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

描述(申请人提供)：尼古丁依赖与参与奖赏处理和习惯性反应的大脑区域的参与增加有关，这有助于增加吸烟的动机动力，尽管已知的负面后果。这些驱动的神经基础包括腹侧和背侧纹状体、前扣带回皮质、背外侧前额叶皮质和脑岛。目前的治疗方法，包括药理学和心理社会干预措施，都以香烟的激励价值、吸烟动机和导致吸烟的情况为目标，但在减少吸烟方面仍然只有一定的效果。一种新的治疗药物滥用的潜在方法利用了对滥用物质的内隐方法动机的认知再培训，并可能通过减少激励动机和消费滥用药物的欲望来发挥作用。很少有人尝试明确地增强涉及行为控制的皮质区域，这是另一种可能减少吸烟动机的方式。经颅直流电刺激(TDC)是一种已知可以增加皮质兴奋性的脑刺激方法，其应用可以减少渴求、增强行为控制和增强学习，提示TDC可能有助于增强目前的治疗方法。我们建议测试大脑刺激和认知再培训相结合的程度可以在以下方面加强尼古丁替代疗法：1)减少对香烟的自动偏向，2)减少尼古丁依赖个人的香烟使用。为此，我们将进行一项双盲调查，研究全力以赴或虚假的TDC与积极或虚假的烟草动机再培训相结合对香烟和吸烟的自动动机偏差的影响。此外，所有参与者都将接受为期10周的尼古丁替代方案作为基线治疗。

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.