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Milivojevic V, Sinha R. Laboratory and Real-World Experimental Approaches to Understanding Alcohol Relapse. Curr Top Behav Neurosci 2023. [PMID: 37985542 DOI: 10.1007/7854_2023_456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Alcohol use disorder is highly prevalent and high risk of relapse remains a significant treatment challenge. Therefore, the utility of human laboratory models of relapse to further the understanding of psychobiological mechanisms that precipitate relapse risk and allow testing of novel interventions could be of benefit in expediting the development of effective treatments to target high relapse risk. Stress is a risk factor for the development of AUD and for relapse, and furthermore, chronic alcohol use leads to adaptations in central and peripheral stress biology. Here, we review our efforts to assess the integrity of these stress pathways in individuals with alcohol use disorder and whether adaptations in these systems play a role in relapse risk. Using validated human laboratory procedures to model two of the most common situations that contribute to relapse risk, namely stress and alcohol cues, we review how such models in the laboratory can predict subsequent relapse, and how we can measure specific identified biobehavioral markers of relapse effectively and ecologically in the real world. Finally, we discuss the significant implications of these findings for the development of novel and effective interventions that target stress dysregulation and craving as risk factors to treatment.
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Affiliation(s)
- Verica Milivojevic
- Department of Psychiatry, The Yale Stress Center, Yale University School of Medicine, New Haven, CT, USA
| | - Rajita Sinha
- Department of Psychiatry, The Yale Stress Center, Yale University School of Medicine, New Haven, CT, USA.
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2
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McFalls AJ, Jenney C, Stanford RS, Woodward E, Hajnal A, Grigson PS, Vrana KE. Greater avoidance of a saccharin cue paired with passive delivery of heroin is associated with a select increase in expression of CRFR2 and CRFbp in the hippocampus in rats. Brain Res Bull 2022; 191:48-60. [DOI: 10.1016/j.brainresbull.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/14/2022] [Accepted: 10/07/2022] [Indexed: 11/02/2022]
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3
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Katner SN, Sentir AM, Steagall KB, Ding ZM, Wetherill L, Hopf FW, Engleman EA. Modeling Aversion Resistant Alcohol Intake in Indiana Alcohol-Preferring (P) Rats. Brain Sci 2022; 12:brainsci12081042. [PMID: 36009105 PMCID: PMC9406111 DOI: 10.3390/brainsci12081042] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 12/26/2022] Open
Abstract
With the substantial social and medical burden of addiction, there is considerable interest in understanding risk factors that increase the development of addiction. A key feature of alcohol use disorder (AUD) is compulsive alcohol (EtOH) drinking, where EtOH drinking becomes “inflexible” after chronic intake, and animals, such as humans with AUD, continue drinking despite aversive consequences. Further, since there is a heritable component to AUD risk, some work has focused on genetically-selected, EtOH-preferring rodents, which could help uncover critical mechanisms driving pathological intake. In this regard, aversion-resistant drinking (ARD) takes >1 month to develop in outbred Wistar rats (and perhaps Sardinian-P EtOH-preferring rats). However, ARD has received limited study in Indiana P-rats, which were selected for high EtOH preference and exhibit factors that could parallel human AUD (including front-loading and impulsivity). Here, we show that P-rats rapidly developed compulsion-like responses for EtOH; 0.4 g/L quinine in EtOH significantly reduced female and male intake on the first day of exposure but had no effect after one week of EtOH drinking (15% EtOH, 24 h free-choice paradigm). Further, after 4−5 weeks of EtOH drinking, males but not females showed resistance to even higher quinine (0.5 g/L). Thus, P-rats rapidly developed ARD for EtOH, but only males developed even stronger ARD with further intake. Finally, rats strongly reduced intake of quinine-adulterated water after 1 or 5 weeks of EtOH drinking, suggesting no changes in basic quinine sensitivity. Thus, modeling ARD in P-rats may provide insight into mechanisms underlying genetic predispositions for compulsive drinking and lead to new treatments for AUDs.
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Affiliation(s)
- Simon N. Katner
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Alena M. Sentir
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Kevin B. Steagall
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Zheng-Ming Ding
- Departments of Anesthesiology and Perioperative Medicine and Pharmacology, Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Frederic W. Hopf
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Eric A. Engleman
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Correspondence:
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4
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Demetrovics Z, van den Brink W, Paksi B, Horváth Z, Maraz A. Relating Compulsivity and Impulsivity With Severity of Behavioral Addictions: A Dynamic Interpretation of Large-Scale Cross-Sectional Findings. Front Psychiatry 2022; 13:831992. [PMID: 35782446 PMCID: PMC9248365 DOI: 10.3389/fpsyt.2022.831992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIM Impulsivity and compulsivity are two key temperament traits involved in behavior regulation. The aim of this study was to test several existing theories in explaining the role of impulsivity and compulsivity in symptom severity in various behavioral addictions. METHODS Data were collected from a (representative) general population sample (N = 2,710, mean age:39.8 years (SD:13.6), 51% woman), and from people who are at increased risk of having a behavioral addiction (N = 9,528 in total, mean age: 28.11 (SD:8.3), 34.3% woman), including people with problematic gaming and internet use, pathological gambling, exercise dependence, compulsive buying and work addiction. Symptom severity, reward driven impulsivity and relief driven compulsivity were assessed. RESULTS For non-problematic groups, impulsivity is present to about the same extent as compulsivity, whereas for problematic groups, compulsivity dominates over impulsivity in all groups (except for gambling). The strength of the correlation between impulsivity and compulsivity is higher in more severe forms of the disorders (from r = 0.18 to r = 0.59 in the representative population). DISCUSSION Based on these data, it appears that relief-driven behavior (negative reinforcement) dominates over reward-driven behavior (positive reinforcement) in more severe cases of a behavioral addiction. CONCLUSION This is the first large-scale study to find empirical support for the neuroscientific theory on the dominance of compulsivity ("needing") over impulsivity ("wanting") in more severe cases of a behavioral addiction. Although longitudinal research is needed, a possible shift from impulsivity to compulsivity takes place, similar to substance use addictions, which maintains the circle of addiction.
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Affiliation(s)
- Zsolt Demetrovics
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Wim van den Brink
- Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Borbála Paksi
- Institute of Education, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Horváth
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Aniko Maraz
- Institut Für Psychologie, Humboldt-Universität zu Berlin, Berlin, Germany
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5
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Berhe O, Gerhardt S, Schmahl C. Clinical Outcomes of Severe Forms of Early Social Stress. Curr Top Behav Neurosci 2021; 54:417-438. [PMID: 34628586 DOI: 10.1007/7854_2021_261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early social stress, particularly severe but nevertheless frequent forms such as abuse and neglect, are among the major risk factors for the development of mental disorders. However, we only have very limited knowledge of the psychobiological disease mechanisms underlying the influence of early life stress and stress-related disorders during this vulnerable phase of life. Early stress can have long-lasting adverse effects on the brain and other somatic systems, e.g. through influences on brain development. In adulthood, the prior experience of abuse or neglect can result in complex clinical profiles. Besides conditions such as mood and anxiety disorders as well as posttraumatic stress disorder, substance use disorders (SUD) are among the most prevalent sequelae of early social stress. Current social stress further influences the development and maintenance of these disorders, e.g., by increasing the risk of relapses. In this chapter, we will first give an overview of currently used methods to assess the phenomenology and pathophysiology of stress-related disorders and then focus on the phenomenological and neurobiological background of the interaction between early social stress and SUD. We will give an overview of important insights from neuroimaging studies and will also highlight recent findings from studies using digital tools such as ecological momentary assessment or virtual reality to capture the influence of early social stress as well as current social stress in everyday life of persons with SUD.
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Affiliation(s)
- Oksana Berhe
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Sarah Gerhardt
- Department of Addictive Behaviour and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany.
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Karl D, Bumb JM, Bach P, Dinter C, Koopmann A, Hermann D, Mann K, Kiefer F, Vollstädt-Klein S. Nalmefene attenuates neural alcohol cue-reactivity in the ventral striatum and subjective alcohol craving in patients with alcohol use disorder. Psychopharmacology (Berl) 2021; 238:2179-2189. [PMID: 33846866 PMCID: PMC8292278 DOI: 10.1007/s00213-021-05842-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/29/2021] [Indexed: 12/31/2022]
Abstract
RATIONALE Alcohol use disorder is a common and devastating mental illness for which satisfactory treatments are still lacking. Nalmefene, as an opioid receptor modulator, could pharmacologically support the reduction of drinking by reducing the (anticipated) rewarding effects of alcohol and expanding the range of treatment options. It has been hypothesized that nalmefene acts via an indirect modulation of the mesolimbic reward system. So far, only a few imaging findings on the neuronal response to nalmefene are available. OBJECTIVES We tested the effect of a single dose of 18 mg nalmefene on neuronal cue-reactivity in the ventral and dorsal striatum and subjective craving. METHODS Eighteen non-treatment-seeking participants with alcohol use disorder (67% male, M = 50.3 ± 13.9 years) with a current high-risk drinking level (M = 76.9 ± 52 g of pure alcohol per day) were investigated using a cue-reactivity task during functional magnetic resonance imaging (fMRI) in a double-blind, placebo-controlled, cross-over study/design. In addition, self-reported craving was assessed before and after exposure to alcohol cues. RESULTS An a priori defined region of interest (ROI) analysis of fMRI data from 15 participants revealed that nalmefene reduced alcohol cue-reactivity in the ventral, but not the dorsal striatum. Additionally, the subjective craving was significantly reduced after the cue-reactivity task under nalmefene compared to placebo. CONCLUSION In the present study, reduced craving and cue-reactivity to alcohol stimuli in the ventral striatum by nalmefene indicates a potential anti-craving effect of this drug via attenuation of neural alcohol cue-reactivity.
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Affiliation(s)
- Damian Karl
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - J Malte Bumb
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Patrick Bach
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Christina Dinter
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Anne Koopmann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Derik Hermann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Karl Mann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
- Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany.
- Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany.
