Effect of Varenicline on Reactivity to Smoking and Drinking Cues in Individuals With Concurrent Tobacco Dependence and Alcohol Use

This study has been completed.
Sponsor:
Collaborator:
Canadian Institutes of Health Research (CIHR)
Information provided by:
Centre for Addiction and Mental Health
ClinicalTrials.gov Identifier:
NCT00873535
First received: March 31, 2009
Last updated: January 22, 2010
Last verified: January 2010
  Purpose

Alcohol and nicotine dependence are often co-morbid, with 85% of alcoholics also smoking. However, very little research has been conducted into the nature of this co-occurrence. Thus, the main aim of this study is to assess differences in alcohol and tobacco consumption and cue-induced craving in treatment-seeking smokers after two weeks treatment of varenicline.

Hypotheses

  1. Two weeks of varenicline treatment will significantly decrease cue-induced tobacco craving compared to placebo (Due to the actions of varenicline on alpha-4-beta-2 receptors and its downstream effect on dopamine release).
  2. Varenicline will decrease cue-induced alcohol craving compared to placebo.
  3. The impact of Varenicline on cue-induced alcohol craving will be greater in heavy drinkers compared to social drinkers.

Condition Intervention
Tobacco Dependence
Alcohol Dependence
Drug: Varenicline
Drug: Placebo

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: Effect of Varenicline on Reactivity to Smoking and Drinking Cues in Individuals With Concurrent Tobacco Dependence and Alcohol Use

Resource links provided by NLM:


Further study details as provided by Centre for Addiction and Mental Health:

Primary Outcome Measures:
  • The Questionnaire of Smoking Urges and the Alcohol Craving Questionnaire. (This questionnaire is used following visual cue presentation consisting of smoking, drinking and neutral pictures). [ Time Frame: day 1, day 14 ] [ Designated as safety issue: No ]
  • Obsessive Compulsive Drinking Scale. (This questionnaire is used following visual cue presentation consisting of smoking, drinking and neutral pictures). [ Time Frame: day 1, day 14 ] [ Designated as safety issue: No ]
  • Diary (Subjects will track their consumption of cigarettes and alcohol in this diary) [ Time Frame: day 1 -14 (inclusive) ] [ Designated as safety issue: No ]

Enrollment: 48
Study Start Date: October 2008
Study Completion Date: January 2010
Primary Completion Date: January 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Varenicline Drug: Varenicline
This group (N=40) will receive Varenicline (0.5mg once daily for days 1-3, 0.5mg twice daily for days 4-7 followed by 1mg twice daily for days 8-14). The group will consist of heavy smokers and heavy drinkers (N=20) and heavy smokers and social drinkers (N=20).
Other Names:
  • Chantix
  • Champix
Placebo Comparator: Placebo Drug: Placebo

Detailed Description:

The relationship between alcohol and tobacco dependence needs to be addressed as such populations are generally excluded from clinical trials involving smoking cessation pharmacotherapy. Furthermore, the effect of Varenicline(Pfizer Pharmaceuticals)treatment on tobacco cue-induced craving has not been empirically measured, nor has the effect of varenicline on alcohol consumption. In addition to being an effective aid in smoking cessation, preliminary evidence has shown that Varenicline can decrease alcohol consumption in animal models.

Varenicline is a partial agonist of the α4β2 nicotinic acetylcholine receptor. This drug's partial agonist effect allows for the activation of this receptor at a lesser degree than nicotine while simultaneously preventing nicotine binding due to the drugs high affinity (i.e.: antagonist effect) for this receptor subtype.

Varenicline has recently been approved in Canada as an aid for smoking cessation. This study will be a double-blind, placebo-controlled randomized study. It will assess differences in alcohol and tobacco consumption and cue-induced craving in treatment-seeking smokers after two weeks of treatment with either varenicline or placebo.Ultimately This study may help to further understand the association between smoking and drinking alcohol.

