Exploring the Impact of Topiramate and Smoking Abstinence on Affect in Smokers with Alcohol Use Disorder
Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Background/Purpose: Affect plays a significant role in smoking behavior and cessation treatment outcomes. Negative affect is a strong predictor of smoking lapses and has been found to be associated with diminished cessation success. It is consistently found that there is a strong association with negative affect and relapse where many factors such as sadness, anxiety, depression, and stress influence cessation outcomes. While affect has a substantial impact on smoking outcomes, it is less known how Cessation medications may influence the smoking treatment process. Topiramate, an anticonvulsant, has shown promise as an effective treatment for both alcohol and nicotine dependence in smaller clinical studies. In the present study’s parent multi-site large-scale clinical trial, topiramate is being tested as a pharmacotherapy for the co-treatment of alcohol and smoking use problems. As a secondary analysis, our aim in this study was to explore the impact of topiramate on affect over an 18-week treatment course among smokers with alcohol use disorder. In the meantime, we would also examine the impact of smoking abstinence on effect over the treatment course.
Methods: 236 community smokers with alcohol use disorder were randomized into three treatment groups: placebo, low dose topiramate (125 mg), and high dose topiramate (250 mg). During the 18-week treatment period, participants attended weekly visits where various data points were collected, including affect (measured with the Positive and Negative Affect Schedules or PANAS), abstinence status (7-day point-prevalence), demographics, and vitals. We ran linear mixed effects models to analyze the effects of abstinence status, medication, and time on positive and negative effects. To account for between-subject variability, our models included subjects as the random effects. In these models, we examined the main effects of these factors and their interaction terms.
Results/Findings: When accounting for both fixed and random effects, there is little to no significance in our results. Interactions where the combined effects of treatment group and abstinence status were assessed also did not show significance on affect outcomes, including positive and negative affect scores. However, in the model evaluating strictly the fixed effects, we found that smoking abstinence was significantly associated with an increase in positive affect. Surprisingly, we also observed that abstinence was associated with an increase in negative affect. In terms of the effect of time, we found that both positive and negative affect scores decreased over the treatment course.
Conclusion/Significance: We did not find any effect of topiramate on affect, further investigation is required to assess its role in effect within a more diverse subset of individuals. Smoking abstinence, however, was significantly associated with increased affect. These results highlight the importance of smoking cessation programs in improving emotional states and can especially be necessary in assisting vulnerable populations. Initiatives leading to abstinence can be designed to create a feedback loop where community members achieve abstinence and experience improved positive affect, which in turn supports continued abstinence. As a key future direction, we will conduct additional analysis to determine how negative effects increased among abstinent smokers.
Embargo Period
6-2-2026
Exploring the Impact of Topiramate and Smoking Abstinence on Affect in Smokers with Alcohol Use Disorder
Suwanee, GA
Background/Purpose: Affect plays a significant role in smoking behavior and cessation treatment outcomes. Negative affect is a strong predictor of smoking lapses and has been found to be associated with diminished cessation success. It is consistently found that there is a strong association with negative affect and relapse where many factors such as sadness, anxiety, depression, and stress influence cessation outcomes. While affect has a substantial impact on smoking outcomes, it is less known how Cessation medications may influence the smoking treatment process. Topiramate, an anticonvulsant, has shown promise as an effective treatment for both alcohol and nicotine dependence in smaller clinical studies. In the present study’s parent multi-site large-scale clinical trial, topiramate is being tested as a pharmacotherapy for the co-treatment of alcohol and smoking use problems. As a secondary analysis, our aim in this study was to explore the impact of topiramate on affect over an 18-week treatment course among smokers with alcohol use disorder. In the meantime, we would also examine the impact of smoking abstinence on effect over the treatment course.
Methods: 236 community smokers with alcohol use disorder were randomized into three treatment groups: placebo, low dose topiramate (125 mg), and high dose topiramate (250 mg). During the 18-week treatment period, participants attended weekly visits where various data points were collected, including affect (measured with the Positive and Negative Affect Schedules or PANAS), abstinence status (7-day point-prevalence), demographics, and vitals. We ran linear mixed effects models to analyze the effects of abstinence status, medication, and time on positive and negative effects. To account for between-subject variability, our models included subjects as the random effects. In these models, we examined the main effects of these factors and their interaction terms.
Results/Findings: When accounting for both fixed and random effects, there is little to no significance in our results. Interactions where the combined effects of treatment group and abstinence status were assessed also did not show significance on affect outcomes, including positive and negative affect scores. However, in the model evaluating strictly the fixed effects, we found that smoking abstinence was significantly associated with an increase in positive affect. Surprisingly, we also observed that abstinence was associated with an increase in negative affect. In terms of the effect of time, we found that both positive and negative affect scores decreased over the treatment course.
Conclusion/Significance: We did not find any effect of topiramate on affect, further investigation is required to assess its role in effect within a more diverse subset of individuals. Smoking abstinence, however, was significantly associated with increased affect. These results highlight the importance of smoking cessation programs in improving emotional states and can especially be necessary in assisting vulnerable populations. Initiatives leading to abstinence can be designed to create a feedback loop where community members achieve abstinence and experience improved positive affect, which in turn supports continued abstinence. As a key future direction, we will conduct additional analysis to determine how negative effects increased among abstinent smokers.