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7
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Green R, Du H, Grodin EN, Nieto SJ, Bujarski S, Roche DJO, Ray LA. A meta-regression of methodological features that predict the effects of medications on the subjective response to alcohol. Alcohol Clin Exp Res 2021; 45:1336-1347. [PMID: 34120356 DOI: 10.1111/acer.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Alcohol administration paradigms have been used for early efficacy testing of novel compounds for alcohol use disorder (AUD). There has been an ongoing debate about sample characteristics and methodological features that affect the likelihood of detecting an early efficacy signal for AUD medications. We conducted a meta-regression to test whether the drinking level of the study sample and the peak breath alcohol concentration (BrAC) in the alcohol administration study predict the efficacy of AUD pharmacotherapies on the subjective responses to alcohol. METHODS We computed the effects of 21 medications on alcohol-induced stimulation, sedation, negative mood, and craving during alcohol administration in 49 studies. RESULTS Meta-regression analyses indicated a significant and positive effect of pre-study drinks per month on alcohol-induced stimulation (β = 0.142, p < 0.0001), such that as drinking increases, the benefit of medication over placebo decreases. There was an effect of drinks per month on negative mood (β = -0.164, p = 0.0248), such that at higher levels of drinks per month, the effects of medications on negative mood are stronger. For sedation, there was an effect of peak BrAC (β = 0.119, p = 0.0002), such that at low levels of peak BrAC, the effects of medication on sedation were null. For craving, there was a peak BrAC × drinks per month interaction such that at low levels of BrAC, a heavier drinking sample is required to detect the effects of medication on craving. Sensitivity analyses comparing naltrexone studies and non-naltrexone studies suggested that naltrexone was less sensitive to drinks per month across subjective response domains. CONCLUSIONS These analyses show that design features are critical in studies that test the effects of medications on the subjective responses to alcohol. By specifying the significance and directionality of these effects, as well as the specific points in BrAC or drinks per month at which medication effects are detectable, the study offers recommendations for design features of alcohol administration studies that aim to inform AUD medication development.
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Affiliation(s)
- ReJoyce Green
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Han Du
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Erica N Grodin
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Steven J Nieto
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Spencer Bujarski
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel J O Roche
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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8
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Affiliation(s)
- Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles
| | - Erica Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles
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9
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Nieto SJ, Grodin EN, Green R, Ray LA. Evaluation of the Addictions Neuroclinical Assessment (ANA) framework through deep phenotyping of problem drinkers. Drug Alcohol Depend 2021; 221:108603. [PMID: 33618192 PMCID: PMC8026564 DOI: 10.1016/j.drugalcdep.2021.108603] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND To advance the development of a neuroscience-informed understanding of alcohol use disorder (AUD) through the Addictions Neuroclinical Assessment (ANA) framework, the present study reports on deep phenotyping of a large sample of problem drinkers. METHODS Participants (n = 1679) were primarily heavy drinkers with and without AUD, who completed a phenotypic battery of well-validated scales and behavioral measures of alcohol use and problems, mood, attention, and impulsivity. These scales were subjected to sequential factor analytic work in order to derive a factor solution that explains biobehavioral variation in the sample. To assess the construct validity of the resulting factor solution, scores on each factor were associated with demographic and clinical indicators. RESULTS Factor analysis techniques using indicators of alcohol use and problems, mood, attention, and impulsivity implicated four functional domains that compliment and extend the proposed ANA domains: negative alcohol-related consequences, incentive salience, negative emotionality, and executive function. Demographic and clinical variables significantly predicted scores on all ANA domains. CONCLUSIONS This study provides an independent test of the recently proposed neuroscience-based ANA framework. Results largely support the novel approach in identifying four core constructs in problem drinkers. Future studies can deepen our understanding of how these domains are relevant to AUD by incorporating biomarkers.
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Affiliation(s)
- Steven J Nieto
- Department of Psychology, University of California at Los Angeles, Psychology Building 1285, Los Angeles, CA 90095, United States
| | - Erica N Grodin
- Department of Psychology, University of California at Los Angeles, Psychology Building 1285, Los Angeles, CA 90095, United States
| | - ReJoyce Green
- Department of Psychology, University of California at Los Angeles, Psychology Building 1285, Los Angeles, CA 90095, United States
| | - Lara A Ray
- Department of Psychology, University of California at Los Angeles, Psychology Building 1285, Los Angeles, CA 90095, United States; Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, United States.
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10
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Abstract
Alcohol dependence is a chronically relapsing disorder characterized by compulsive drug-seeking and drug-taking, loss of control in limiting intake, and the emergence of a withdrawal syndrome in the absence of the drug. Accumulating evidence suggests an important role for synaptic transmission in the central nucleus of the amygdala (CeA) in mediating alcohol-related behaviors and neuroadaptive mechanisms associated with alcohol dependence. Acute alcohol facilitates γ-aminobutyric acid (GABA)ergic transmission in the CeA via both pre- and postsynaptic mechanisms, and chronic alcohol increases baseline GABAergic transmission. Acute alcohol inhibits glutamatergic transmission via effects at N-methyl-d-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors in the CeA, whereas chronic alcohol up-regulates NMDA receptor (NMDAR)-mediated transmission. Pro- (e.g., corticotropin-releasing factor [CRF]) and antistress (e.g., nociceptin/orphanin FQ, oxytocin) neuropeptides affect alcohol- and anxiety-related behaviors, and also alter the alcohol-induced effects on CeA neurotransmission. Alcohol dependence produces plasticity in these neuropeptide systems, reflecting a recruitment of those systems during the transition to alcohol dependence.
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Affiliation(s)
- Marisa Roberto
- Departments of Molecular Medicine and Neuroscience, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Dean Kirson
- Departments of Molecular Medicine and Neuroscience, The Scripps Research Institute, La Jolla, California 92037, USA
| | - Sophia Khom
- Departments of Molecular Medicine and Neuroscience, The Scripps Research Institute, La Jolla, California 92037, USA
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Ray LA, Du H, Green R, Roche DJO, Bujarski S. Do behavioral pharmacology findings predict clinical trial outcomes? A proof-of-concept in medication development for alcohol use disorder. Neuropsychopharmacology 2021; 46:519-527. [PMID: 33235284 PMCID: PMC8026961 DOI: 10.1038/s41386-020-00913-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022]
Abstract
Behavioral pharmacology paradigms have been used for early efficacy testing of novel compounds for alcohol use disorder (AUD). However, the degree to which early efficacy in the human laboratory predicts clinical efficacy remains unclear. To address this gap in the literature we employed a novel meta-analytic approach. We searched the literature for medications tested for AUD using both behavioral pharmacology (i.e., alcohol administration) and randomized clinical trials (RCTs). For behavioral pharmacology, we computed medication effects on alcohol-induced stimulation, sedation, and craving during the alcohol administration (k = 51 studies, 24 medications). For RCTs, we computed medication effects on any drinking and heavy drinking (k = 118 studies, 17 medications). We used medication as the unit of analysis and applied the Williamson-York bivariate weighted least squares estimation to preserve the errors in both the independent and dependent variables. Results, with correction for publication bias, revealed a significant and positive relationship between medication effects on alcohol-induced stimulation (β = 1.18 p < 0.05), sedation (β = 2.38, p < 0.05), and craving (β = 3.28, p < 0.001) in the laboratory, and drinking outcomes in RCTs, such that medications that reduced stimulation, sedation, and craving during the alcohol administration were associated with better clinical outcomes. A leave-one-out Monte Carlo analysis examined the predictive utility of these laboratory endpoints for each medication. The observed clinical effect size was within one standard deviation of the mean predicted effect size for all but three pharmacotherapies. This proof-of-concept study demonstrates that behavioral pharmacology endpoints of alcohol-induced stimulation, sedation, and craving track medication effects from the human laboratory to clinical trial outcomes. These results apply to alcohol administration phenotypes and may be especially useful to medications for which the mechanisms of action involve alterations in subjective responses to alcohol (e.g., antagonist medication). These methods and results can be applied to a host of clinical questions and can streamline the process of screening novel compounds for AUD. For instance, this approach can be used to quantify the predictive utility of cue-reactivity screening models and even preclinical models of medication development.
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Affiliation(s)
- Lara A. Ray
- grid.19006.3e0000 0000 9632 6718University of California, Department of Psychology, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718University of California, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA USA
| | - Han Du
- grid.19006.3e0000 0000 9632 6718University of California, Department of Psychology, Los Angeles, CA USA
| | - ReJoyce Green
- grid.19006.3e0000 0000 9632 6718University of California, Department of Psychology, Los Angeles, CA USA
| | - Daniel J. O. Roche
- grid.19006.3e0000 0000 9632 6718University of California, Department of Psychology, Los Angeles, CA USA
| | - Spencer Bujarski
- grid.19006.3e0000 0000 9632 6718University of California, Department of Psychology, Los Angeles, CA USA
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12
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Abstract
OBJECTIVE We assessed self-reported drives for alcohol use and their impact on clinical features of alcohol use disorder (AUD) patients. Our prediction was that, in contrast to "affectively" (reward or fear) driven drinking, "habitual" drinking would be associated with worse clinical features in relation to alcohol use and higher occurrence of associated psychiatric symptoms. METHODS Fifty-eight Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol abuse patients were assessed with a comprehensive battery of reward- and fear-based behavioral tendencies. An 18-item self-report instrument (the Habit, Reward and Fear Scale; HRFS) was employed to quantify affective (fear or reward) and non-affective (habitual) motivations for alcohol use. To characterize clinical and demographic measures associated with habit, reward, and fear, we conducted a partial least squares analysis. RESULTS Habitual alcohol use was significantly associated with the severity of alcohol dependence reflected across a range of domains and with lower number of detoxifications across multiple settings. In contrast, reward-driven alcohol use was associated with a single domain of alcohol dependence, reward-related behavioral tendencies, and lower number of detoxifications. CONCLUSION These results seem to be consistent with a shift from goal-directed to habit-driven alcohol use with severity and progression of addiction, complementing preclinical work and informing biological models of addiction. Both reward-related and habit-driven alcohol use were associated with lower number of detoxifications, perhaps stemming from more benign course for the reward-related and lack of treatment engagement for the habit-related alcohol abuse group. Future work should further explore the role of habit in this and other addictive disorders, and in obsessive-compulsive related disorders.
