Neuromodulation Applications in Alcohol Use Disorder

National Institute On Alcohol Abuse And Alcoholism

Investigators

Abstract

Evaluating Real Time fMRI Neurofeedback - During the past four years we have worked with collaborators in the National Institute on Mental Health (NIMH) and developed and implemented several neurofeedback prototypes for the Siemens 3T Prisma scanner. We have completed stage 1 of this study and continue our recruitment for stage 2 of the study from the Alcohol Use Disorder (AUD) inpatient behavioral unit. A manuscript was published in the journal of Psychophysiology (Fede et al., 2023) detailing the evaluation of three real time neurofeedback algorithms with the goal of downregulating craving. In this study participants received one of three types of neurofeedback: multi-region of interest (ROI), support vector machine with continuous feedback (cSVM) and support vector machine with intermittent feedback (iSVM). Performance was assessed on the success rate, change in neural downregulation and change in self-reported craving for alcohol. According to our results, participants had more successful trials in run 4 versus 1, as well as improved downregulation of the insula, anterior cingulate, and dorsolateral prefrontal cortex (dlPFC). Greater downregulation of the latter two regions predicted greater reduction in craving. iSVM performed significantly worse than the other two methods. Downregulation of the striatum and dlPFC, enabled by ROI but not cSVM neurofeedback, was correlated with a greater reduction in craving. Our results suggested an advantage of multi-ROI over SVM and intermittent feedback approaches. TMS Neuromodulation of Negative Urgency We had planned to initiate another collaborative study with Dr. Lauren Atlas in order to assess how negative urgency relates to impulsive decision-making in individuals with alcohol use disorder (AUD); and to characterize the associated hemodynamic response in prefrontal areas using functional near infrared spectroscopy (fNIRS) imaging. Due to COVID-19 restrictions the preparation of laboratory space for this project has been delayed. Upon completion of the pilot study, we will test whether negative urgency can be modulated via prefrontal stimulation using repetitive transcranial magnetic stimulation (rTMS), as this technique has been shown to affect top-down regulatory circuits (prefrontal-limbic) during emotion regulation and impulsive decision-making, which are the two key components of negative urgency.