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The Efficacy and Neurobehavioural Mechanism of Cannabidiol (CBD) for Alcohol Dependence

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT05387148
Recruitment Status : Recruiting
First Posted : May 24, 2022
Last Update Posted : June 3, 2022
Sponsor:
Collaborators:
University of Sydney
Lambert Initiative for Cannabinoid Therapeutics
Information provided by (Responsible Party):
Kirsten Morley BPsych MPH PhD, University of Sydney

Brief Summary:
The study will explore the psychophysiological and neurobiological and mechanisms of CBD in participants with alcohol use disorder

Condition or disease Intervention/treatment Phase
Alcohol Use Disorder (AUD) Drug: Cannabidiol (CBD) Drug: Placebo Phase 2

Detailed Description:

New treatment strategies for treating symptoms of alcohol dependence are urgently needed. Although alcohol related disorders are a leading cause of preventable death in Australia, their treatment is generally not evidence based. Cannabidiol (CBD) may serve as a novel pharmacotherapeutic due to its anxiolytic, anti-epileptic, neuro-protective, antioxidant and neuroprotective properties as well as a particularly safe side effect profile. Further, CBD has been shown to modulate drug craving and seeking behaviours.

This project will examine whether CBD exerts an effect on cue-induced craving by reducing activation in areas of the brain responsive to alcohol cues in comparison to a placebo. This study will use functional magnetic resonance imaging (fMRI) to examine activity in the brain while participants are exposed alcohol related cues and magnetic resonance spectroscopy (MRS) to determine levels of neurotransmitters that may be responsible for craving. In addition, we aim to investigate the effects of CBD on autonomic nervous system parameters associated with alcohol withdrawal symptoms and anxiety, such as heart rate variability and skin conductance. Additionally, clinical outcome measures will be taken to investigate CBDs influence on drinking, sleep

This project uses a randomised, double blind, crossover design with 800mg CBD vs matched placebo. The dosing paradigm will consist of one dose per day for three days per arm with a 18 days washout period in-between arms.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double (Participant, Investigator)
Masking Description: Double-blind
Primary Purpose: Treatment
Official Title: The Efficacy and Neurobehavioural Mechanism of Cannabidiol (CBD) for Alcohol Dependence: An Exploratory Pilot Study
Estimated Study Start Date : June 2022
Estimated Primary Completion Date : June 2023
Estimated Study Completion Date : June 2024

Resource links provided by the National Library of Medicine

Drug Information available for: Cannabidiol

Arm Intervention/treatment
Experimental: Cannabidiol (CBD)
For a total of three days, so that both study participants and staff are blind to treatment condition
Drug: Cannabidiol (CBD)
Four 200mg soft gel capsules of Cannabidiol (CBD) will be taken orally daily for a total of 3 days.

Placebo Comparator: Placebo
For a total of three days, so that both study participants and staff are blind to treatment condition
Drug: Placebo
The placebo will be identical in appearance, taste, and composition except for the active ingredient of pure CBD. So, four 200mg soft gel capsules of the placebo will be taken orally daily for a total of 3 days.




Primary Outcome Measures :
  1. Changes in High Frequency Heart Rate Variability [ Time Frame: 22 days ]
    To assess whether acute ingestion of CBD can modulate heart rate variability when responding to alcohol cues compared to neutral cues

  2. Changes in Skin Conductance Levels [ Time Frame: 22 days ]
    To assess whether acute ingestion of CBD modulates skin conductance levels when responding to alcohol cues compared to neutral cues

  3. Changes in Brain Activation [ Time Frame: 22 days ]
    To assess whether acute ingestion of CBD can attenuate brain activation via blood oxygen level dependent (BOLD) in areas associated with alcohol cue-elicited craving measured by an fMRI machine

  4. Changes in Neurotransmitter levels in the Brain [ Time Frame: 22 days ]
    To assess whether CBD treatment leads to changes in brain levels of the neurotransmitters: glutamate, gamma-aminobutyric acid (GABA), N-acetylaspartate (NAA) and glutathione (GSH)

  5. Heavy Drinking Days [ Time Frame: Up to 43 days ]
    Reduction in Heavy Drinking Days (HDD; defined as 4 or more drinks in a day for women and five or more drinks in a day for men). This will be measured by the Timeline Follow Back.

  6. Absence of any Heavy Drinking Day [ Time Frame: Up to 43 days ]
    Measured by Timeline Follow Back

  7. Mean Alcohol Consumption per Drinking Day [ Time Frame: Up to 43 days ]
    Measured by Timeline Follow Back

  8. Alcohol Dependence Severity [ Time Frame: Baseline ]
    Measured by the Alcohol Dependence Scale. The minimum score is 0 and the maximum score is 47. A higher score indicates more severe dependence.

  9. Alcohol Craving [ Time Frame: Up to 43 days ]
    As measured by the Penn Alcohol Craving Scale (PACS), which measures the amount of time spent thinking and craving for alcohol, difficulty in resisting consumption of alcohol if present and hypothetical pleasure associated with consumption of alcohol. This scale has a minimum score of 0 and a maximum score of 6. A higher score indicates greater levels of craving.