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13
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Ray LA, Green R, Roche DJ, Magill M, Bujarski S. Naltrexone effects on subjective responses to alcohol in the human laboratory: A systematic review and meta-analysis. Addict Biol 2019; 24:1138-1152. [PMID: 31148304 DOI: 10.1111/adb.12747] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/13/2019] [Accepted: 02/24/2019] [Indexed: 02/03/2023]
Abstract
Naltrexone (NTX) has been widely studied for the treatment of alcohol use disorder with overall support for its efficacy. The mechanisms of action of naltrexone are thought to involve attenuation of the hedonic effects of alcohol and potentiation of its aversive effects. In order to provide a quantitative estimate of the effects of naltrexone on subjective response to alcohol, the aims of this meta-analytic review are to examine the effects of naltrexone across four domains of subjective response. Meta-analyses of naltrexone effects on alcohol craving (k = 16, N = 686), stimulation (k = 15, N = 675), sedation (k = 18, N = 777), and negative mood (k = 9, N = 281) suggested that under laboratory conditions and compared with placebo, naltrexone reduces craving (Hedges g = -0.252; SE = 0.054; 95% CI, -0.375 to -0.130; P < 0.01), reduces stimulation (g = -0.223; SE = 0.067; 95% CI, -0.372 to -0.074; P < 0.01), increases sedation (g = 0.251; SE = 0.064; 95% CI, 0.112-0.389; P < 0.01), and increases negative mood (g = 0.227; SE = 0.047; 95% CI, 0.100-0.354; P < 0.01). Results were robust when drinks per month and alcohol dose were added to the models as covariates. The effects of naltrexone varied by severity of alcohol use with medication effects on craving and stimulation being observed in sample of both heavy drinkers and AUD individuals. These results are consistent with the hypothesized mechanisms of action of NTX, although the effects are of small magnitude. This meta-analysis aggregates across multiple human laboratory studies of NTX's effects on subjective response to alcohol, providing a comprehensive summary of a key mechanism of NTX efficacy, namely, alteration of the subjective experience of alcohol.
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Affiliation(s)
- Lara A. Ray
- Department of PsychologyUniversity of California, Los Angeles Los Angeles CA USA
- Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles Los Angeles CA USA
| | - ReJoyce Green
- Department of PsychologyUniversity of California, Los Angeles Los Angeles CA USA
| | | | - Molly Magill
- Center for Alcohol and Addiction StudiesBrown University Providence RI USA
| | - Spencer Bujarski
- Department of PsychologyUniversity of California, Los Angeles Los Angeles CA USA
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14
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Schell SE, Brassard SL, Racine SE. Extending the Acquired Preparedness model of binge eating: Testing the indirect effects of high-risk personality traits on binge eating via positive and negative reinforcement expectancies. Appetite 2019; 140:206-212. [DOI: 10.1016/j.appet.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/21/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
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15
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Burchi E, Makris N, Lee MR, Pallanti S, Hollander E. Compulsivity in Alcohol Use Disorder and Obsessive Compulsive Disorder: Implications for Neuromodulation. Front Behav Neurosci 2019; 13:70. [PMID: 31139059 PMCID: PMC6470293 DOI: 10.3389/fnbeh.2019.00070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/22/2019] [Indexed: 01/22/2023] Open
Abstract
Alcohol use Disorder (AUD) is one of the leading causes of morbidity and mortality worldwide. The progression of the disorder is associated with the development of compulsive alcohol use, which in turn contributes to the high relapse rate and poor longer term functioning reported in most patients, even with treatment. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines AUD by a cluster of symptoms, parsing its heterogeneous phenotype by domains of behavior such as compulsivity may be a critical step to improve outcomes of this condition. Still, neurobiological underpinnings of compulsivity need to be fully elucidated in AUD in order to better design targeted treatment strategies. In this manuscript, we review and discuss findings supporting common mechanisms between AUD and OCD, dissecting the construct of compulsivity and focusing specifically on characteristic disruptions in habit learning and cognitive control in the two disorders. Finally, neuromodulatory interventions are proposed as a probe to test compulsivity as key pathophysiologic feature of AUD, and as a potential therapy for the subgroup of individuals with compulsive alcohol use, i.e., the more resistant stage of the disorder. This transdiagnostic approach may help to destigmatize the disorder, and suggest potential treatment targets across different conditions.
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Affiliation(s)
- Elisabetta Burchi
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Nikolaos Makris
- Center for Morphometric Analysis, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Mary R Lee
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, Bethesda, MD, United States
| | - Stefano Pallanti
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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16
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Kan C, Cardi V, Stahl D, Treasure J. Precision psychiatry—What it means for eating disorders? EUROPEAN EATING DISORDERS REVIEW 2018; 27:3-7. [DOI: 10.1002/erv.2651] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Carol Kan
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College London London UK
- Eating DisordersSouth London and Maudsley NHS Foundation Trust London UK
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College London London UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology & NeuroscienceKing's College London London UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College London London UK
- Eating DisordersSouth London and Maudsley NHS Foundation Trust London UK
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17
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Leslie M, Turton R, Burgess E, Nazar BP, Treasure J. Testing the addictive appetite model of binge eating: The importance of craving, coping, and reward enhancement. EUROPEAN EATING DISORDERS REVIEW 2018; 26:541-550. [DOI: 10.1002/erv.2621] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Monica Leslie
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Robert Turton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
| | - Emilee Burgess
- Department of Psychology; University of Alabama at Birmingham; Birmingham Alabama USA
| | - Bruno Palazzo Nazar
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
- Federal University of Rio de Janeiro-Institute of Psychiatry (IPUB-UFRJ); Rio de Janeiro Brazil
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
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18
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Pexacerfont as a CRF1 antagonist for the treatment of withdrawal symptoms in men with heroin/methamphetamine dependence: a randomized, double-blind, placebo-controlled clinical trial. Int Clin Psychopharmacol 2018; 33:111-119. [PMID: 29064909 DOI: 10.1097/yic.0000000000000200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We assessed the efficacy of pexacerfont, a CRF1 antagonist, for the treatment of withdrawal symptoms. In this randomized, double-blind, placebo-controlled clinical trial, male patients with amphetamine or opioid dependence, on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR), in the age range 18-55 years, received either pexacerfont or placebo (300, 200, and 100 mg/day in the first, second, and third week, respectively). No antidepressants, behavioral interventions, or substitution therapy were administered. Candidates were excluded if they had DSM-IV-TR axis I or II disorders (other than depressive/anxiety disorders). The primary outcomes were difference in the distribution of positive urine test results for heroin and methamphetamine at the end of the trial, and the mean difference in the change in the Visual Analog Scale (VAS) score for craving from the baseline to the endpoint between the two groups. No significant difference was detected for urine test results, but a significant difference was observed for craving scores. Also, significant time×treatment interactions were found for all the scales including VAS craving, VAS temptation severity, frequency of temptation, Clinical Opiate Withdrawal Scale, Amphetamine Withdrawal Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory II. Our findings favor pexacerfont as a potential treatment for withdrawal from drug dependence; however, further comprehensive studies are warranted.
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19
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Mann K, Roos CR, Hoffmann S, Nakovics H, Leménager T, Heinz A, Witkiewitz K. Precision Medicine in Alcohol Dependence: A Controlled Trial Testing Pharmacotherapy Response Among Reward and Relief Drinking Phenotypes. Neuropsychopharmacology 2018; 43:891-899. [PMID: 29154368 PMCID: PMC5809801 DOI: 10.1038/npp.2017.282] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/02/2017] [Accepted: 11/12/2017] [Indexed: 12/20/2022]
Abstract
Randomized trials of medications for alcohol dependence (AD) often report no differences between active medications. Few studies in AD have tested hypotheses regarding which medication will work best for which patients (ie, precision medicine). The PREDICT study tested acamprosate and naltrexone vs placebo in 426 randomly assigned AD patients in a 3-month treatment. PREDICT proposed individuals whose drinking was driven by positive reinforcement (ie, reward drinkers) would have a better treatment response to naltrexone, whereas individuals whose drinking was driven by negative reinforcement (ie, relief drinkers) would have a better treatment response to acamprosate. The goal of the current analysis was to test this precision medicine hypothesis of the PREDICT study via analyses of subgroups. Results indicated that four phenotypes could be derived using the Inventory of Drinking Situations, a 30-item self-report questionnaire. These were high reward/high relief, high reward/low relief, low reward/high relief, and low reward/low relief phenotypes. Construct validation analyses provided strong support for the validity of these phenotypes. The subgroup of individuals who were predominantly reward drinkers and received naltrexone vs placebo had an 83% reduction in the likelihood of any heavy drinking (large effect size). Cutoff analyses were done for clinical applicability: individuals are reward drinkers and respond to naltrexone if their reward score was higher than their relief score AND their reward score was between 12 and 31. Using naltrexone with individuals who are predominantly reward drinkers produces significantly higher effect sizes than prescribing the medication to a more heterogeneous sample.
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Affiliation(s)
- Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Corey R Roos
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque NM, USA
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Helmut Nakovics
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tagrid Leménager
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katie Witkiewitz
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque NM, USA
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20
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Abstract
INTRODUCTION Substance use disorders are a group of chronic relapsing disorders of the brain, which have massive public health and societal impact. In some disorders (e.g., heroin/prescription opioid addictions) approved medications have a major long-term benefit. For other substances (e.g., cocaine, amphetamines and cannabis) there are no approved medications, and for alcohol there are approved treatments, which are not in wide usage. Approved treatments for tobacco use disorders are available, and novel medications are also under study. Areas covered: Medication-based approaches which are in advanced preclinical stages, or which have reached proof-of concept clinical laboratory studies, as well as clinical trials. Expert opinion: Current challenges involve optimizing translation between preclinical and clinical development, and between clinical laboratory studies to therapeutic clinical trials. Comorbidities including depression or anxiety are challenges for study design and analysis. Improved pharmacogenomics, biomarker and phenotyping approaches are areas of interest. Pharmacological mechanisms currently under investigation include modulation of glutamatergic, GABA, vasopressin and κ-receptor function, as well as inhibition of monoamine re-uptake. Other factors that affect potential market size for emerging medications include stigma, availability of treatment settings, adoption by clinicians, and the prevalence of persons with SUD who are not actively treatment-seeking.
