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。这些入路动机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。目前的治疗包括药物和心理社会干预，似乎部分是通过减少参与刺激动机的神经回路的参与，如腹侧纹状体。此外，一种新的潜在治疗方法使用了对内隐方法动机的认知再培训，可能通过减少酒精的激励动机从而减少饮酒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求、增强行为控制和增强学习，提示tdcs可能有助于增强现有的治疗方法。在认知再培训努力的基础上，我们建议1)研究与方法相关的神经机制，避免高风险饮酒者的饮酒动机，以及2)调查tDCS的应用在多大程度上可以在认知再培训方案中增强学习，并随后减少与方法相关的动机和饮酒。为此，我们将首先确定与社会饮酒者相比，高风险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，我们将对参加避免饮酒或虚假认知再培训计划的个人进行双盲调查，以了解全力以赴或虚假的tdcs对内隐酒精方法和避免动机和饮酒的影响。通过研究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酒精依赖治疗中的应用提供初步证据。

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.