The Role of Neural Systems for Emotion Regulation in Coping with Alcohol Craving

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DESCRIPTION (provided by applicant): In this application for a K23 Career Development Award, the Principal Investigator, Nasir Naqvi, MD, PhD, proposes a comprehensive plan for becoming an independent translational researcher who is capable of integrating cognitive neuroscience and clinical methods in order to elucidate the neural mechanisms by which psychosocial treatments for alcohol dependence change behavior. Psychosocial treatments are commonly utilized, though they remain at best only moderately effective. By identifying the neural mechanisms through which psychosocial treatments change drinking behavior, it may be possible to improve their efficacy. The project focuses specifically on Cognitive Behavioral Coping Skills Therapy (CBCST), an evidence-based psychosocial treatment that promotes abstinence by teaching "coping skills" for managing alcohol-related thoughts and emotions. The proposed research combines (1) a clinical trial of CBCST in alcohol dependent patients who have completed inpatient rehabilitation and have a goal of maintaining abstinence with (2) functional MRI (fMRI) experiments that probe neural activity related to the utilization of a specifc coping skill that is taught in CBCST: reducing cue-induced craving by thinking about the negative consequences of drinking. The fMRI studies will be performed both before and immediately after treatment with CBCST, with the goal of determining (1) the pattern of neural activity that is related to coping skills utilization prior to undergoing CBCST, with particular fous on neural systems known to play a role in emotion regulation~ (2) whether this pattern of neural activity predicts abstinence vs. relapse during CBCST~ and (3) how CBCST changes this pattern of neural activity. While pursuing this line of research under the guidance of mentors who are recognized experts in psychosocial treatment mechanisms (Jon Morgenstern, PhD) and the cognitive neuroscience of emotion regulation (Kevin Ochsner, PhD), Dr. Naqvi will engage in a comprehensive training program in the following areas: (1) fMRI methods~ (2) clinical trials methods~ (3) translational neuroimaging~ (4) the relevant literature on social cognitive neuroscience, emotion regulation and psychosocial treatment mechanisms~ and (5) grant writing and management skills. This training program will build upon Dr. Naqvi's background as an addiction psychiatrist who has significant experience treating alcohol dependence, but who has relatively little experience in clinical research. Furthermore, while Dr. Naqvi is a PhD-trained cognitive neuroscientist who has already made substantial contributions to our understanding of the pathophysiology of addiction, he has no prior training or experience using fMRI methods. Thus, the K23 award will support an innovative and clinically relevant program of patient-oriented research, while helping Dr. Naqvi acquire critical skills that will ensure his development into an independent translational researcher.