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Affiliation(s)
- Eduardo R Butelman
- a Laboratory in the Biology of Addictive Diseases , The Rockefeller University , New York , NY , USA
| | - Mary Jeanne Kreek
- a Laboratory in the Biology of Addictive Diseases , The Rockefeller University , New York , NY , USA
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21
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Crabbe JC, Ozburn AR, Metten P, Barkley-Levenson A, Schlumbohm JP, Spence SE, Hack WR, Huang LC. High Drinking in the Dark (HDID) mice are sensitive to the effects of some clinically relevant drugs to reduce binge-like drinking. Pharmacol Biochem Behav 2017; 160:55-62. [PMID: 28827047 PMCID: PMC5603423 DOI: 10.1016/j.pbb.2017.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/14/2017] [Accepted: 08/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a serious public health need for better understanding of alcohol use disorder disease mechanisms and for improved treatments. At this writing, only three drugs are approved by the Food and Drug Administration as medications to treat alcohol use disorders - disulfiram, naltrexone, and acamprosate. Binge drinking is a form of abusive alcohol drinking defined by the NIAAA as a drinking to blood alcohol levels (BALs)>0.08% during a period of approximately 2h. To model genetic risk for binge-like drinking, we have used selective breeding to create a unique animal model, High Drinking in the Dark (HDID) mice. Behavioral characterization of HDID mice has revealed that HDID mice exhibit behavioral impairment after drinking, withdrawal after a single binge-drinking session, and escalate their intake in response to induction of successive cycles of dependence. Notably, HDID mice do not exhibit altered tastant preference or alcohol clearance rates. We therefore asked whether drugs of known clinical relevance could modulate binge-like ethanol drinking in HDID mice, reasoning that this characterization of HDID responses should inform future use of this genetic animal model for screening and development of novel potential therapeutics. METHODS We tested the efficacy of acamprosate and naltrexone to reduce binge-like drinking in HDID mice. Additionally, we tested the GABAB receptor agonist, baclofen, based on recent pre-clinical and clinical studies demonstrating that it reduces alcohol drinking. We elected not to include disulfiram due to its more limited clinical usage. Mice were tested after acute doses of drugs in the limited-access Drinking in the Dark (DID) paradigm. RESULTS HDID mice were sensitive to the effects of acamprosate and baclofen, but not naltrexone. Both drugs reduced binge-like drinking. However, naltrexone failed to reduce drinking in HDID mice. Thus, HDID mice may represent a useful model for screening novel compounds.
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Affiliation(s)
- John C Crabbe
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, OR 97239, USA.
| | - Angela R Ozburn
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, OR 97239, USA
| | - Pamela Metten
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, OR 97239, USA
| | - Amanda Barkley-Levenson
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, OR 97239, USA
| | - Jason P Schlumbohm
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, OR 97239, USA
| | - Stephanie E Spence
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, OR 97239, USA
| | - Wyatt R Hack
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, OR 97239, USA
| | - Lawrence C Huang
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, and VA Portland Health Care System, Portland, OR 97239, USA
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22
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Roberto M, Spierling SR, Kirson D, Zorrilla EP. Corticotropin-Releasing Factor (CRF) and Addictive Behaviors. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 136:5-51. [PMID: 29056155 PMCID: PMC6155477 DOI: 10.1016/bs.irn.2017.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Drug addiction is a complex disorder that is characterized by compulsivity to seek and take the drug, loss of control in limiting intake of the drug, and emergence of a withdrawal syndrome in the absence of the drug. The transition from casual drug use to dependence is mediated by changes in reward and brain stress functions and has been linked to a shift from positive reinforcement to negative reinforcement. The recruitment of brain stress systems mediates the negative emotional state produced by dependence that drives drug seeking through negative reinforcement mechanisms, defined as the "dark side" of addiction. In this chapter we focus on behavioral and cellular neuropharmacological studies that have implicated brain stress systems (i.e., corticotropin-releasing factor [CRF]) in the transition to addiction and the predominant brain regions involved. We also discuss the implication of CRF recruitment in compulsive eating disorders.
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Affiliation(s)
- Marisa Roberto
- The Scripps Research Institute, La Jolla, CA, United States.
| | | | - Dean Kirson
- The Scripps Research Institute, La Jolla, CA, United States
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23
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Ray LA, Bujarski S, Shoptaw S, Roche DJO, Heinzerling K, Miotto K. Development of the Neuroimmune Modulator Ibudilast for the Treatment of Alcoholism: A Randomized, Placebo-Controlled, Human Laboratory Trial. Neuropsychopharmacology 2017; 42:1776-1788. [PMID: 28091532 PMCID: PMC5520778 DOI: 10.1038/npp.2017.10] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 02/06/2023]
Abstract
Current directions in medication development for alcohol use disorder (AUD) emphasize the need to identify novel molecular targets and efficiently screen new compounds aimed at those targets. Ibudilast (IBUD) is a neuroimmune modulator that inhibits phosphodiesterase-4 and -10 and macrophage migration inhibitory factor and was recently found to reduce alcohol intake in rats by ∼50%. To advance medication development for AUD, the present study consists of a randomized, crossover, double-blind, placebo-controlled laboratory study of IBUD in nontreatment-seeking individuals with current (ie, past month) mild-to-severe AUD. This study tested the safety, tolerability, and initial human laboratory efficacy of IBUD (50 mg b.i.d.) on primary measures of subjective response to alcohol as well as secondary measures of cue- and stress-induced changes in craving and mood. Participants (N=24) completed two separate 7-day intensive outpatient protocols that included daily visits for medication administration and testing. Upon reaching a stable target dose of IBUD (or matched placebo), participants completed a stress-exposure session (day 5; PM), an alcohol cue-exposure session (day 6; AM), and an i.v. alcohol administration session (day 6; PM). Participants stayed overnight after the alcohol administration, and discharge occurred on day 7 of the protocol. Medication conditions were separated by a washout period that was ⩾7 days. IBUD was well tolerated; however, there were no medication effects on primary measures of subjective response to alcohol. IBUD was associated with mood improvements on the secondary measures of stress exposure and alcohol cue exposure, as well as reductions in tonic levels of craving. Exploratory analyses revealed that among individuals with higher depressive symptomatology, IBUD attenuated the stimulant and mood-altering effects of alcohol as compared with placebo. Together, these findings extend preclinical demonstrations of the potential utility of IBUD for the treatment of AUD and suggest that depressive symptomatology should be considered as a potential moderator of efficacy for pharmacotherapies with neuroimmune effects, such as IBUD.
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Affiliation(s)
- Lara A Ray
- Department of Psychology, University of California, Los Angeles, CA, USA,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA,Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA, Tel: 310 794 5383, Fax: 310 206 5895, E-mail:
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Steve Shoptaw
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA,Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - Daniel JO Roche
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Keith Heinzerling
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA,Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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24
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Bell RL, Hauser SR, Liang T, Sari Y, Maldonado-Devincci A, Rodd ZA. Rat animal models for screening medications to treat alcohol use disorders. Neuropharmacology 2017; 122:201-243. [PMID: 28215999 PMCID: PMC5659204 DOI: 10.1016/j.neuropharm.2017.02.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 01/21/2023]
Abstract
The purpose of this review is to present animal research models that can be used to screen and/or repurpose medications for the treatment of alcohol abuse and dependence. The focus will be on rats and in particular selectively bred rats. Brief introductions discuss various aspects of the clinical picture, which provide characteristics of individuals with alcohol use disorders (AUDs) to model in animals. Following this, multiple selectively bred rat lines will be described and evaluated in the context of animal models used to screen medications to treat AUDs. Next, common behavioral tests for drug efficacy will be discussed particularly as they relate to stages in the addiction cycle. Tables highlighting studies that have tested the effects of compounds using the respective techniques are included. Wherever possible the Tables are organized chronologically in ascending order to describe changes in the focus of research on AUDs over time. In general, high ethanol-consuming selectively bred rats have been used to test a wide range of compounds. Older studies usually followed neurobiological findings in the selected lines that supported an association with a propensity for high ethanol intake. Most of these tests evaluated the compound's effects on the maintenance of ethanol drinking. Very few compounds have been tested during ethanol-seeking and/or relapse and fewer still have assessed their effects during the acquisition of AUDs. Overall, while a substantial number of neurotransmitter and neuromodulatory system targets have been assessed; the roles of sex- and age-of-animal, as well as the acquisition of AUDs, ethanol-seeking and relapse continue to be factors and behaviors needing further study. This article is part of the Special Issue entitled "Alcoholism".
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Affiliation(s)
- Richard L Bell
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, USA.
| | - Sheketha R Hauser
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, USA
| | - Tiebing Liang
- Indiana University School of Medicine, Department of Gastroenterology, Indianapolis, IN 46202, USA
| | - Youssef Sari
- University of Toledo, Department of Pharmacology, Toledo, OH 43614, USA
| | | | - Zachary A Rodd
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, USA
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25
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Kwako LE, Momenan R, Grodin EN, Litten RZ, Koob GF, Goldman D. Addictions Neuroclinical Assessment: A reverse translational approach. Neuropharmacology 2017; 122:254-264. [PMID: 28283392 PMCID: PMC5569299 DOI: 10.1016/j.neuropharm.2017.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/02/2017] [Accepted: 03/04/2017] [Indexed: 12/21/2022]
Abstract
Incentive salience, negative emotionality, and executive function are functional domains that are etiologic in the initiation and progression of addictive disorders, having been implicated in humans with addictive disorders and in animal models of addictions. Measures of these three neuroscience-based functional domains can capture much of the effects of inheritance and early exposures that lead to trait vulnerability shared across different addictive disorders. For specific addictive disorders, these measures can be supplemented by agent specific measures such as those that access pharmacodynamic and pharmacokinetic variation attributable to agent-specific gatekeeper molecules including receptors and drug-metabolizing enzymes. Herein, we focus on the translation and reverse translation of knowledge derived from animal models of addiction to the human condition via measures of neurobiological processes that are orthologous in animals and humans, and that are shared in addictions to different agents. Based on preclinical data and human studies, measures of these domains in a general framework of an Addictions Neuroclinical Assessment (ANA) can transform the assessment and nosology of addictive disorders, and can be informative for staging disease progression. We consider next steps and challenges for implementation of ANA in clinical care and research. This article is part of the Special Issue entitled "Alcoholism".
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Affiliation(s)
- Laura E Kwako
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Reza Momenan
- Clinical Neuroimaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Erica N Grodin
- Clinical Neuroimaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Raye Z Litten
- Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA
| | - George F Koob
- Office of the Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA; Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA
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26
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Abstract
Addiction has been conceptualized as a three-stage cycle—binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation—that worsens over time and involves allostatic changes in hedonic function via changes in the brain reward and stress systems. Using the withdrawal/negative affect stage and negative reinforcement as an important source of motivation for compulsive drug seeking, we outline the neurobiology of the stress component of the withdrawal/negative affect stage and relate it to a derivative of the Research Domain Criteria research construct for the study of psychiatric disease, known as the Addictions Neuroclinical Assessment. Using the Addictions Neuroclinical Assessment, we outline five subdomains of negative emotional states that can be operationally measured in human laboratory settings and paralleled by animal models. We hypothesize that a focus on negative emotionality and stress is closely related to the acute neurobiological alterations that are experienced in addiction and may serve as a bridge to a reformulation of the addiction nosology to better capture individual differences in patients for whom the withdrawal/negative affect stage drives compulsive drug taking.
