Neurobiological mechanisms of control in alcohol use disorder – Moving towards mechanism-based non-invasive brain stimulation treatments

Ghin, Filippo; Beste, Christian; Stock, Ann‐Kathrin

doi:10.1016/j.neubiorev.2021.12.031

Cited by 9 publications

(32 citation statements)

References 345 publications

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“…However, it should be noted that it is still a matter of debate whether inhibitory control impairments already arise at the early stages of the disorder or can only be found in more severe cases of AUD [ 55 ]. It has been suggested that the lack of consistency among studies investigating inhibitory control in AUD could not only be associated with variability in drinking levels among samples, but also with differences in experimental designs [ 10 ]. In line with this, the role of stimulus salience during inhibitory control could be another critical factor which may help to explain our results.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, there is growing interest in investigating potential alternative treatment approaches [ 8 , 9 ]. Ideally, those approaches should be derived from a better understanding of the functional cognitive and neurobiological mechanisms underlying the development and maintenance of AUD [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…In healthy individuals, these somewhat opposing modes of generating behavior are in relative balance. However, it has been suggested that this balance may be disrupted in AUD patients [ 9 , 10 ]. Nevertheless, it remains unclear whether and how the imbalance between automated and controlled processes during inhibitory control is linked to drinking behavior and relapse rates in AUD.…”

Section: Introductionmentioning

confidence: 99%

“…Lastly, we performed source localization analyses to examine which functional neuroanatomical structures are associated with the most distinct neural activity differences between conditions and groups. This information may be particularly crucial to further develop and refine non-invasive brain stimulation approaches targeted to treat AUD [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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On the Role of Stimulus-Response Context in Inhibitory Control in Alcohol Use Disorder

Ghin

Beste

Stock

2022

JCM

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The behavioral and neural dynamics of response inhibition deficits in alcohol use disorder (AUD) are still largely unclear, despite them possibly being key to the mechanistic understanding of the disorder. Our study investigated the effect of automatic vs. controlled processing during response inhibition in participants with mild-to-moderate AUD and matched healthy controls. For this, a Simon Nogo task was combined with EEG signal decomposition, multivariate pattern analysis (MVPA), and source localization methods. The final sample comprised n = 59 (32♂) AUD participants and n = 64 (28♂) control participants. Compared with the control group, AUD participants showed overall better response inhibition performance. Furthermore, the AUD group was less influenced by the modulatory effect of automatic vs. controlled processes during response inhibition (i.e., had a smaller Simon Nogo effect). The neurophysiological data revealed that the reduced Simon Nogo effect in the AUD group was associated with reduced activation differences between congruent and incongruent Nogo trials in the inferior and middle frontal gyrus. Notably, the drinking frequency (but not the number of AUD criteria we had used to distinguish groups) predicted the extent of the Simon Nogo effect. We suggest that the counterintuitive advantage of participants with mild-to-moderate AUD over those in the control group could be explained by the allostatic model of drinking effects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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On the Role of Stimulus-Response Context in Inhibitory Control in Alcohol Use Disorder

Ghin

Beste

Stock

2022

JCM

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“…In sum, AUD is broadly compromising the different facets of cognitive control. Most importantly, cognitive control inhibits or modifies habitual and automatic responses associated with drinking behavior 3 . There is typically a shift from controlled to habitual alcohol use in individuals who develop AUD, while the cognitive capabilities required to keep the increasingly habitual use in check gradually weaken.…”

Section: Cognitive Control Processes In Audmentioning

confidence: 99%

Auricular transcutaneous vagus nerve stimulation for alcohol use disorder: A chance to improve treatment?

