain maturation and subtypes of conduct disorder: interactive effects on p300 amplitude and topography in male adolescents. J Am Acad Child Adolesc Psychiatry. 2003 Jan;42(1):106-15. doi: 10.1097/00004583-200301000-00017.
• Background HAMILTON M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5. doi: 10.1111/j.2044-8341.1959.tb00467.x. No abstract available.
• Background Higley AE, Crane NA, Spadoni AD, Quello SB, Goodell V, Mason BJ. Craving in response to stress induction in a human laboratory paradigm predicts treatment outcome in alcohol-dependent individuals. Psychopharmacology (Berl). 2011 Nov;218(1):121-9. doi: 10.1007/s00213-011-2355-8. Epub 2011 May 24.
• Background Pietrzak B, Czarnecka E. Effect of the combined administration of ethanol and acamprosate on rabbit EEG. Pharmacol Rep. 2005 Jan-Feb;57(1):61-9.
• Background Staner L, Boeijinga P, Danel T, Gendre I, Muzet M, Landron F, Luthringer R. Effects of acamprosate on sleep during alcohol withdrawal: A double-blind placebo-controlled polysomnographic study in alcohol-dependent subjects. Alcohol Clin Exp Res. 2006 Sep;30(9):1492-9. doi: 10.1111/j.1530-0277.2006.00180.x.

Drugs

Indications