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Affiliation(s)
- Laura E Kwako
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - George F Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
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27
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Savulich G, Riccelli R, Passamonti L, Correia M, Deakin JFW, Elliott R, Flechais RSA, Lingford-Hughes AR, McGonigle J, Murphy A, Nutt DJ, Orban C, Paterson LM, Reed LJ, Smith DG, Suckling J, Tait R, Taylor EM, Sahakian BJ, Robbins TW, Ersche KD. Effects of naltrexone are influenced by childhood adversity during negative emotional processing in addiction recovery. Transl Psychiatry 2017; 7:e1054. [PMID: 28267152 PMCID: PMC5416677 DOI: 10.1038/tp.2017.34] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/12/2022] Open
Abstract
Naltrexone is an opioid receptor antagonist used in the management of alcohol dependence. Although the endogenous opioid system has been implicated in emotion regulation, the effects of mu-opioid receptor blockade on brain systems underlying negative emotional processing are not clear in addiction. Individuals meeting criteria for alcohol dependence alone (n=18, alcohol) and in combination with cocaine and/or opioid dependence (n=21, alcohol/drugs) and healthy individuals without a history of alcohol or drug dependence (n=21) were recruited. Participants were alcohol and drug abstinent before entered into this double-blind, placebo-controlled, randomized, crossover study. Functional magnetic resonance imaging was used to investigate brain response while viewing aversive and neutral images relative to baseline on 50 mg of naltrexone and placebo. We found that naltrexone modulated task-related activation in the medial prefrontal cortex and functional connectivity between the anterior cingulate cortex and the hippocampus as a function of childhood adversity (for aversive versus neutral images) in all groups. Furthermore, there was a group-by-treatment-by-condition interaction in the right amygdala, which was mainly driven by a normalization of response for aversive relative to neutral images under naltrexone in the alcohol/drugs group. We conclude that early childhood adversity is one environmental factor that influences pharmacological response to naltrexone. Pharmacotherapy with naltrexone may also have some ameliorative effects on negative emotional processing in combined alcohol and drug dependence, possibly due to alterations in endogenous opioid transmission or the kappa-opioid receptor antagonist actions of naltrexone.
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Affiliation(s)
- G Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - R Riccelli
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - L Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - M Correia
- Cognition and Brain Sciences Unit, Medical Research Council, Cambridge, UK
| | - J F W Deakin
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - R Elliott
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - R S A Flechais
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | | | - J McGonigle
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - A Murphy
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - D J Nutt
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - C Orban
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - L M Paterson
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - L J Reed
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - D G Smith
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - J Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - R Tait
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - E M Taylor
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - B J Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - T W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychology, University of Cambridge, Cambridge, UK
| | - K D Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK. E-mail:
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Fenton T, Wiers RW. Free Will, Black Swans and Addiction. NEUROETHICS-NETH 2016; 10:157-165. [PMID: 28725285 PMCID: PMC5486524 DOI: 10.1007/s12152-016-9290-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/07/2016] [Indexed: 11/05/2022]
Abstract
The current dominant perspective on addiction as a brain disease has been challenged recently by Marc Lewis, who argued that the brain-changes related to addiction are similar to everyday changes of the brain. From this alternative perspective, addictions are bad habits that can be broken, provided that people are motivated to change. In that case, autonomous choice or "free will" can overcome bad influences from genes and or environments and brain-changes related to addiction. Even though we concur with Lewis that there are issues with the brain disease perspective, we also argue that pointing to black swans can be important, that is: there can be severe cases where addiction indeed tips over into the category of brain disease, but obviously that does not prove that every case of addiction falls into the disease category, that all swans are black. We argue that, for example, people suffering from Korsakoff's syndrome, can be described as having a brain disease, often caused by alcohol addiction. Moreover, the brain changes occurring with addiction are related to choice-behaviour (and the related notions of willed action), habit formation and insight, hence essential mental abilities to break the addiction. We argue for a more graded perspective, where both black swans (severe brain disease which makes recovery virtually impossible) and white swans (unaffected brain) are rare, and most cases of addiction come as geese in different shades of gray.
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Affiliation(s)
- Ted Fenton
- King’s College London, Strand, London, UK
| | - Reinout W. Wiers
- Addiction, Development and Psychopathology (ADAPT)-lab, Department of Psychology, Amsterdam Brain & Cognition (ABC), Research Priority Area Yield, University of Amsterdam, Amsterdam, Netherlands
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Bujarski S, Ray LA. Experimental psychopathology paradigms for alcohol use disorders: Applications for translational research. Behav Res Ther 2016; 86:11-22. [PMID: 27266992 PMCID: PMC5067182 DOI: 10.1016/j.brat.2016.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/12/2016] [Accepted: 05/26/2016] [Indexed: 02/05/2023]
Abstract
In spite of high prevalence and disease burden, scientific consensus on the etiology and treatment of Alcohol Use Disorder (AUD) has yet to be reached. The development and utilization of experimental psychopathology paradigms in the human laboratory represents a cornerstone of AUD research. In this review, we describe and critically evaluate the major experimental psychopathology paradigms developed for AUD, with an emphasis on their implications, strengths, weaknesses, and methodological considerations. Specifically we review alcohol administration, self-administration, cue-reactivity, and stress-reactivity paradigms. We also provide an introduction to the application of experimental psychopathology methods to translational research including genetics, neuroimaging, pharmacological and behavioral treatment development, and translational science. Through refining and manipulating key phenotypes of interest, these experimental paradigms have the potential to elucidate AUD etiological factors, improve the efficiency of treatment developments, and refine treatment targets thus advancing precision medicine.
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Affiliation(s)
- Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, United States.
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, United States; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States
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Ray LA, Bujarski S, Roche DJO. Subjective Response to Alcohol as a Research Domain Criterion. Alcohol Clin Exp Res 2016; 40:6-17. [PMID: 26727518 DOI: 10.1111/acer.12927] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 10/12/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Individual differences in the subjective experience of the pharmacological effects of alcohol have long been implicated in the likelihood that one will drink heavily and develop alcoholism. The theme of this conceptual review and perspective article is to synthesize the literature on subjective responses to alcohol and to set an agenda for the next generation of research in the area. Specifically, we contend that in order for subjective response to alcohol to play a prominent role in alcoholism research, it is critical that it be studied as a multimodal phenotype. METHODS First, we review the human research on subjective response to alcohol measured under controlled laboratory conditions and draw recommendations for the application of these findings to understanding alcoholism neurobiology in humans. Second, we highlight multimodal approaches, including studies of the genetic and neural substrates of individual differences in subjective response to alcohol. Third, we review treatment implications with a focus on subjective response to alcohol as an intervention target. Upon review of the research on subjective response to alcohol across levels of analyses, we provide recommendations for leveraging these phenotypes in a systematic and methodologically rigorous fashion that can address central questions about alcoholism etiology, disease progression, and personalized treatment. DISCUSSION The approach recommended herein is largely consistent with the Research Domain Criteria (RDoC) initiative across the National Institute of Mental Health. The defining feature of such domains is that they inform behavior yet be amenable to examination through multiple units of analysis, such as molecular, genetic, circuit-level, and behavioral measurements. To that end, we contend that subjective response to alcohol represents a behaviorally and biologically plausible phenotype upon which to build using the RDoC framework for understanding alcohol use disorder.
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Affiliation(s)
- Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
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Kwako LE, Momenan R, Litten RZ, Koob GF, Goldman D. Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders. Biol Psychiatry 2016; 80:179-89. [PMID: 26772405 PMCID: PMC4870153 DOI: 10.1016/j.biopsych.2015.10.024] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/30/2015] [Accepted: 10/30/2015] [Indexed: 02/06/2023]
Abstract
This article proposes a heuristic framework for the Addictions Neuroclinical Assessment that incorporates key functional domains derived from the neurocircuitry of addiction. We review how addictive disorders (ADs) are presently diagnosed and the need for new neuroclinical measures to differentiate patients who meet clinical criteria for addiction to the same agent while differing in etiology, prognosis, and treatment response. The need for a better understanding of the mechanisms provoking and maintaining addiction, as evidenced by the limitations of current treatments and within-diagnosis clinical heterogeneity, is articulated. In addition, recent changes in the nosology of ADs, challenges to current classification systems, and prior attempts to subtype individuals with ADs are described. Complementary initiatives, including the Research Domain Criteria project, that have established frameworks for the neuroscience of psychiatric disorders are discussed. Three domains-executive function, incentive salience, and negative emotionality-tied to different phases in the cycle of addiction form the core functional elements of ADs. Measurement of these domains in epidemiologic, genetic, clinical, and treatment studies will provide the underpinnings for an understanding of cross-population and temporal variation in addictions, shared mechanisms in addictive disorders, impact of changing environmental influences, and gene identification. Finally, we show that it is practical to implement such a deep neuroclinical assessment using a combination of neuroimaging and performance measures. Neuroclinical assessment is key to reconceptualizing the nosology of ADs on the basis of process and etiology, an advance that can lead to improved prevention and treatment.
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Affiliation(s)
- Laura E Kwako
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.
| | - Reza Momenan
- Section on Brain Electrophysiology and Imaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Raye Z Litten
- Division of Intramural Clinical and Biological Research; Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - George F Koob
- Office of the Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland; Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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Figee M, Pattij T, Willuhn I, Luigjes J, van den Brink W, Goudriaan A, Potenza MN, Robbins TW, Denys D. Compulsivity in obsessive-compulsive disorder and addictions. Eur Neuropsychopharmacol 2016; 26:856-68. [PMID: 26774279 DOI: 10.1016/j.euroneuro.2015.12.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/17/2015] [Accepted: 12/01/2015] [Indexed: 01/05/2023]
Abstract
Compulsive behaviors are driven by repetitive urges and typically involve the experience of limited voluntary control over these urges, a diminished ability to delay or inhibit these behaviors, and a tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is not only a central characteristic of obsessive-compulsive disorder (OCD) but is also crucial to addiction. Based on this analogy, OCD has been proposed to be part of the concept of behavioral addiction along with other non-drug-related disorders that share compulsivity, such as pathological gambling, skin-picking, trichotillomania and compulsive eating. In this review, we investigate the neurobiological overlap between compulsivity in substance-use disorders, OCD and behavioral addictions as a validation for the construct of compulsivity that could be adopted in the Research Domain Criteria (RDoC). The reviewed data suggest that compulsivity in OCD and addictions is related to impaired reward and punishment processing with attenuated dopamine release in the ventral striatum, negative reinforcement in limbic systems, cognitive and behavioral inflexibility with diminished serotonergic prefrontal control, and habitual responding with imbalances between ventral and dorsal frontostriatal recruitment. Frontostriatal abnormalities of compulsivity are promising targets for neuromodulation and other interventions for OCD and addictions. We conclude that compulsivity encompasses many of the RDoC constructs in a trans-diagnostic fashion with a common brain circuit dysfunction that can help identifying appropriate prevention and treatment targets.