Secondary Outcome Measures :
  1. Changes in Alcohol Craving [ Time Frame: 22 days ]
    To assess whether acute ingestion of CBD can modulate subjective measures of alcohol cue elicited craving. This will be measured during the fMRI scan using the Visual Analogue Scale. This scale will assess alcohol craving, thirst and anxiety.

  2. Changes in Alcohol Craving in response to alcohol cues [ Time Frame: 22 days ]
    To assess whether acute ingestion of CBD can modulate subjective measures of alcohol cue elicited craving. This will be measured before and after the fMRI scan using the Alcohol Urge Questionnaire (AUQ). This Questionnaire consists of 8 questions that are scored on a Likert scale of 7 points. Two of the questions are reversed scored. Total score is computed by averaging the item scores. A greater score indicates greater craving.

  3. Changes in Positive and Negative Mood States [ Time Frame: 22 days ]
    To assess whether acute ingestion of CBD can modulate subjective measures of positive and negative mood states following alcohol cues. This will be measured before and after the fMRI scan using the Positive and Negative Affect Schedule (PANAS).

  4. Changes in Anxiety [ Time Frame: Up to 43 days ]
    Measured by cumulative scores on the DASS-21 Anxiety Scale. This scale has a minimum score of 0 and maximum score of 21. A higher score indicates more anxiety.

  5. Changes in Depression [ Time Frame: Up to 43 days ]
    Measured by cumulative scores on the DASS-21 Depression Scale. This scale has a minimum score of 0 and maximum score of 21. A higher score indicates greater depression.

  6. Changes in Stress [ Time Frame: Up to 43 days ]
    Measured by cumulative scores on the DASS-21 Stress Scale. This scale has a minimum score of 0 and maximum score of 21. A higher score indicates more stress.

  7. Sleep Disturbances [ Time Frame: Up to 43 days ]
    As measured by the ISI (Insomnia Severity Index). This Index has a minimum score of 0 and a maximum score of 28. The higher the score indicates more severe insomnia.

  8. Sleep Disturbances [ Time Frame: 22 days ]
    To assess whether acute ingestion of CBD has any impact of sleep. This will be measured by an Actiwatch. The Actiwatch records motion and light to determine information about participants sleep and wake patterns. The participants will wear this watch for 48 hours on two separate occasions.

  9. Changes in Tension Reduction Alcohol Expectancies [ Time Frame: Up to 43 days ]
    To assess whether CBD treatment can reduce participants need to use alcohol to attenuate tension states (such as anxiety) as measured by the Tension Reduction subscale of the Alcohol Expectancy Questionnaire. Higher scores indicate greater reliance on alcohol to reduce tension/ anxiety.

  10. Lifetime Consequences related to Drinking [ Time Frame: Baseline ]
    To examine the adverse consequences a participant has experienced in their lifetime due to alcohol abuse in five areas: Interpersonal, Physical, Social, Impulsive, and Intrapersonal. This is measured using the Drinker Inventory of Consequences Lifetime Edition (DrInC-2L). Higher scores indicate more consequences.

  11. Recent Consequences related to Drinking [ Time Frame: Baseline ]
    To examine the adverse consequences a participant has experienced in the last 3 months due to alcohol abuse in five areas: Interpersonal, Physical, Social, Impulsive, and Intrapersonal. This is measured using the Drinker Inventory of Consequences Recent Edition (DrInC-2R). Higher scores indicate more consequences.

  12. Behavioural Inhibition/Avoidance Scales [ Time Frame: 22 days ]
    The BIS/BAS Scale is a 20-item self-report questionnaire designed to measure two motivational systems: the behavioral inhibition system (BIS), which corresponds to motivation to avoid aversive outcomes, and the behavioral activation system (BAS), which corresponds to motivation to approach goal-oriented outcomes.

  13. Obsessive Compulsive Drinking [ Time Frame: 22 days ]
    To assess an individuals obsessive thoughts about alcohol use and compulsive behaviours towards drinking as measured by the Obsessive Compulsive Drinking Scale. Six of the questions measure to obsession and eight of the questions measure compulsivity. Higher scores on these subscales indicate more obsession and compulsion, respectively.

  14. Self-Confidence to Remain Abstinent [ Time Frame: 22 days ]
    To measure an individual's self-confidence in avoiding alcohol through the Alcohol Abstinence Self-Efficacy Scale (AASE). There are 20 questions and each is scored from 0 to 4. Higher scores on this scale indicate more self-confidence.

  15. Intolerance of Uncertainty [ Time Frame: 22 days ]
    To assess an individual's reactions to situations that are ambiguous, the consequences of being uncertain, and attempts the individual might make to control the future. This will be measured through the Intolerance of Uncertainty Scale (IUS). This scale includes 27-items that are scored on a Likert scale (1 - Not at all characteristic of me to 5 - entirely characteristic of me). All scores are summed up and a higher score indicates greater inability to deal with uncertainty.

  16. Impulsivity [ Time Frame: 22 days ]
    To assess an individual's impulsivity across four domains: urgency, lack of premeditation and perseverance, and sensation seeking. This will be measured through the Impulsivity Scale (UPPS). Greater scores on this scale indicate greater impulsivity.

