Clinical Trials Logo

Clinical Trial Summary

There is growing interest in the utilization of transcranial magnetic stimulation (TMS) as a novel, non-pharmacologic approach to decreasing alcohol use among treatment-seeking individuals with Alcohol Use Disorder (AUD). The results of this study will be used to determine which of the 2 proposed TMS strategies has a larger effect on drinking behavior (% days abstinent, % heavy drinking days) as well as alcohol cue-reactivity in a 4 month period. These data will pave the way for TMS to be used as an innovative, new treatment option for individuals with AUD.


Clinical Trial Description

Alcohol Use Disorder (AUD) is prevalent, devastating, and difficult to treat. The majority of therapeutic approaches to date have relied on pharmaceutical modulation or and/or psychotherapy. With a growing knowledge of the neural circuits that contribute to relapse in AUD, there is an emerging interest in developing a novel, neural-circuit specific therapeutic tool to enhance AUD treatment outcomes. The long term goal of this multidisciplinary research team is to develop an evidence-based brain stimulation treatment protocol which will improve AUD treatment outcomes. The competing neurobehavioral decision systems (CNDS) theory posits that in addiction, choice results from a regulatory imbalance between two decision-making systems (impulsive and executive). These behavioral systems are functionally linked to two discrete frontal-striatal circuits which regulate limbic and executive control. Modulating these competing neural circuits (e.g. either dampening the limbic/impulsive system or amplifying the executive control system) may render alcohol users less vulnerable to relapse. These two frontal-striatal neural circuits - the limbic loop (ventromedial prefrontal cortex (VMPFC)-ventral striatum), and executive control loop (dorsolateral PFC (DLPFC)-dorsal striatum) can be differentially stimulated by theta burst stimulation (TBS), a patterned form of transcranial magnetic stimulation. Over the past 7 years, through the scaffolding of a National Institute on Alcohol Abuse and Alcoholism (NIAAA) P50 Center and a strong Brain Stimulation Research program, this multidisciplinary group of clinicians and neuroscientists has demonstrated) it is possible to differentially activate these circuits through TMS/Blood-oxygen-level-dependent (BOLD) imaging TBS to the VMPFC decreases orbitofrontal cortex and ventral striatal/accumbens BOLD signal in heavy alcohol users TBS also decreases alcohol cue reactivity in this population and in AUD patients currently enrolled in intensive outpatient treatment, 10 days of TBS to the VMPFC is feasible, well-tolerated, increases 1 and 2 month retention rates, and attenuates limbic brain reactivity to alcohol cues after 1 month. While these studies provide a strong foundation for pursuing a larger multisite trial of TBS, the CNDS theory and other alcohol TMS studies suggests that the DLPLC may also be a fruitful treatment target. In a sham-controlled pilot study the study team recently compared the efficacy of VMPFC TBS to DLPFC TBS, and, to the study team's surprise demonstrated that a single session of DLPFC TBS had a greater effect on the brain response to alcohol cues than VMPFC TBS. To resolve this gap in understanding, the investigator proposes a randomized, double-blind, sham-controlled clinical trial to evaluate the relative efficacy of these 2 strategies as novel tools to improve AUD treatment outcomes (e.g. percent days abstinent up to 4 months after TMS treatment initiation). These outcomes will be measured with urine ethyl glucuronide (ETG) and blood carbohydrate deficient transferrin (CDT) measurements. The study team will also evaluate the effect of these TBS treatments brain reactivity to alcohol cues. The investigator's long-term vision is that TBS would be used as an adjuvant to behavioral treatment, enabling individuals to maximize the likelihood of behavioral change. 180 treatment-seeking men and women recruited from the community at large, will be randomized to receive 15 visits of TMS (2x/day; 3x/week, 20-30 min intersession interval) of either real or sham TBS to the VMPFC or left DLPFC while they are enrolled in the proposed study. Randomization will occur after the participant has been consented and screened for eligibility and prior to the first treatment visit. Real/Sham TBS will be delivered three times per week for a total of 15 TMS visits. Quantitative ETG will be collected daily. Quantitative CDT will be collected monthly throughout the course of the study. Additional assessments and/or brain reactivity to alcohol cues will be measured at the following timepoints: baseline screening visit, MRI visit #1 (before TMS treatment visit 1), TMS treatment visits 1, 6, 11, and 15, MRI visit #2, and at the 3 monthly Follow Up visits. A saliva sample taken for genetic analysis of a specific Brain-derived neurotrophic factor (BDNF) variant will be obtained on enrollment and used to also analyze across these measures and individual outcomes in response to TMS. Building on recent pilot data, the study team will test the hypotheses that for both Strategy 1 & 2, real TBS will improve AUD treatment outcomes significantly more than sham. Analysis will be performed using repeated measures analysis of variance (ANOVA) on change scores from baseline for each visit. The main independent variable in the ANOVA will be time (TMS visits 1, 6, 11, and 15), group (VMPFC vs. DLPFC TBS vs. sham) and their interaction. Aim 1 (Strategy 1): Modulating the limbic system: VMPFC TBS. The study team will evaluate the effect of VMPFC TBS, relative to sham, on number of days abstinent (primary outcome) and heavy drinking days in 30 day intervals for 4 months. Participants will receive stimulation over the left frontal pole electroencephalogram (EEG)10-20 system: Frontal Pole 1 (FP1). This location has been used in previous studies in alcohol users which demonstrate VMPFC target engagement. Aim 2 (Strategy 2): Modulating the executive system: DLPFC TBS. The study team will evaluate the effect of DLPFC TBS, relative to sham, on the parameters listed. TBS will be delivered over the left DLPFC EEG 10-20 system: Frontal 3 (F3) as this location has also been validated to reliable result in target engagement by this group. Exploratory Aim- Baseline alcohol cue reactivity as a mediator of TBS clinical response. The study team will test the hypotheses that individuals with a higher ratio of (DLPFC-striatal)/(VMPFC-striatal) response to alcohol cues will be more likely to have a change in drinking after Strategy 2. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT04154111
Study type Interventional
Source Wake Forest University Health Sciences
Contact Merideth A Addicott, PhD
Phone 336-716-7792
Email maddicot@wakehealth.edu
Status Recruiting
Phase N/A
Start date May 26, 2020
Completion date August 2025