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Affiliation(s)
- Martijn Figee
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
| | - Tommy Pattij
- Neuroscience Campus Amsterdam, Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Ingo Willuhn
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; The Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Judy Luigjes
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
| | - Wim van den Brink
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anneke Goudriaan
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Neurobiology, Yale University School of Medicine, New Haven, CT, United States; Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Trevor W Robbins
- Department of Psychology and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Damiaan Denys
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; The Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
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Bell RL, Hauser S, Rodd ZA, Liang T, Sari Y, McClintick J, Rahman S, Engleman EA. A Genetic Animal Model of Alcoholism for Screening Medications to Treat Addiction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2016; 126:179-261. [PMID: 27055615 PMCID: PMC4851471 DOI: 10.1016/bs.irn.2016.02.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purpose of this review is to present up-to-date pharmacological, genetic, and behavioral findings from the alcohol-preferring P rat and summarize similar past work. Behaviorally, the focus will be on how the P rat meets criteria put forth for a valid animal model of alcoholism with a highlight on its use as an animal model of polysubstance abuse, including alcohol, nicotine, and psychostimulants. Pharmacologically and genetically, the focus will be on the neurotransmitter and neuropeptide systems that have received the most attention: cholinergic, dopaminergic, GABAergic, glutamatergic, serotonergic, noradrenergic, corticotrophin releasing hormone, opioid, and neuropeptide Y. Herein, we sought to place the P rat's behavioral and neurochemical phenotypes, and to some extent its genotype, in the context of the clinical literature. After reviewing the findings thus far, this chapter discusses future directions for expanding the use of this genetic animal model of alcoholism to identify molecular targets for treating drug addiction in general.
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Affiliation(s)
- R L Bell
- Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - S Hauser
- Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Z A Rodd
- Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, United States
| | - T Liang
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Y Sari
- University of Toledo, Toledo, OH, United States
| | - J McClintick
- Center for Medical Genomics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - S Rahman
- Department of Pharmaceutical Sciences, South Dakota State University, Brookings, SD, United States
| | - E A Engleman
- Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN, United States
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Le Foll B. What does addiction medicine expect from neuroscience? From genes and neurons to treatment responses. PROGRESS IN BRAIN RESEARCH 2016; 224:419-47. [DOI: 10.1016/bs.pbr.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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The nociceptin/orphanin FQ receptor agonist SR-8993 as a candidate therapeutic for alcohol use disorders: validation in rat models. Psychopharmacology (Berl) 2016; 233:3553-63. [PMID: 27515665 PMCID: PMC5021736 DOI: 10.1007/s00213-016-4385-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/16/2016] [Indexed: 12/30/2022]
Abstract
RATIONALE Alcoholism is a complex disorder in which diverse pathophysiological processes contribute to initiation and progression, resulting in a high degree of heterogeneity among patients. Few pharmacotherapies are presently available, and patient responses to these are variable. The nociceptin/orphanin FQ (NOP) receptor has been suggested to play a role both in alcohol reward and in negatively reinforced alcohol seeking. Previous studies have shown that NOP-receptor activation reduces alcohol intake in genetically selected alcohol-preferring as well as alcohol-dependent rats. NOP activation also blocks stress- and cue-induced reinstatement of alcohol-seeking behavior. OBJECTIVES Here, we aimed to examine a novel, potent, and brain-penetrant small-molecule NOP-receptor agonist, SR-8993, in animal models of alcohol- as well as anxiety-related behavior using male Wistar rats. RESULTS SR-8993 was mildly anxiolytic when given to naïve animals and potently reversed acute alcohol withdrawal-induced ("hangover") anxiety. SR-8993 reduced both home-cage limited access drinking, operant responding for alcohol, and escalation induced through prolonged intermittent access to alcohol. SR-8993 further attenuated stress- as well as cue-induced relapse to alcohol seeking. For the effective dose (1.0 mg/kg), non-specific effects such as sedation may be limited, since a range of control behaviors were unaffected, and this dose did not interact with alcohol elimination. CONCLUSION These findings provide further support for NOP-receptor agonism as a promising candidate treatment for alcoholism and establish SR-8993 or related molecules as suitable for further development as therapeutics.
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Alongkronrusmee D, Chiang T, van Rijn RM. Delta Opioid Pharmacology in Relation to Alcohol Behaviors. Handb Exp Pharmacol 2016; 247:199-225. [PMID: 27316912 DOI: 10.1007/164_2016_30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Delta opioid receptors (DORs) are heavily involved in alcohol-mediated processes in the brain. In this chapter we provide an overview of studies investigating how alcohol directly impacts DOR pharmacology and of early studies indicating DOR modulation of alcohol behavior. We will offer a brief summary of the different animal species used in alcohol studies investigating DORs followed by a broader overview of the types of alcohol behaviors modulated by DORs. We will highlight a small set of studies investigating the relationship between alcohol and DORs in analgesia. We will then provide an anatomical overview linking DOR expression in specific brain regions to different alcohol behaviors. In this section, we will provide two models that try to explain how endogenous opioids acting at DORs may influence alcohol behaviors. Next, we will provide an overview of studies investigating certain new aspects of DOR pharmacology, including the formation of heteromers and biased signaling. Finally, we provide a short overview of the genetics of the DORs in relation to alcohol use disorders (AUDs) and a short statement on the potential of using DOR-based therapeutics for treatment of AUDs.
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Affiliation(s)
- Doungkamol Alongkronrusmee
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, USA
| | - Terrance Chiang
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, USA
| | - Richard M van Rijn
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN, USA.
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Ray LA, Bujarski S. Mechanisms of topiramate effects: refining medications development for alcoholism. Addict Biol 2016; 21:183-184. [PMID: 25876675 DOI: 10.1111/adb.12226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lara A. Ray
- Department of Psychology; University of California; Los Angeles CA 90095-1563 USA
| | - Spencer Bujarski
- Department of Psychology; University of California; Los Angeles CA 90095-1563 USA
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Bach P, Kirsch M, Hoffmann S, Jorde A, Mann K, Frank J, Charlet K, Beck A, Heinz A, Walter H, Rietschel M, Kiefer F, Vollstädt-Klein S. The effects of single nucleotide polymorphisms in glutamatergic neurotransmission genes on neural response to alcohol cues and craving. Addict Biol 2015; 20:1022-32. [PMID: 26289945 DOI: 10.1111/adb.12291] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/24/2015] [Accepted: 07/14/2015] [Indexed: 11/29/2022]
Abstract
The aim of the current study was to determine genotype effects of four single nucleotide polymorphisms (SNPs) in the genes of the N-Methyl-d-aspartate receptor (GRIN1, GRIN2A, GRIN2C) and kainate receptor (GRIK1), which have been previously associated with alcoholism, on behavior, neural cue-reactivity and drinking outcome. Eighty-six abstinent alcohol dependent patients were recruited from an in-patient setting. Neuropsychological tests, genotyping and functional magnetic resonance imaging (fMRI) were used to study genotype effects. GRIN2C risk allele carriers displayed increased alcohol cue-induced activation in the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (dlPFC). Neural activation in the ACC positively correlated with craving for alcohol (r = 0.201, P = 0.032), whereas activation in the dlPFC showed a negative association (r = -0.215, P = 0.023). In addition, dlPFC activation predicted time to first relapse (HR = 2.701, 95%CI 1.244-5.864, P = 0.012). GRIK1 risk allele carriers showed increased cue-induced activation in the medial prefrontal (PFC) and orbitofrontal cortex (OFC) and in the lateral PFC and OFC. Activation in both clusters positively correlated with alcohol craving (rmedOFC, medPFC = 0.403, P = 0.001, rlatOFC, latPFC = 0.282, P = 0.008), and activation in the cluster that encompassed the medial OFC predicted time to first relapse (HR = 1.911, 95%CI 1.030-3.545, P = 0.040). Findings indicate that SNPs in the GRIN2C and GRIK1 genes are associated with altered cue-induced brain activation that is related to craving for alcohol and relapse risk.
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Affiliation(s)
- Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
| | - Martina Kirsch
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
| | - Anne Jorde
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
| | - Katrin Charlet
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte; Charité-Universitätsmedizin; Germany
| | - Anne Beck
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte; Charité-Universitätsmedizin; Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte; Charité-Universitätsmedizin; Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin; Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health; Medical Faculty Mannheim, University of Heidelberg; Germany
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Phillips TJ, Reed C, Pastor R. Preclinical evidence implicating corticotropin-releasing factor signaling in ethanol consumption and neuroadaptation. GENES BRAIN AND BEHAVIOR 2015; 14:98-135. [PMID: 25565358 DOI: 10.1111/gbb.12189] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 11/22/2014] [Accepted: 11/25/2014] [Indexed: 12/15/2022]
Abstract
The results of many studies support the influence of the corticotropin-releasing factor (CRF) system on ethanol (EtOH) consumption and EtOH-induced neuroadaptations that are critical in the addiction process. This review summarizes the preclinical data in this area after first providing an overview of the components of the CRF system. This complex system involves hypothalamic and extra-hypothalamic mechanisms that play a role in the central and peripheral consequences of stressors, including EtOH and other drugs of abuse. In addition, several endogenous ligands and targets make up this system and show differences in their involvement in EtOH drinking and in the effects of chronic or repeated EtOH treatment. In general, genetic and pharmacological approaches paint a consistent picture of the importance of CRF signaling via type 1 CRF receptors (CRF(1)) in EtOH-induced neuroadaptations that result in higher levels of intake, encourage alcohol seeking during abstinence and alter EtOH sensitivity. Furthermore, genetic findings in rodents, non-human primates and humans have provided some evidence of associations of genetic polymorphisms in CRF-related genes with EtOH drinking, although additional data are needed. These results suggest that CRF(1) antagonists have potential as pharmacotherapeutics for alcohol use disorders. However, given the broad and important role of these receptors in adaptation to environmental and other challenges, full antagonist effects may be too profound and consideration should be given to treatments with modulatory effects.
