Modafinil for Alcohol Dependence: In Search of Solutions to an Epidemic

Derick E. Vergne, MD


March 25, 2014

In This Article

Effect of Modafinil on Impulsivity and Relapse in Alcohol Dependent Patients: A Randomized, Placebo-Controlled Trial

Joos L, Goudriaan AE, Schmaal L, et al
Eur Neuropsychopharmacol. 2013;23:948-955

The Role of the Frontal Lobes in Inhibition/Disinhibition

Alcohol abuse and dependence are a leading cause of morbidity and mortality in the United States and worldwide.[1] The problem has been tackled on many fronts, and real answers remain elusive.

The psychosocial and psychological aspects of alcohol dependence treatment and recovery are beyond the scope of this article, although they are probably of fundamental importance. The role of impulsivity and its neurobiological underpinnings in the etiology and progression of alcoholism has become a new avenue of intense study.[2,3]

To understand the role that impulsivity might play in the genesis and progression of alcohol dependence, it is necessary to first understand the role of the human frontal lobes in the proper inhibition of impulses. Efficient functioning of the frontal lobes and their connection to more primitive subcortical structures is needed for proper inhibition of impulses.[4,5,6] The advent of the frontal lobes by evolutionary processes added to the brain the capacity for task completion -- a critical cognitive task needed for our ancestors to survive.[7,8]

Dramatic examples of the loss of frontal lobe function can be observed in acquired frontal lobe injury, in which patients become more disinhibited and highly impulsive -- typically the reason they are seen by the psychiatrist in the first place. In other words, the frontal lobes are our "evolutionary brakes." Developmental, genetic, or structural (acquired) frontal brain loss turns the disciplined person into the undisciplined, and the reliable person into the opposite.


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