Abstract
Rationale
Cue-exposure therapy (CET) has been advocated as a potentially effective treatment of addictive behaviours. Strategies that enhance learning may improve the outcome of CET. d-cycloserine (DCS), a partial N-methyl-d-aspartate receptor agonist, has been shown to facilitate extinction of learned fear in rats and augment exposure-based treatment in some anxiety disorders in man.
Objective
This double-blind placebo-controlled pilot study used a cue-exposure paradigm, salient for an individual’s alcohol drinking, to see if DCS would reduce cue-reactivity compared with placebo.
Methods
Sixteen abstinent, alcohol-dependent individuals were randomised to receive either a single-dose (250 mg) DCS or placebo before CET sessions, separated by at least 1 week. Subjective responses were assessed using the Alcohol Urge Questionnaire (AUQ) and visual analogue scales. Cardiovascular responses were assessed using Finapres©.
Results
The cue-exposure paradigm significantly increased craving assessed with the AUQ during the first session. In subsequent sessions, the degree of craving was reduced. However, no significant difference was seen between the DCS and placebo groups in any outcome measure. The variability of responses between individuals was great with more than half the groups reporting no or very small changes in AUQ scores.
Conclusion
This is the first human study to our knowledge to assess the efficacy of DCS in facilitating CET in alcohol dependence. The high proportion of subjects with little or no response to cue-exposure would make any effect of DCS very difficult to detect. It is important that future studies carefully consider the criteria for inclusion.
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Acknowledgments
This study was funded by the Avon and Wiltshire Mental Health Partnership NHS Trust R&D Department. There is no conflict of interest with any of the authors in relation to this article.
Funding
This study was funded by the Avon and Wiltshire Mental Health Partnership NHS Trust R&D Department.
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Watson, B.J., Wilson, S., Griffin, L. et al. A pilot study of the effectiveness of d-cycloserine during cue-exposure therapy in abstinent alcohol-dependent subjects. Psychopharmacology 216, 121–129 (2011). https://doi.org/10.1007/s00213-011-2199-2
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DOI: https://doi.org/10.1007/s00213-011-2199-2