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Affiliation(s)
- T J Phillips
- VA Portland Health Care System, Portland Alcohol Research Center, Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA; Department of Behavioral Neuroscience, Portland Alcohol Research Center, Methamphetamine Abuse Research Center, Oregon Health & Science University, Portland, OR, USA
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Paterson LM, Flechais RSA, Murphy A, Reed LJ, Abbott S, Boyapati V, Elliott R, Erritzoe D, Ersche KD, Faluyi Y, Faravelli L, Fernandez-Egea E, Kalk NJ, Kuchibatla SS, McGonigle J, Metastasio A, Mick I, Nestor L, Orban C, Passetti F, Rabiner EA, Smith DG, Suckling J, Tait R, Taylor EM, Waldman AD, Robbins TW, Deakin JFW, Nutt DJ, Lingford-Hughes AR. The Imperial College Cambridge Manchester (ICCAM) platform study: An experimental medicine platform for evaluating new drugs for relapse prevention in addiction. Part A: Study description. J Psychopharmacol 2015; 29:943-60. [PMID: 26246443 DOI: 10.1177/0269881115596155] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Drug and alcohol dependence are global problems with substantial societal costs. There are few treatments for relapse prevention and therefore a pressing need for further study of brain mechanisms underpinning relapse circuitry. The Imperial College Cambridge Manchester (ICCAM) platform study is an experimental medicine approach to this problem: using functional magnetic resonance imaging (fMRI) techniques and selective pharmacological tools, it aims to explore the neuropharmacology of putative relapse pathways in cocaine, alcohol, opiate dependent, and healthy individuals to inform future drug development. Addiction studies typically involve small samples because of recruitment difficulties and attrition. We established the platform in three centres to assess the feasibility of a multisite approach to address these issues. Pharmacological modulation of reward, impulsivity and emotional reactivity were investigated in a monetary incentive delay task, an inhibitory control task, and an evocative images task, using selective antagonists for µ-opioid, dopamine D3 receptor (DRD3) and neurokinin 1 (NK1) receptors (naltrexone, GSK598809, vofopitant/aprepitant), in a placebo-controlled, randomised, crossover design. In two years, 609 scans were performed, with 155 individuals scanned at baseline. Attrition was low and the majority of individuals were sufficiently motivated to complete all five sessions (n=87). We describe herein the study design, main aims, recruitment numbers, sample characteristics, and explain the test hypotheses and anticipated study outputs.
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Affiliation(s)
- Louise M Paterson
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Remy S A Flechais
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Anna Murphy
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - Laurence J Reed
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Sanja Abbott
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | | | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - David Erritzoe
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Karen D Ersche
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Yetunde Faluyi
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Luca Faravelli
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Emilio Fernandez-Egea
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Nicola J Kalk
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | | | - John McGonigle
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Antonio Metastasio
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK 5 Boroughs Partnership NHS Foundation Trust, Warrington, UK
| | - Inge Mick
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Liam Nestor
- Centre for Neuropsychopharmacology, Imperial College London, London, UK Clinical Research Unit, GlaxoSmithKline, Cambridge, UK
| | - Csaba Orban
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - Filippo Passetti
- Centre for Neuropsychopharmacology, Imperial College London, London, UK Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Dana G Smith
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychology, University of Cambridge, Cambridge, UK
| | - John Suckling
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Roger Tait
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Eleanor M Taylor
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - Adam D Waldman
- Centre for Neuroinflammation and Neurodegeneration, Imperial College London, London, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK Department of Psychology, University of Cambridge, Cambridge, UK
| | - J F William Deakin
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
| | - David J Nutt
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
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Mann K, Vollstädt-Klein S, Reinhard I, Leménager T, Fauth-Bühler M, Hermann D, Hoffmann S, Zimmermann US, Kiefer F, Heinz A, Smolka MN. Predicting naltrexone response in alcohol-dependent patients: the contribution of functional magnetic resonance imaging. Alcohol Clin Exp Res 2015; 38:2754-62. [PMID: 25421512 DOI: 10.1111/acer.12546] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 08/11/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Effect sizes of pharmacotherapy in alcoholism are modest. They might improve if subjects could be divided into more homogeneous subgroups and would then be treated targeted to their neurobiological profile. In such an effort, we tested neural cue reactivity as a potential predictor of treatment response to naltrexone. Alcohol-associated cues cause brain activations in mesocorticolimbic networks due to the positive reinforcing properties of alcohol. These activations were reported to be associated with relapse behavior. Naltrexone, an antagonist at the mu-opioid receptor, improves drinking behavior in some but not all patients probably by blocking the positive reinforcement of alcohol. Conversely, acamprosate is proposed to modulate negative reinforcement (withdrawal and cue-induced withdrawal). Identifying subjects with elevated cue reactivity and testing their response to medical treatment could thus improve our understanding of some of the mechanisms underlying pharmacotherapy response. METHODS A picture-perception task featuring alcohol-related and neutral stimuli was presented to 64 recently detoxified alcohol-dependent patients. Patients came from 1 center of a larger double-blind randomized multicenter clinical trial (the "PREDICT Study"). They were scanned prior to being randomized to either naltrexone or acamprosate. We examined the interaction between medication and functional magnetic resonance imaging (fMRI) cue reactivity, as measured by the percentage of voxels activated, using the time to the first severe relapse as the outcome criterion. Our a priori formulated hypothesis was that naltrexone but not acamprosate should be efficacious in subjects with high cue reactivity. RESULTS We observed an interaction effect between pretreatment brain activation induced by alcohol images and medication (acamprosate/naltrexone) on relapse behavior. In line with our hypothesis, this interaction was driven by treatment response to naltrexone in patients with elevated pretreatment cue reactivity in the ventral striatum. CONCLUSIONS fMRI has the potential for predicting treatment response to naltrexone in a subgroup of alcohol-dependent patients. However, this approach will be limited to researching the mechanisms and principles of treatment response.
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Affiliation(s)
- Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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Kronenberg LM, Goossens PJ, van Busschbach J, van Achterberg T, van den Brink W. Coping styles in substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). BMC Psychiatry 2015; 15:159. [PMID: 26169586 PMCID: PMC4501102 DOI: 10.1186/s12888-015-0530-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/14/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with a substance use disorder (SUD) and co-occurring attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) often start using substances in an attempt to cope with the stress related to their ADHD or ASD. To improve treatment for these patient groups, it is important to identify and compare the various coping styles between SUD patients with and without ADHD or ASD and with subjects from a general population sample. METHODS Cross-sectional study using the Utrecht Coping List (UCL) in 50 SUD patients, 41 SUD + ADHD patients, 31 SUD + ASD patients and 1,200 railway employees. RESULTS Compared with the reference group, all three SUD groups showed a significant higher mean on the Palliative reaction, Avoidance, and Passive reaction subscales of the UCL. The scores for all UCL subscales of the SUD and the SUD + ADHD groups were very similar. However, the SUD + ASD group scored higher on Passive reaction and lower on Reassuring thoughts than the SUD and the SUD + ADHD groups and lower on Expression of emotions subscale in comparison with the SUD + ADHD group. CONCLUSIONS Regardless of the presence of a co-occurring disorder, SUD patients reported more palliative, avoidant and passive coping when confronted than people in the general population. In addition, SUD patients with co-occurring ASD were different from other SUD patients in their coping and professionals should take this into account when working on more adaptive coping strategies with these patients.
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Affiliation(s)
- Linda M. Kronenberg
- Department of residency training MANP mental health, Dimence, P.O. Box 5003, 7400 GC Deventer, The Netherlands ,Dimence Group, Center for Mental Health Care, Expertise Centre Developmental Disorders, Deventer, The Netherlands
| | - Peter J.J. Goossens
- Dimence Group, Center for Mental Health Care, Expertise Centre Bipolar Disorders, Deventer, The Netherlands ,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands ,Department of Public Health, University Centre for Nursing and Midwifery, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,GGZ-VS, Institute for Education of Clinical Nurse Specialist in Mental Health, Utrecht, The Netherlands
| | - Jooske van Busschbach
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
| | - Theo van Achterberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands. .,Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium. .,Department of Public health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands.
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Roche DJ, Ray LA. Subjective response as a consideration in the pharmacogenetics of alcoholism treatment. Pharmacogenomics 2015; 16:721-36. [PMID: 25950242 DOI: 10.2217/pgs.14.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Currently available pharmacological treatments for alcoholism have modest efficacy and high individual variability in treatment outcomes, both of which have been partially attributed to genetic factors. One path to reducing the variability and improving the efficacy associated with these pharmacotherapies may be to identify overlapping genetic contributions to individual differences in both subjective responses to alcohol and alcoholism pharmacotherapy outcomes. As acute subjective response to alcohol is highly predictive of future alcohol related problems, identifying such shared genetic mechanisms may inform the development of personalized treatments that can effectively target converging pathophysiological mechanisms that convey risk for alcoholism. The focus of this review is to revisit the association between subjective response to alcohol and the etiology of alcoholism while also describing genetic contributions to this relationship, discuss potential pharmacogenetic approaches to target subjective response to alcohol in order to improve the treatment of alcoholism and examine conceptual and methodological issues associated with these topics, and outline future approaches to overcome these challenges.
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Affiliation(s)
- Daniel Jo Roche
- 1Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA
| | - Lara A Ray
- 1Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA
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Miranda R, Monti PM, Ray L, Treloar HR, Reynolds EK, Ramirez J, Chun T, Gwaltney CJ, Justus A, Tidey J, Blanchard A, Magill M. Characterizing subjective responses to alcohol among adolescent problem drinkers. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 123:117-29. [PMID: 24661164 DOI: 10.1037/a0035328] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Theoretical models of alcoholism emphasize the acute reinforcing properties of alcohol as chief determinants of drinking, and animal research suggests adolescents are uniquely sensitive to these effects. Human studies of these phenomena, however, are virtually nonexistent. We used ecological momentary assessment methods to capture adolescents' subjective responses to alcohol in real time in their natural environments. Adolescent participants were 22 problem drinkers, ages 15 to 19 years (M = 18.3, SD = 0.09; 55% female; 55% alcohol dependent). Participants consumed alcohol on 38% of days during a 1-week monitoring period, with an average of 5 drinks per occasion. Momentary data revealed that adolescents experience decreased stimulation and increased sedation and "high" across the ascending limb of the blood alcohol curve. Notably, greater craving predicted higher volumes of subsequent alcohol consumption during the episode, whereas greater "high" attenuated use. To test for developmental differences in these effects, we pooled these data with data from a similarly ascertained sample of 36 adult heavy drinkers, ages 24 to 64 years (M = 38.1, SD = 11.8; 50% female; 61% alcohol dependent). Adolescents were more sensitive to the stimulant effects of alcohol than adults. This study provides novel data on how adolescent problem drinkers experience alcohol in their natural contexts and illustrates how these effects, which appear to differ from adult problem drinkers, confer liability for future drinking.