  17. Alcohol Withdrawal [ Time Frame: 22 days ]
    To assess an individual's severity of alcohol withdrawal through the Clinical Institute Withdrawal Assessment of Alcohol Scale - Revised (CIWA-Ar). Greater scores on this scale indicate the participant is experiencing greater alcohol withdrawal symptoms.

  18. Approach and Avoidance towards Alcohol [ Time Frame: Up to 43 days ]
    To assess an individual's automatic action tendencies (either approve or avoid) towards alcohol. This will be measured through the Approach Avoidance Task (AAT).

  19. Response Time and Visuospatial Skills [ Time Frame: Up to 43 days ]
    To assess an individual's response time and visuospatial skills through the Trail Making Test Part A (TMT-A).

  20. Set-shifting Flexibility, Attention, and Inhibition [ Time Frame: Up to 43 days ]
    To assess an individual's set-shifting flexibility, attention and inhibition through the Trail Making Test Part B (TMT-B).

  21. Risk/Reward Taking Behaviour [ Time Frame: Up to 43 days ]
    To assess an individual's risk taking behaviour measured through the Balloon Analogue Risk Task (BART).

  22. Decision Making [ Time Frame: Up to 43 days ]
    To assess an individual's decision making skills measured through the Columbia Card Task (CCT).

  23. Response Inhibition [ Time Frame: Up to 43 days ]
    To assess an individual's ability to inhibit prepotent responses measured through the Stroop task.

  24. Working Memory Capacity to Update Information [ Time Frame: Up to 43 days ]
    To assess an individual's capacity to update working memory information measured through the N-back task.

  25. Working Memory Capacity to Shift Information [ Time Frame: Up to 43 days ]
    To assess an individual's capacity to shift between two tasks measured by the Number Letter task.

  26. Markers of neuroinflammation [ Time Frame: Up to 43 days ]
    As measured by differences in blood sampling levels of glutathione.

  27. Markers of Stress [ Time Frame: Up to 43 days ]
    As measured by differences in blood sampling levels of cortisol. This will be measured at rest, before the fMRI scan and following the fMRI scan.



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male and female patients between ages of 18 and 65 meeting DSM-5 criteria for current alcohol use disorder
  • Adequate cognition and English language skills to give valid consent and complete research interviews;
  • A BrAC reading of 0.00
  • Must have a stable residence and be able to identify an individual who could locate subject if needed
  • Provision of informed consent

Exclusion Criteria:

  • Active major psychological disorder associated with psychosis, significant suicide risk
  • Pregnancy or lactation - women shall be advised to use reliable contraception for the duration of drug therapy and a urine pregnancy test will be performed where necessary;
  • Dependence on any substance other than nicotine (eg methadone)
  • Diagnosis of epilepsy, and/or current use of anti-epileptic drugs (AED)
  • Liver failure with jaundice or prolonged INR above 1.3
  • Medical complications such as liver failure, cardiac ischemia or conduction abnormalities, renal impairment or unstable elevated vital signs (systolic blood pressure > 180, diastolic blood pressure > 120 or heart rate > 150)
  • Severe cognitive impairment or insufficient English or literacy to complete study processes
  • Concurrent use of drugs potentially exacerbated by CBD via CYP3A5 including cardiac medication (e.g. betablockers, calcium channel blockers and statins), macrolides and recent antihistamine use.
  • Claustrophobia;
  • Extreme obesity;
  • Previous brain surgery;
  • Ever employed as a machinist, a welder or a metal worker;
  • Metal items such as pacemakers; aneurysm clips in the brain; metal dental implants; metallic fragments in the eye or anywhere else; insulin pump; metal implants; hearing aid or a prosthetic device.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05387148


Contacts
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Contact: Kirsten Morley, PhD +61295153636 kirsten.morley@sydney.edu.au

Locations
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Australia, New South Wales
Drug Health Services, Royal Prince Alfred Hospital Recruiting
Sydney, New South Wales, Australia, 2050
Contact: Kirsten Morley, PhD       Kirsten.morley@sydney.edu.au   
Contact: Central Contact Line    0459877108    sydneyalcoholtreatmentgroup@gmail.com   
Principal Investigator: Paul Haber, MBBS         
Principal Investigator: Warren Logge, PhD         
Sponsors and Collaborators
South West Sydney Local Health District
University of Sydney
Lambert Initiative for Cannabinoid Therapeutics
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Responsible Party: Kirsten Morley BPsych MPH PhD, Associate Professor Kirsten Morley, University of Sydney
ClinicalTrials.gov Identifier: NCT05387148    
Other Study ID Numbers: X19-0416
First Posted: May 24, 2022    Key Record Dates
Last Update Posted: June 3, 2022
Last Verified: May 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Kirsten Morley BPsych MPH PhD, University of Sydney:
Alcohol Withdrawal
Alcohol-Related Disorders
Substance-Related Disorders
Mental Disorders
Additional relevant MeSH terms:
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Alcoholism
Alcohol-Related Disorders
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders
Cannabidiol
Anticonvulsants