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

描述（由申请人提供）：尼古丁依赖与参与奖励处理和习惯性反应的大脑区域的参与增强有关，这有助于增加吸烟的动机驱动力，尽管已知有负面后果。这些驱动背后的神经基质包括腹侧和背侧纹状体、前扣带皮层、背外侧前额叶皮层和小脑。目前的治疗，包括药理学和心理社会干预，目标是香烟的激励价值，吸烟的动机，以及导致吸烟的情况，但在减少吸烟方面仍然只有适度的效果。药物滥用的一种新的潜在治疗方法利用了对滥用药物的内隐接近动机的认知再训练，并且可能通过减少激励动机和消费滥用药物的欲望来起作用。很少有人试图明确地增强涉及行为控制的皮层区域，这是另一种可能减少吸烟动机的方式。经颅直流电刺激（TDCS）是一种已知可增加皮质兴奋性的脑刺激方法，其应用可导致减少渴望，增强行为控制和增强学习，这表明TDCS可用于增强当前的治疗方法。我们建议测试结合脑刺激和认知再训练可以在1）减少对香烟的自动接近偏差和2）减少尼古丁依赖个体的香烟使用方面增强尼古丁替代疗法的程度。为此，我们将进行一项双盲调查，研究将全强度或假TDCS与主动或假烟草动机再培训相结合对自动动机偏见的影响。此外，所有受试者将接受为期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.