TDCS and Cognitive Retraining to Augment Pharmacotherapy for the Treatment of Nicotine Dependence

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): Nicotine dependence is associated with enhanced engagement of brain regions involved in reward processing and habitual responses that contributes to an increased motivational drive to smoke despite known negative consequences. The neural substrates underlying these drives include ventral and dorsal striatum, anterior cingulate cortex, dorsolateral prefrontal cortex, and insula. Current treatments, including both pharmacological and psychosocial interventions, target the incentive value of cigarettes, motivation to smoke, and situations that lead to smoking, but remain only modestly effective at reducing cigarette smoking. A new potential treatment for substance abuse has utilized cognitive retraining of implicit approach motivations towards substance of abuse, and likely works by reducing incentive motivation and desire to consume drugs of abuse. Few attempts have been made to explicitly enhance cortical regions involved behavioral control, another manner by which it may be possible to reduce motivational drives to smoke. Trans-cranial direct current stimulation (TDCS) is one method of brain stimulation that is known to increase cortical excitability, and its application can result in reduced craving, enhanced behavioral control, and enhanced learning, suggesting that TDCS may be useful for augmenting current treatment approaches. We propose to test the degree to which combined brain stimulation and cognitive retraining can augment nicotine replacement therapy in 1) reducing automatic approach biases towards cigarettes, and 2) reducing cigarette use in nicotine dependent individuals. To that end, we will conduct a double-blind investigation of the effects of combining full strength or sham TDCS with active or sham tobacco motivation retraining on automatic motivational biases towards cigarettes and smoking. In addition, all participants will receive a 10-week nicotine replacement regimen as the baseline treatment.