Modifying Alcohol Approach Motivations with tDCS and Cognitive Retraining

描述（由申请人提供）：摄入酒精的动机是导致酒精使用障碍发展和维持的最重要因素之一。这些接近动机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脑岛。目前的治疗方法包括药理学和社会心理干预，似乎部分通过减少与激励动机有关的神经回路的参与，如腹侧纹状体。此外，一种新的潜在治疗方法，使用内隐方法动机的认知再训练，可能通过减少对酒精的激励动机，从而减少消费酒精的欲望来发挥其效果。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饮酒动机的方式。经颅直流电刺激（tDCS）是一种已知可以增加皮质兴奋性的脑刺激方法，它的应用可以减少渴望，增强行为控制和增强学习，这表明tDCS可能有助于增强当前的治疗方法。在认知再训练的基础上，我们建议：1)研究高危饮酒者接近和避免饮酒动机的神经机制；2)研究tDCS在认知再训练过程中提高学习能力的程度，从而减少与接近和饮酒相关的动机。为此，我们将首先确定与社交饮酒者相比，高危饮酒者对酒精相关刺激的回避反应的神经相关性。在这项初步研究之后，我们将进行一项双盲调查，研究全强度或假性tDCS对参与避免酒精或假性认知再训练项目的个体的影响，这些项目涉及内隐酒精方法和避免动机和饮酒。通过检查tDCS对酒精相关动机认知再训练的影响，我们希望为脑刺激技术在治疗酒精依赖中的效用提供初步证据。

DESCRIPTION (provided by applicant): Motivation to ingest alcohol is among the most important factors that contributes to the development and maintenance of alcohol use disorders. The neural substrates underlying these approach motivations include ventral and dorsal striatum, anterior cingulate cortex, dorsolateral prefrontal cortex, and insula. Current treatments including both pharmacological and psychosocial interventions, appear to work in part by reducing engagement of neural circuits involved in incentive motivation such as the ventral striatum. Further, a new potential treatment that uses cognitive retraining of implicit approach motivations likely exerts its effects by reducing incentive motivation for alcohol and thus the desire to consume alcohol. 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 use alcohol. Transcranial direct current stimulation (tDCS) is one method of brain stimulation that is known to increase cortical excitability, and its application can result in redued craving, enhanced behavioral control, and enhanced learning, suggesting that tDCS may be useful for augmenting current treatment approaches. Building on cognitive retraining efforts, we propose to 1) investigate the neural mechanisms associated with approach and avoid motivations towards alcohol in high risk drinkers, and 2) investigate the degree to which application of tDCS can enhance learning during cognitive retraining protocols and subsequently reduce approach related motivations and drinking. To that end, we will first determine the neural correlates of avoidance responses to alcohol related stimuli in high risk drinkers as compared to social drinkers. Following this initial study, we will conduct a double-blind investigation of the effects of full strength or sham tDCS on individuals engaged in an avoid alcohol or sham cognitive retraining program on implicit alcohol approach and avoid motivations and drinking. By examining the effects of tDCS on cognitive retraining of alcohol related motivations, we hope to provide initial evidence of the utility of brain stimulation techniques in treatment for alcohol dependence.