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Affiliation(s)
- Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University
| | - Lara Ray
- Center for Alcohol and Addiction Studies, Brown University
| | | | | | - Jason Ramirez
- Center for Alcohol and Addiction Studies, Brown University
| | - Thomas Chun
- Center for Alcohol and Addiction Studies, Brown University
| | | | - Alicia Justus
- Center for Alcohol and Addiction Studies, Brown University
| | - Jennifer Tidey
- Center for Alcohol and Addiction Studies, Brown University
| | | | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University
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45
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Development and Validation of the Craving Automated Scale for Alcohol. Alcohol Clin Exp Res 2015; 39:333-42. [DOI: 10.1111/acer.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 11/10/2014] [Indexed: 02/02/2023]
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Bell RL, Lopez MF, Cui C, Egli M, Johnson KW, Franklin KM, Becker HC. Ibudilast reduces alcohol drinking in multiple animal models of alcohol dependence. Addict Biol 2015; 20:38-42. [PMID: 24215262 PMCID: PMC4017009 DOI: 10.1111/adb.12106] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Neuroinflammatory signaling pathways in the central nervous system are of current interest as potential pharmacotherapy targets for alcohol dependence. In this study, we examined the ability of ibudilast, a non-selective phosphodiesterase inhibitor, to reduce alcohol drinking and relapse in alcohol-preferring P rats, high-alcohol drinking HAD1 rats, and in mice made dependent on alcohol through cycles of alcohol vapor exposure. When administered twice daily, ibudilast reduced alcohol drinking in rats by approximately 50% and reduced drinking by alcohol-dependent mice at doses which had no effect in non-dependent mice. These findings support the viability of ibudilast as a possible treatment for alcohol dependence.
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Affiliation(s)
- Richard L. Bell
- Department of Psychiatry and Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Marcelo F. Lopez
- Department of Psychiatry and Behavioral Sciences, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Changhai Cui
- Division of Neuroscience and Behavior, National Institute on Alcohol Abuse and Alcoholism, NIH, DHHS, Bethesda, MD 20892, USA
| | - Mark Egli
- Division of Neuroscience and Behavior, National Institute on Alcohol Abuse and Alcoholism, NIH, DHHS, Bethesda, MD 20892, USA
| | | | - Kelle M. Franklin
- Department of Psychiatry and Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Howard C. Becker
- Department of Psychiatry and Behavioral Sciences, Charleston Alcohol Research Center, Medical University of South Carolina, Charleston, SC 29425, USA
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Courtney KE, Ray LA. Subjective responses to alcohol in the lab predict neural responses to alcohol cues. J Stud Alcohol Drugs 2014; 75:124-35. [PMID: 24411804 DOI: 10.15288/jsad.2014.75.124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Subjective responses to alcohol represent a biologically based, genetically moderated, and clinically informative marker of alcoholism risk; however, the physiology underlying this phenotype remains unclear. This study tested whether subjective responses during alcohol administration predict neural responses to alcohol cues in the scanner and whether these neural responses differ between OPRM1 genotypes. METHOD Twenty alcohol-dependent individuals were recruited (10 G-allele carriers; 6 women; Mage = 29.4) for a within-subjects alcohol administration in the laboratory and a functional magnetic resonance imaging session consisting of an alcohol taste cues task. Laboratory assessments of alcohol high, liking, craving, and positive and negative reinforcement during alcohol administration were entered as predictors of neural response to the presentation of alcohol cues versus water cues in the scanner and further tested for OPRM1 genotype moderation (whole-brain cluster-corrected at Z > 1.96, p < .05). RESULTS Alcohol craving during alcohol administration predicted less neural activity, whereas alcohol reinforcement predicted greater neural activity to alcohol cues versus water cues in regions including the precuneus, posterior cingulate gyrus, and lingual gyrus. Alcohol high predicted greater neural activity to alcohol cues in regions including the precuneus and anterior cingulate cortex. OPRM1 genotype was found to moderate these relationships. No results were observed for alcohol liking. CONCLUSIONS This study provides initial evidence that subjective responses to alcohol, namely craving, high, and the reinforcing properties of alcohol, predict neural markers of alcohol cue reactivity. These results support the validity of laboratory and neuroimaging measures of subjective responses to alcohol and offer an integration of these methods in a sample of alcohol-dependent individuals.
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Affiliation(s)
- Kelly E Courtney
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
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Levetiracetam results in increased and decreased alcohol drinking with different access procedures in C57BL/6J mice. Behav Pharmacol 2014; 25:61-70. [PMID: 24322822 DOI: 10.1097/fbp.0000000000000019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The antiepileptic levetiracetam (LEV) has been investigated for the treatment of alcohol abuse. However, little is known about how LEV alters the behavioral effects of alcohol in laboratory animals. The acute effects of LEV on alcohol drinking by male C57BL/6J mice were investigated using two different drinking procedures, limited access [drinking-in-the-dark (DID)] and intermittent access (IA) drinking. In the first experiment (DID), mice had access to a single bottle containing alcohol or sucrose for 4 h every other day. In the second experiment (IA), mice had IA to two bottles, one containing alcohol or sucrose and one containing water, for 24 h on Monday, Wednesday, and Friday. In both experiments, mice were administered LEV (0.3-100 mg/kg intraperitoneally) or vehicle 30 min before access to the drinking solutions. In the DID mice, LEV increased alcohol intake from 4.3 to 5.4 g/kg, whereas in the IA mice LEV decreased alcohol intake from 4.8 to 3.0 g/kg in the first 4 h of access and decreased 24 h alcohol intake from 20 to ∼15 g/kg. These effects appear specific to alcohol, as LEV did not affect sucrose intake in either experiment. LEV appears to differentially affect drinking in animal models of moderate and heavier alcohol consumption.
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49
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Fish EW, DiBerto JF, Krouse MC, Robinson JE, Malanga CJ. Different contributions of dopamine D1 and D2 receptor activity to alcohol potentiation of brain stimulation reward in C57BL/6J and DBA/2J mice. J Pharmacol Exp Ther 2014; 350:322-9. [PMID: 24917543 DOI: 10.1124/jpet.114.216135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
C57BL/6J (C57) and DBA/2J (DBA) mice respond differently to drugs that affect dopamine systems, including alcohol. The current study compared effects of D1 and D2 receptor agonists and antagonists, and the interaction between D1/D2 antagonists and alcohol, on intracranial self-stimulation in male C57 and DBA mice to determine the role of dopamine receptors in the effects of alcohol on brain stimulation reward (BSR). In the initial strain comparison, dose effects on BSR thresholds and maximum operant response rates were determined for the D1 receptor agonist SKF-82958 (±-6-chloro-7,8-dihydroxy-3-allyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine; 0.1-0.56 mg/kg) and antagonist SCH 23390 (+-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepinehydrochloride; 0.003-0.056 mg/kg), and the D2 receptor agonist quinpirole (0.1-3.0 mg/kg) and antagonist raclopride (0.01-0.56 mg/kg). For the alcohol interaction, SCH 23390 (0.003 mg/kg) or raclopride (0.03 mg/kg) was given before alcohol (0.6-2.4 g/kg p.o.). D1 antagonism dose-dependently elevated and SKF-82958 dose-dependently lowered BSR threshold in both strains; DBA mice were more sensitive to SKF-82958 effects. D2 antagonism dose-dependently elevated BSR threshold only in C57 mice. Low doses of quinpirole elevated BSR threshold equally in both strains, whereas higher doses of quinpirole lowered BSR threshold only in C57 mice. SCH 23390, but not raclopride, prevented lowering of BSR threshold by alcohol in DBA mice. Conversely, raclopride, but not SCH 23390, prevented alcohol potentiation of BSR in C57 mice. These results extend C57 and DBA strain differences to D1/D2 sensitivity of BSR, and suggest differential involvement of D1 and D2 receptors in the acute rewarding effects of alcohol in these two mouse strains.
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Affiliation(s)
- Eric W Fish
- Bowles Center for Alcohol Studies (E.W.F., J.E.R., C.J.M.), Department of Neurology, University of North Carolina School of Medicine (J.F.D., M.C.K., J.E.R., C.J.M.), and Neurobiology Curriculum, University of North Carolina School of Medicine (J.E.R., C.J.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey F DiBerto
- Bowles Center for Alcohol Studies (E.W.F., J.E.R., C.J.M.), Department of Neurology, University of North Carolina School of Medicine (J.F.D., M.C.K., J.E.R., C.J.M.), and Neurobiology Curriculum, University of North Carolina School of Medicine (J.E.R., C.J.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael C Krouse
- Bowles Center for Alcohol Studies (E.W.F., J.E.R., C.J.M.), Department of Neurology, University of North Carolina School of Medicine (J.F.D., M.C.K., J.E.R., C.J.M.), and Neurobiology Curriculum, University of North Carolina School of Medicine (J.E.R., C.J.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - J Elliott Robinson
- Bowles Center for Alcohol Studies (E.W.F., J.E.R., C.J.M.), Department of Neurology, University of North Carolina School of Medicine (J.F.D., M.C.K., J.E.R., C.J.M.), and Neurobiology Curriculum, University of North Carolina School of Medicine (J.E.R., C.J.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - C J Malanga
- Bowles Center for Alcohol Studies (E.W.F., J.E.R., C.J.M.), Department of Neurology, University of North Carolina School of Medicine (J.F.D., M.C.K., J.E.R., C.J.M.), and Neurobiology Curriculum, University of North Carolina School of Medicine (J.E.R., C.J.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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50
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Haass-Koffler CL, Leggio L, Kenna GA. Pharmacological approaches to reducing craving in patients with alcohol use disorders. CNS Drugs 2014; 28:343-60. [PMID: 24573997 PMCID: PMC3990000 DOI: 10.1007/s40263-014-0149-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Research on the concept of craving may lead to better understanding of the biobehavioural circuitries that contribute to the complexity of alcohol use disorders (AUDs). The experiences described as craving or desire to drink are often associated with physical responses such as increased salivation and heart rate, and alteration of stress hormones, as well as psychological responses such as anxiety and depression. Greater craving has been associated with an increased probability of alcohol relapse. Reversal of craving, which is understood as a symptom of protracted abstinence, offers the possibility of preventing relapses and treating alcoholism. Various medications have been studied to establish whether they are able to reduce craving; however, the results obtained from clinical studies have been inconsistent. Here, we review the interdisciplinary models developed to evaluate craving, then the different approaches used to assess and measure craving and, finally, the medications utilized and tested to lessen craving in patients suffering from AUDs.
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Affiliation(s)
| | - Lorenzo Leggio
- Center for Alcohol & Addiction Studies, Brown University, Providence, Rhode Island, USA
- Intramural Research Program, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Baltimore, Maryland, USA
| | - George A. Kenna
- Center for Alcohol & Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
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