et al. 2022

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Alcohol use disorder (AUD) is a relapsing–remitting condition characterized by excessive and/or continued alcohol consumption despite harmful consequences. New adjuvant tools, such as noninvasive brain stimulation techniques, might be helpful additions to conventional treatment approaches or even provide an alternative option for patients who fail to respond adequately to other treatment options. Here, we discuss the potential use of auricular transcutaneous vagus nerve stimulation (atVNS) as an ADD‐ON intervention in AUD. Compared with other techniques, atVNS has the advantage of directly stimulating nuclei that synthesize GABA and catecholamines, both of which are functionally altered by alcohol intake in AUD patients. Pharmacological options targeting those neurotransmitters are widely available, but have relatively limited beneficial effects on cognition, even though restoring normal cognitive functioning, especially cognitive control, is key to maintaining abstinence. Against this background, atVNS could be a particularly useful add‐on because there is substantial meta‐analytic evidence based on studies in healthy individuals that atVNS can enhance cognitive control processes that are crucial to regaining control over drug intake. We discuss essential future research on using atVNS as an ADD‐ON intervention in AUD to enhance clinical and cognitive outcomes by providing a translational application. Given that this novel technique can be worn like an earpiece and can be employed without medical supervision/outside the clinical settings, atVNS could be well integratable into the daily life of the patients, where the task of regaining control over drug intake is most challenging.

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Alcohol Cue Processing in Co-Occurring Bipolar Disorder and Alcohol Use Disorder

Mellick¹,

Tolliver

Brenner

et al. 2023

JAMA Psychiatry

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ImportanceReward circuitry dysfunction is a candidate mechanism of co-occurring bipolar disorder and alcohol use disorder (BD + AUD) that remains understudied. This functional magnetic resonance imaging (fMRI) research represents the first evaluation of alcohol cue reward processing in BD + AUD.ObjectiveTo determine how alcohol cue processing in individuals with BD + AUD may be distinct from that of individuals with AUD or BD alone.Design, Setting, and ParticipantsThis cross-sectional case-control study (April 2013-June 2018) followed a 2 × 2 factorial design and included individuals with BD + AUD, AUD alone, BD alone, and healthy controls. A well-validated visual alcohol cue reactivity fMRI paradigm was administered to eligible participants following their demonstration of 1 week or more of abstinence from alcohol and drugs assessed via serial biomarker testing. Study procedures were completed at the Medical University of South Carolina. Analysis took place between June and August 2022.Main Outcomes and MeasuresPast-week mood symptoms were rated by clinicians using the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. The Alcohol Dependence Scale, Obsessive-Compulsive Drinking Scale, and Barratt Impulsiveness Scale were included questionnaires. Functional MRI whole-brain data were analyzed along with percent signal change within a priori regions of interest located in the ventral striatum, dorsal striatum, and ventromedial prefrontal cortex. Exploratory analyses of associations between cue reactivity and select behavioral correlates (alcohol craving, impulsivity, maximum number of alcohol drinks on a single occasion, and days since last alcohol drink) were also performed.ResultsOf 112 participants, 28 (25.0%) had BD + AUD, 26 (23.2%) had AUD alone, 31 (27.7%) had BD alone, and 27 (24.1%) were healthy controls. The mean (SD) age was 38.7 (11.6) years, 50 (45.5%) were female, 33 (30%) were smokers, and 37 (34.9%) reported recent alcohol consumption. Whole-brain analyses revealed a BD × AUD interaction (F = 10.64; P = .001; η2 = 0.09) within a cluster spanning portions of the right inferior frontal gyrus and insula. Region of interest analyses revealed a main association of BD (F = 8.02; P = .006; η2 = 0.07) within the dorsal striatum. In each instance, individuals with BD + AUD exhibited reduced activation compared with all other groups who did not significantly differ from one another. These hypoactivations were associated with increased impulsivity and obsessive-compulsive alcohol craving exclusively among individuals with BD + AUD.Conclusion and RelevanceThe findings of this study suggest conceptualizing reward dysfunction in BD + AUD by the potential interaction between blunted reward responsivity and deficient inhibitory control may help guide treatment development strategies. To this end, reduced right inferior frontal gyrus and insula alcohol cue reactivity represents a novel candidate biomarker of BD + AUD that may respond to pharmacological interventions targeting impulsivity-related neural mechanisms for improved executive control.

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Neurobiological mechanisms of control in alcohol use disorder – Moving towards mechanism-based non-invasive brain stimulation treatments

Cited by 9 publications

References 345 publications

On the Role of Stimulus-Response Context in Inhibitory Control in Alcohol Use Disorder

On the Role of Stimulus-Response Context in Inhibitory Control in Alcohol Use Disorder

Auricular transcutaneous vagus nerve stimulation for alcohol use disorder: A chance to improve treatment?

Alcohol Cue Processing in Co-Occurring Bipolar Disorder and Alcohol Use Disorder

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