This study will consist of two study groups composed of 40 subjects each being randomized to receive either placebo or varenicline (0.5mg once daily for days 1-3, 0.5mg twice daily for days 4-7 followed by 1mg twice daily for days 8-14). One group will be heavy smokers and heavy drinkers while the other will be heavy smokers and social drinkers. Upon entering the study, subjects will undergo baseline cognitive and craving measures for both tobacco and alcohol associated cue presentations prior to randomization to varenicline or placebo. Subjects will be provided a 1-week supply of study medications and directions for use. During this period, subjects will be requested to complete a diary outlining their cigarette and alcohol craving and consumption each day and outline any adverse effects. Upon completion of this 1-week period, subjects will attend the Centre for Addiction and Mental Health (CAMH) where their old pill bottles and daily diaries will be collected and they will be supplied with study medication (1mg varenicline taken twice daily or placebo) and daily diary for an additional week. At this visit, subjects will complete the symptom checklist. At the end of the second week of treatment, subjects will be requested to return to CAMH where craving for tobacco and alcohol and cue-reactivity will be assessed in a similar manner as to study day After study completion, all subjects will be given the option to continue with varenicline in a 12-week treatment plan through the Nicotine Dependence Clinic.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria: Heavy Smokers/Heavy Drinkers

  • Treatment seeking smokers
  • Age 18 to 65 years
  • Smoke ≥ 10 cigarettes per day
  • Fagerstrom Test of Nicotine Dependence score > 3
  • Alcohol Use Disorders Identification Test (AUDIT) > 8
  • Drink > 25 drinks per week for males or > 20 drinks per week for females
  • Able to provide written informed consent

Inclusion Criteria (Heavy Smokers/Social Drinkers):

  • Treatment seeking smokers
  • Age 18 to 65 years
  • Smoke ≥ 10 cigarettes per day
  • Fagerstrom Test of Nicotine Dependence score > 3
  • Alcohol Use Disorders Identification Test(AUDIT) < 8
  • Drink < 14 drinks per week for males or < 9 drinks per week for females
  • Able to provide written informed consent

Exclusion Criteria (Heavy Smokers/Heavy Drinkers):

  • Any medical condition requiring immediate investigation or treatment
  • Beck Depression Inventory score >16
  • Insulin-dependent diabetes
  • Drink > 70 standard alcoholic drinks per week for males or drink > 52 standard alcoholic drinks per week for females
  • Pregnancy or lactation
  • Current DSM-IV Axis 1 psychiatric disorder
  • Regular use of any therapeutic or recreational psychoactive drug use during the last three months or other substance use disorder, with the exception of tobacco and alcohol.

Exclusion Criteria (Heavy Smokers/Social Drinkers):

  • Any medical condition requiring immediate investigation or treatment
  • Beck Depression Inventory score >16
  • Insulin-dependent diabetes
  • Drink > 14 standard alcoholic drinks per week for males or > 9 standard alcoholic drinks per week for females
  • Pregnancy or lactation
  • Current DSM-IV Axis 1 psychiatric disorder
  • Regular use of any therapeutic or recreational psychoactive drug use during the last three months or other substance use disorder, with the exception of tobacco.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00873535

Locations
Canada, Ontario
Centre for Addiction and Mental Health
33 Russell Street, Toronto, Ontario, Canada, M5S 2S1
Sponsors and Collaborators
Centre for Addiction and Mental Health
Canadian Institutes of Health Research (CIHR)
Investigators
Principal Investigator: Usoa E. Busto, Pharm.D. Centre for Addiction and Mental Health
  More Information

Additional Information:
Publications:
Responsible Party: Dr. Usoa E. Busto, Centre for Addiction and Mental Health
ClinicalTrials.gov Identifier: NCT00873535     History of Changes
Other Study ID Numbers: 114/2008
Study First Received: March 31, 2009
Last Updated: January 22, 2010
Health Authority: Canada: Health Canada
Canada: Canadian Institutes of Health Research

Keywords provided by Centre for Addiction and Mental Health:
Nicotine
Nicotine dependence
Smoking cessation
Alcohol
Alcohol dependence
Alcohol cessation
Treatment
Smoking
Cigarette
Heavy drinkers
Social drinkers
Co-morbidity of alcohol and nicotine dependence
Nicotine receptor
Nicotinic receptor
Nicotinic acetycholine receptor
Alpha-4-beta-2 nicotinic acetycholine receptor
Cholinergic receptor
Dopamine
Craving
Diary
Cue induced
Pharmacotherapy
Varenicline
Chantix
Champix

Additional relevant MeSH terms:
Alcoholism
Tobacco Use Disorder
Alcohol-Related Disorders
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders
Varenicline
Nicotinic Agonists
Cholinergic Agonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on September 18, 2014