Abstract
A recent NIH epidemiology study found the lifetime prevalence of alcohol use disorder in the United States to be 29%. Alcohol drinking behavior is strongly “learned” via pleasure center activation/reinforcement. Alcohol craving is a powerful desire to drink alcoholic beverages. Craving was added as one of the defining criteria for alcohol use disorder in DSM5, and craving reduction is becoming an increasingly important treatment goal. In the current study, patients with alcohol use disorder received 10 days of inpatient multi-modal treatments at Schick Shadel Hospital (SSH) of Seattle. The treatments included five chemical aversion conditioning sessions that associated alcohol cues (and alcohol) with nausea and emesis. All patients met DSM4 criteria for alcohol use disorder, were heavy drinkers, and reported craving alcohol pre-treatment. Craving reduction was one of the primary treatment goals. This is the first fMRI study to measure the effects of chemical aversion therapy on alcohol craving-related brain activity. Patients were recruited as subjects for the University of Washington (UW) brain scan study following SSH admission but before treatment onset. Prior to treatment, patients reported craving/desire for alcohol. After treatment (after four SSH chemical aversion treatments, again after five SSH chemical treatments, 30 and 90-days post-discharge), these same patients reported avoidance/aversion to alcohol. Most of the participants (69%) reported being still sober 12 months post-treatment. Consistent with a craving reduction mechanism of how chemical aversion therapy facilitates sobriety, results of the UW fMRI brain scans showed significant pre- to post-treatment reductions in craving-related brain activity in the occipital cortex. Additional fMRI brain scan studies are needed to further explore the neurobiological mechanism of chemical aversion therapy treatment for alcohol use disorder, and other substance use disorders for which chemical aversion therapy is used (e.g., opioid dependence and cocaine dependence). Substance use disorders are estimated to affect well over one billion people worldwide.
Highlights
Alcohol-use disorders, which include both alcohol abuse and dependence, make up one of the most prevalent categories of substance use disorders
The pre- to post-treatment reduction in alcohol craving related brain activity in the occipital cortex was statistically significant at a corrected p-value < 0.05
According to Schick Shadel’s standard follow-up assessments, when contacted at 1 year post-treatment, 69% of the patients in our fMRI study above reported still being sober at 1 year post-treatment followup
Summary
Alcohol-use disorders, which include both alcohol abuse and dependence, make up one of the most prevalent categories of substance use disorders. According to the DSM-5 (American Psychiatric Association, 2013), activation of the brain’s reward (pleasure) system is a major source of problems for alcohol users. Human brains have evolved to reward life-sustaining activities to encourage organisms to repeat those behaviors. When the reward center of the brain activates, the organism is more likely to remember and repeat the behavior they are currently performing at the time, without even thinking about it (Ostafin et al, 2008). When the behavior is drinking alcohol, the alcohol drinking behavior is strongly “learned” via pleasure center activation/reinforcement. The pleasure of drinking can be so rewarding that the people with alcohol use disorder focus on behaviors that repeat this experience (e.g., drinking) at the expense of other more important behaviors
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