Effect of rTMS to the Prefrontal Cortex in Alcohol Use Disorders

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Treatment for alcohol use disorders (AUD) is a research priority, and innovative treatment approaches are needed. The goal of this application is to investigate an innovative technology that targets a brain region, rather than a medication, for AUD. Using repetitive transcranial magnetic stimulation (rTMS) with a newly developed coil that can reach deeper brain regions (the H coil), this proposal will study the effects of deep rTMS directed at the dorsolateral prefrontal cortex, medial prefrontal cortex and anterior cingulate. Previous imaging studies heavily implicate these brain regions in AUD, and show that their dysregulation is associated with impaired decision-making, risky drinking, and weak performance on attention-demanding tasks. We will use the H7 coil, which reaches deeper and wider regions of the prefrontal cortex. Subjects with AUD (moderate to severe) will undergo alcohol self- administration sessions before and after rTMS. Subjects will be randomly assigned to high frequency active rTMS (n=16, 8M/8F) vs sham (n=16, 8M/8F). The primary outcome measure will be the amount of alcohol consumed in alcohol self-administration sessions, a laboratory model of alcohol seeking behavior, which also provides measures of craving and the subjective effects of alcohol.