The purpose of this study is to develop transcranial magnetic stimulation (TMS), specifically TMS at a frequency known as theta burst stimulation (TBS), to see how it affects the brain and changes the brain's response to alcohol-related pictures. TMS and TBS are stimulation techniques that use magnetic pulses to temporarily excite specific brain areas in awake people (without the need for surgery, anesthetic, or other invasive procedures). TBS, which is a form of TMS, will be applied over the medial prefrontal cortex, (MPFC), which has been shown to be involved with drinking patterns and alcohol consumption. This study will test whether TBS can be used as an alternative tool to reduce the desire to use alcohol and reducing the brain's response to alcohol-related pictures.
Age 21-65 (to maximize participation; note: Scalp-to-Cortex distance will be included as a covariate to calculate adjusted TMS dose given expected cortical atrophy in heavy alcohol users and older adults and the demonstrated effect50 on TMS-fMRI responses in addiction)
Alcohol Use Disorder, determined by DSM-V criteria, using the Structured Clinical Interview for DSM-V
Consumption of more than 14 drinks (women) or 21 drinks (men) per week, with at least 4 heavy drinking days (defined as ≥ 4 drinks for women and ≥ 5 for men) per week during the 30-days prior to enrolling.
Able to read and understand questionnaires and informed consent.
Has metal placed above the neck
Is at elevated risk of seizure (i.e., has a history of seizures, is currently prescribed medications known to lower seizure threshold)
Has a history of moderate to severe alcohol withdrawal or medicated alcohol withdrawal
Has a history of claustrophobia
Parallel
Real TBS to the mPFC
DeviceThis will be delivered with the Magventure Magpro system; 600 pulses of continuous theta burst stimulation with the active sham coil (double blinded using the integrated active sham system).
Sham TBS to the mPFC
DeviceThis will be delivered with the Magventure Magpro system; 600 pulses with the active sham coil (double blinded using the integrated active sham system). The MagVenture MagPro system has an integrated active sham that passes current through two surface electrodes placed on the scalp. The electrodes are placed on the left frontalis muscle under the coil for both the real and sham stimulation sessions.
Change in Percent Heavy Drinking Days (PHDD) from baseline
The primary outcome analysis will examine the TMS treatment effect (active vs. sham) on drinking outcomes-measured as percent heavy drinking days (PHDD) (heavy drinking day defined as 4 or more drinks for women and 5 or more drinks for men)-in the follow-up period beginning after the final treatment session. Collected via timeline follow back (TLFB) in three 28-day (month) intervals, this will be analyzed using multivariate mixture models to consider the effect of time (month after treatment) and the interaction of treatment with time, baseline drinking, number of treatment sessions received, and any other potential covariates (e.g., age, nicotine use, time since last drink). Drinking data will be collected on all randomized participants, irrespective of treatment completion. Lower percentages indicate fewer heavy drinking days in the 28-day interval.
Change in Percent Days Abstinent (PDA) from baseline
The primary outcome analysis will examine the TMS treatment effect (active vs. sham) on drinking outcomes-measured as percent days abstinent (PDA) - in the follow-up period beginning after the final treatment session. Collected via timeline follow back (TLFB) in three 28-day (month) intervals, this will be analyzed using multivariate mixture models to consider the effect of time (month after treatment) and the interaction of treatment with time, baseline drinking, number of treatment sessions received, and any other potential covariates (e.g., age, nicotine use, time since last drink). Drinking data will be collected on all randomized participants, irrespective of treatment completion. Higher percentages indicate increased days abstinent from alcohol in the 28-day interval.
Change in alcohol cue task MRI activation 1-week post treatment from baseline
For the alcohol cue reactivity task, multivariate mixture model analyses will be used to calculate the difference in activation between the ALC and BEV blocks for vmPFC and ventral striatal ROIs, and to analyze maximum likelihood estimates for ALC vs. BEV activation as a function of time, treatment, and the cross-level interactions of these factors. Specifically, the cue task stimuli will be nested within time (post- vs. pre-treatment scan); time will be nested within participant; and participants will be nested within treatment (Sham vs. Active).
Change in anxiety via State-Trait Anxiety Inventory from baseline
As an exploratory analysis, anxiety will be measured using the State-Trait Anxiety Inventory to assess the impact of treatment on self-reported comorbid affective psychopathology. Scoring ranges from 20-80 for each subscale, with higher scores indicating higher anxiety symptoms.
Change in alcohol use via Obsessive-Compulsive Drinking Scale from baseline
As an exploratory analysis, alcohol craving will be measured using the Obsessive-Compulsive Drinking Scale to assess the impact of treatment on self-reported obsessive-compulsive aspects of craving. Scoring ranges from 0-40, with 0 indicating a higher ability to control drinking. This questionnaire also includes an obsessive sub-scale and a compulsive sub-scale each ranging from 0-20, with lower scores indicating lower aspects of alcohol craving and higher ability to control these urges.
Change in depression via Becks Depression Inventory-II from baseline
As an exploratory analysis, depression will be measured using the Becks Depression Inventory-II to assess the impact of treatment on self-reported comorbid affective psychopathology. Scoring ranges from 0-63, with higher scores indicating higher levels of depressive symptoms.
Change in alcohol use via Alcohol Audit from baseline
As an exploratory analysis, alcohol severity will be measured using the Alcohol AUDIT assessment to assess the impact of treatment on self-reported alcohol severity. Scoring ranges from 0-40, with 40 indicating a higher risk of alcohol severity.
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Medical University of South Carolina
Lead sponsor
National Institutes of Health (NIH)
Collaborator
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Collaborator
