Weight-Loss Drug Topiramate Helps Keep Cocaine Addicts in Treatment
Simultaneous Cocaine and Alcohol Addiction
Cocaine and alcohol carry risks for abuse and addiction because they alter the brain chemistry in longtime users and make the brain dependent on their continuing presence. People addicted to these substances subsequently develop persistent cravings for their use and make drastic, dysfunctional changes in their daily routines to support the fulfillment of these cravings. By itself, cocaine addiction puts affected individuals at great risk for a variety of life-threatening health problems. The risks to life are even more severe in cocaine addicts who develop alcoholism, as well as in alcoholics who develop cocaine addictions. Experts in the field refer to the simultaneous use of more than one abused substance as polydrug use.
Topiramate was developed as an anti-seizure medication designed to limit the effects of epilepsy or another condition known as Lennox-Gastaut syndrome. In addition, doctors use it to help prevent the onset of migraines in people prone to this type of headache. When combined with another prescription medication called phentermine, topiramate also helps decrease appetite and promote weight loss in people who carry enough excess body weight to meet the standard definition for obesity or morbid obesity. In all of these situations, the medication achieves its primary effects by slowing down the normal rate of communication between the brain’s main nerve cells.
Prior research findings indicate that use of topiramate can ease the effects of alcoholism in people who don’t have cocaine addictions, and can also ease the effects of cocaine addiction in people unaffected by alcoholism. In these contexts, the medication apparently produces its benefits by reducing the ability of both alcohol and cocaine to alter the brain’s chemical environment. In the study published in Drug and Alcohol Dependence, the University of Pennsylvania researchers sought to determine topiramate’s effects on people with coexisting alcohol and cocaine addictions. They undertook their efforts because no previous studies had specifically explored this issue.
The new study involved 170 adults with simultaneous cocaine and alcohol addictions who had gone through withdrawal and subsequently established a significant period of drug and alcohol abstinence. Half of these adults received regular doses of topiramate for 13 weeks, while the other half received a placebo for the same amount of time. Each participant was assigned to one of these two groups randomly, and none of them knew if they received topiramate or the placebo. As part of their overall recovery plan, all study participants also received regular psychotherapeutic treatment.
Over the course of the study, some of the participants continued to successfully abstain from cocaine and/or alcohol use, while others did not. After reviewing the evidence for topiramate’s impact, the researchers concluded that the medication did not reduce the cravings for cocaine use in people with simultaneous cocaine/alcohol addictions. However, compared to addicts who received a placebo medication, the addicts who received topiramate stayed in treatment for a substantially longer period of time. In addition, in the study’s final three weeks, one-fifth of the topiramate users managed to abstain from cocaine use, while less than one-tenth of the placebo users managed to remain cocaine free. Critically, the participants with heavy cocaine addictions also remained drug-free while using topiramate roughly twice as often as those who received a placebo medication.
Significance and Considerations
The authors of the study in Drug and Alcohol Dependence concluded that topiramate use also reduced the level of alcohol craving in the study’s participants. However, use of the medication did not improve the participants’ ability to stay alcohol-free or reduce their alcohol intake. This finding does not match up with the findings of previous studies on topiramate. To explain this discrepancy, the authors note that topiramate may only produce beneficial alcohol-related effects in alcoholics with very heavy high levels of intake. Altogether, they believe that their work points toward a real usefulness for topiramate as a treatment option for people addicted to both alcohol and cocaine.