Brain Targets for Alcohol Craving in Veterans with mTBI.

产品说明： 轻度创伤性脑损伤（mTBI）是当前军事冲突的标志性损伤：伊拉克自由行动，持久自由行动和新黎明行动（OEF/OIF/OND）。在这些冲突的退伍军人中，mTBI通常与精神健康障碍如创伤后应激障碍（PTSD）共同发生。危险的酒精使用或可能的酒精使用障碍（AUD）在退伍军人中也非常普遍。AUD的存在对我们患有TBI的退伍军人的康复效果有进一步的负面影响。渴望，或渴望消费某种物质，是AUD的一个重要特征。酒精渴望对康复产生负面影响，并与酒精戒断成瘾者的复发有关。到目前为止，还没有研究检查酒精渴望在退伍军人中的作用，这些退伍军人同时患有mTBI，PTSD和AUD（mTBI+PTSD+AUD）。因此，当前CDA II应用的目标是表征酒精渴求，更好地理解酒精渴求的潜在机制，并开发一种新的治疗干预措施来减少酒精渴求。为此，将招募OEF/OIF/OND退伍军人，并根据自我报告和神经心理学评估将其分为两组：1）可能患有AUD（单独AUD）的无症状战斗控制退伍军人和2）mTBI+PTSD+AUD退伍军人。首先，将比较这两组中的酒精渴望和过度饮酒。这将通过对酒精使用进行客观测量来实现（例如，尿液和呼吸酒精浓度测试），酒精使用的自我报告，以及酒精渴望。第二，酒精渴望的神经生理机制将被检查，以开发一种新的治疗干预减少渴望。为此，退伍军人将参加一项功能性磁共振成像（fMRI）协议，在该协议中，将测量大脑激活对观看与酒精相关的图像与中性图像的反应。还将进行先进的神经成像程序，以确定大脑中白色物质纤维的结构完整性，并确定神经元网络中的自发活动，这一过程称为功能连接分析。将对神经影像学数据进行综合评价，以阐明酒精渴求的潜在机制，并沿着文献，这些数据将用于制定神经治疗干预重复经颅磁刺激（rTMS）的方案。第三，将检查单次rTMS治疗对患有mTBI+PTSD+AUD的退伍军人的酒精渴望沿着神经活动和连接的安全性、可行性和即时效果。退伍军人将完成神经成像，酒精渴望，和酒精使用的措施，如上文所述的前和后rTMS。还将在rTMS后一天、一周和一个月通过电话访谈评估自我报告的酒精渴望。预计这个创新项目将为我们的基础知识提供一个缺失的基本元素，没有它，就无法理解mTBI+PTSD+AUD退伍军人的酒精渴望。这些知识的获得是至关重要的改进治疗策略的发展，酒精成瘾的退伍军人与共同发生的mTBI和PTSD。

DESCRIPTION : Mild traumatic brain injury (mTBI) is the signature injury of the current military conflicts: Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (OEF/OIF/OND). In Veterans of these conflicts, mTBI commonly co-occurs with mental health disorders such as post-traumatic stress disorder (PTSD). Hazardous alcohol use or probable alcohol use disorder (AUD) is also extremely prevalent in Veterans. The presence of an AUD has further negative impact on rehabilitation effectiveness for our Veterans with TBI. Craving, or the urge to consume a substance, is a critical characteristic of AUD. Alcohol craving negatively impacts rehabilitation and is associated with relapse in the alcohol-withdrawn addict. No studies to date have examined the role of alcohol craving in Veterans with co-occurring mTBI, PTSD and AUD (mTBI+PTSD+AUD). Therefore, the objectives of the current CDA II application are to characterize alcohol craving, develop a better understanding of the mechanism underlying alcohol craving, and develop a novel treatment intervention for alcohol craving reduction. In order to do so, OEF/OIF/OND Veterans will be recruited and classified into one of two groups based on self-report and neuropsychological assessments: 1) asymptomatic combat control Veterans with probable AUD (AUD alone) and 2) Veterans with mTBI+PTSD+AUD. First, alcohol craving and excessive alcohol use in these two groups will be compared. This will be done by conducting objective measures of alcohol use (e.g., urine and breath alcohol concentration tests), self-reports of alcohol use, and alcohol craving. Second, the neurophysiological mechanisms of alcohol craving will be examined in order to develop a novel treatment intervention for craving reduction. To do so, Veterans will participate in a functional magnetic resonance imaging (fMRI) protocol where brain activation will be measured in response to viewing images relating to alcohol compared to neutral images. Advanced neuroimaging procedures to determine the structural integrity of white matter fibers in the brain and to determine spontaneous activity in neuronal networks, a process called functional connectivity analysis, will also take place. The neuroimaging data will be evaluated collectively to elucidate the mechanism underlying alcohol craving and, along with the literature, these data will be used to develop a protocol for the neurotherapeutic intervention repetitive transcranial magnetic stimulation (rTMS). Third, the safety, feasibility, and the immediate effect of a single rTMS session on alcohol cravings along with neural activity and connectivity in Veterans with mTBI+PTSD+AUD will be examined. Veterans will complete neuroimaging, alcohol craving, and alcohol use measures as described above pre- and post-rTMS. Self-report alcohol craving will also be assessed at one day, one week, and one month post-rTMS via phone interview. It is expected that this innovative project will contribute a missing, fundamental element to our base knowledge, without which alcohol craving in Veterans with mTBI+PTSD+AUD cannot be understood. The acquisition of such knowledge is critical to the development of improved therapeutic strategies for alcohol addiction in Veterans with co-occurring mTBI and PTSD.