See also
  Status Clinical Trial Phase
Recruiting NCT04788004 - Long-term Recovery: Longitudinal Study of Neuro-behavioral Markers of Recovery and Precipitants of Relapse
Recruiting NCT05684094 - Mechanisms of Risky Alcohol Use in Young Adults: Linking Sleep to Reward- and Stress-Related Brain Function N/A
Completed NCT03406039 - Testing the Efficacy of an Online Integrated Treatment for Comorbid Alcohol Misuse and Emotional Problems N/A
Completed NCT03573167 - Mobile Phone-Based Motivational Interviewing in Kenya N/A
Completed NCT04817410 - ED Initiated Oral Naltrexone for AUD Phase 1
Active, not recruiting NCT04267692 - Harm Reduction Talking Circles for American Indians and Alaska Natives With Alcohol Use Disorders N/A
Completed NCT03872128 - The Role of Neuroactive Steroids in Stress, Alcohol Craving and Alcohol Use in Alcohol Use Disorders Phase 1
Completed NCT02989662 - INIA Stress and Chronic Alcohol Interactions: Glucocorticoid Antagonists in Heavy Drinkers Phase 1/Phase 2
Recruiting NCT06030154 - Amplification of Positivity for Alcohol Use N/A
Active, not recruiting NCT05419128 - Family-focused vs. Drinker-focused Smartphone Interventions to Reduce Drinking-related Consequences of COVID-19 N/A
Completed NCT04564807 - Testing an Online Insomnia Intervention N/A
Completed NCT04284813 - Families With Substance Use and Psychosis: A Pilot Study N/A
Completed NCT04203966 - Mental Health and Well-being of People Who Seek Help From Their Member of Parliament
Recruiting NCT05861843 - Craving Assessment in Patients With Alcohol Use Disorder Using Virtual Reality Exposure
Terminated NCT04404712 - FAAH Availability in Psychiatric Disorders: A PET Study Early Phase 1
Enrolling by invitation NCT04128761 - Decreasing the Temporal Window in Individuals With Alcohol Use Disorder N/A
Not yet recruiting NCT06444243 - Psilocybin-assisted Therapy for Alcohol Use Disorder Phase 2
Not yet recruiting NCT06163651 - Evaluating a One-Year Version of the Parent-Child Assistance Program N/A
Not yet recruiting NCT06337721 - Preventing Alcohol Use Disorders and Alcohol-Related Harms in Pacific Islander Young Adults N/A
Enrolling by invitation NCT02544581 - Preliminary Analysis of the Soberlink Alcohol Breath Analyzer System's (SABA) Clinical Utility During Aftercare N/A