Modafinil and Naltrexone to Reduce Cocaine and Alcohol Dependence (Mod-Nal)

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Kyle Kampman, University of Pennsylvania
ClinicalTrials.gov Identifier:
NCT00142818
First received: September 1, 2005
Last updated: December 12, 2013
Last verified: December 2013
  Purpose

Modafinil is a medication that may enhance mood and increase energy in cocaine addicts, which may be useful in preventing cocaine relapse. Naltrexone is a medication that is currently used to treat drug and alcohol addiction. A combination of these two medications may be beneficial in reducing drug and alcohol use in individuals undergoing substance abuse treatment. The purpose of this study is to evaluate the effectiveness of modafinil and naltrexone, alone and in combination, at reducing drug and alcohol use in individuals addicted to cocaine and alcohol.


Condition Intervention Phase
Alcohol-Related Disorders
Alcoholism
Cocaine-Related Disorders
Drug: Naltrexone
Drug: Modafinil
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase II, Double-blind, Placebo-Controlled, Pilot Trial of the Combination of Modafinil and Naltrexone for the Treatment of Cocaine and Alcohol Dependence

Resource links provided by NLM:


Further study details as provided by University of Pennsylvania:

Primary Outcome Measures:
  • Cocaine use (measured by Timeline Follow Back and urine screen at Week 14 and the 6-month evaluation) [ Time Frame: 4+13 weeks ] [ Designated as safety issue: No ]
  • Number of days of abstinence from drinking and number of days of clinically significant drinking (measured by Timeline Follow Back at Week 14 and the 6-month evaluation) [ Time Frame: 4+13 weeks ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Naltrexone-treated subjects will demonstrate a significantly greater reduction in cocaine use measured by the number of BE-negative urine samples and significantly reduced alcohol use measured by fewer days of clinically significant drinking. [ Time Frame: 4+13 weeks ] [ Designated as safety issue: No ]
  • Modafinil-treated subjects will demonstrate a significantly greater reduction in cocaine use measured by the number of BE-negative urine samples and significantly reduced alcohol use measured by fewer days of clinically significant drinking. [ Time Frame: 4+13 weeks ] [ Designated as safety issue: No ]
  • Naltrexone/modafinil-treated subjects will have fewer days of cocaine use, more abstinent days from alcohol, and fewer heavy drinking days during the follow up period compared to placebo-treated subjects. [ Time Frame: 4+13 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 200
Study Start Date: February 2006
Estimated Study Completion Date: June 2014
Primary Completion Date: August 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Nal + Mod
Drug: Naltrexone
150 mg daily for males; 100 mg daily for females
Other Name: ReVia
Drug: Modafinil
400 mg daily
Other Name: Provigil
Experimental: 2
Nal
Drug: Naltrexone
150 mg daily for males; 100 mg daily for females
Other Name: ReVia
Experimental: 3
Mod
Drug: Modafinil
400 mg daily
Other Name: Provigil
Placebo Comparator: 4
Placebo
Drug: Placebo
400 mg and/or 100-150 mg placebo pills

Detailed Description:

Cocaine and alcohol addiction are serious health problems with no available medical treatment for preventing relapse. Past research has shown that individuals who are addicted to both cocaine and alcohol typically respond poorly to conventional substance abuse treatment. Little attention has been directed towards how best to treat these individuals. Naltrexone is a medication that is currently used to treat drug and alcohol addiction. It acts by blocking the "high" feeling produced by drugs and alcohol. Modafinil, another medication, enhances mood, increases energy, and improves concentration in people with narcolepsy. Preliminary research has shown that it may produce similar effects to cocaine, thereby potentially countering the symptoms of cocaine withdrawal. Cognitive Behavioral Coping Skills Therapy (CBT), a form of therapy that aims to alter an individual's patterns of behavior and drug use, is also an important component of substance abuse treatment. The purpose of this study is to compare the effectiveness of CBT plus placebo, CBT plus modafinil, CBT plus naltrexone, and CBT plus a combination of modafinil and naltrexone at reducing cocaine and alcohol use in individuals addicted to both substances.

This 14-week study will enroll individuals addicted to both cocaine and alcohol. During a 1-week screening period, potential participants will be required to complete a detoxification program, including stopping all cocaine and alcohol use. Participants will also undergo a physical exam and an electrocardiogram. Blood will be drawn for laboratory tests, and urine tests will be used to screen for the presence of drugs and alcohol. Individuals who complete the screening and meet all study requirements will be permitted to participate in the treatment phase of the study. During the 13-week treatment phase, participants will be randomly assigned to receive modafinil, naltrexone, a combination of modafinil and naltrexone, or placebo. All participants will attend a CBT session once a week. Study visits will take place twice a week. At each visit, a urine test and breathalyzer will be used to screen for the presence of alcohol and drugs. Participants will also complete standardized psychological questionnaires to measure drug and alcohol craving, treatment services received, severity of illness, and withdrawal symptoms. In addition, participants will meet weekly with a nurse practitioner, who will dispense study medications, monitor adverse events, and evaluate the participant's clinical status. A follow-up evaluation will occur 6 months following the end of treatment.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

4.1 Inclusion Criteria

  1. Male and females, 18 years of age or older.
  2. Meets DSM-IV criteria for current diagnoses of cocaine and alcohol dependence, determined by the SCID-IV.
  3. In the past 30 days, used no less than $200-worth of cocaine and meets the following drinking criteria as measured by the Timeline Followback (TLFB) (Sobell, 1995):

    1. drank within 30 days of intake day,
    2. reports a minimum of 48 standard alcoholic (avg. 12 drinks/wk) in a consecutive 30-day period over the 90-day period prior to starting intake (i.e., a minimum of 40% days drinking), and
    3. has 2 or more days of heavy drinking (defined as 5 or more drinks per day in males and 4 or more drinks per day in females) in this same pre-treatment period.
  4. 72 consecutive hours of abstinence from alcohol, determined by self-reports and confirmed by a negative breathalyzer tests, and a Clinical Institute Withdrawal Scale for Alcohol (CIWA-AR) (Sullivan, 1989) score below eight. Subjects will be encouraged to achieve 72 consecutive hours of abstinence, however, subjects who have achieved between 48 and 72 consecutive hours of abstinence will be included with the approval of the principal investigator. We anticipate that these subjects will comprise less than 5% of total enrolled subjects. Subjects will be given 2 additional weeks beyond the screening week to attain the appropriate period of alcohol abstinence prior to randomization.
  5. Lives a commutable distance from the TRC and agrees to attend all research visits including follow-up visits.
  6. Speaks, understands, and prints in English
  7. Ability to give informed consent

Exclusion Criteria

  1. Abstinent from cocaine or alcohol for 30 consecutive days prior to signing consent form.
  2. Meets DSM IV criteria for dependence on any substance other than cocaine and alcohol (except nicotine), determined by the SCID.
  3. Needs treatment with any psychoactive medications including any anti-seizure medications (with the exception of diphenhydramine used sparingly, if necessary, for sleep).
  4. Meets current or lifetime DSM-IV criteria for schizophrenia or any psychotic disorder or organic mental disorder. Subject meets current DSM-IV diagnosis of any other clinically significant psychiatric disorder that will interfere with study participation.
  5. Has evidence of a history of significant hematological, pulmonary, endocrine, cardiovascular, renal or gastrointestinal disease (including a history of myocardial infarction, mitral valve prolapse, left ventricular hypertrophy, uncontrolled hypertension).
  6. Severe physical or medical illnesses such as AIDS, active hepatitis, significant hepatocellular injury as evidenced by elevated total bilirubin levels (>1.3 mg/dl),or elevated levels (over 4.5x normal) of aspartate aminotransferase (AST), and serum glutamic-pyruvic transaminase (SGPT) after the required 3 days of abstinence.
  7. Use of an investigational medication in the 30 days prior to randomization.
  8. History of hypersensitivity to modafinil or naltrexone
  9. Receiving chronic therapy with any drug known to interact adversely with either modafinil or naltrexone including propranolol, phenytoin, warfarin, diazepam
  10. Took a monoamine oxidase inhibitor within 30 days of randomization.
  11. Is female and tests positive on a pregnancy test, is contemplating pregnancy in the next 6 months, is nursing, or is not using an effective contraceptive method (if relevant). Acceptable methods of contraception include barrier methods (diaphragm or condom with spermicide, female condom), intrauterine progesterone contraceptive system, levonorgrestrel implant, and medroxyprogeterone acetate contraceptive injection, copper IUD, vaginal contraceptive film, cervical cap, contraceptive foam.
  12. Current use of an oral contraceptive without other acceptable barrier method of contraception.
  13. Received therapy with any opiate substitute (methadone, LAAM, buprenorphine) within 60 days of randomization
  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: NCT00142818

Locations
United States, Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104 6178
Sponsors and Collaborators
Kyle Kampman
Investigators
Principal Investigator: Kyle M. Kampman, M.D. University of Pennsylvania
  More Information

No publications provided

Responsible Party: Kyle Kampman, Principal Investigator, University of Pennsylvania
ClinicalTrials.gov Identifier: NCT00142818     History of Changes
Other Study ID Numbers: NIDA-12756-3, P50DA012756-03, DPMC
Study First Received: September 1, 2005
Last Updated: December 12, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Pennsylvania:
Alcohol Abuse
Cocaine Abuse

Additional relevant MeSH terms:
Alcoholism
Alcohol-Related Disorders
Cocaine-Related Disorders
Substance-Related Disorders
Mental Disorders
Cocaine
Naltrexone
Modafinil
Vasoconstrictor Agents
Cardiovascular Agents
Therapeutic Uses
Pharmacologic Actions
Dopamine Uptake Inhibitors
Dopamine Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Uptake Inhibitors
Physiological Effects of Drugs
Anesthetics, Local
Anesthetics
Central Nervous System Depressants
Sensory System Agents
Peripheral Nervous System Agents
Central Nervous System Agents
Narcotic Antagonists
Central Nervous System Stimulants
Neuroprotective Agents
Protective Agents

ClinicalTrials.gov processed this record on July 29, 2014