Modification of cue-reactivity by neurofeedback in Alcohol Use Disorder

Introduction Alcohol, one of the most dangerous legal drugs, has a huge impact on health and wellbeing of addicted individuals, on their social relationships and society. It is accountable for approximately 3.3 million of all global deaths per year (WHO 2014). One underlying process accountable for the urge to drink in individuals suffering from Alcohol Use Disorder (AUD) is cue-reactivity. It is described as an increase of motivation to consume a substance after being exposed to related cues. On the neurobiological level the ventral striatum (VS) is activated during cue-reactivity, but existing treatments can currently only indirectly target this region (Schacht et al., 2013). Regulating the VS directly could be a promising way of down regulating cue-reactivity and preventing future relapse, as a high level of activation in the VS is also known to be predictive for relapsing (Reinhard et al., 2015).

Methods Using real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF), Kirsch and colleagues (2016) showed a successful reduction of neural cue-reactivity to alcohol related cues in heavy social drinkers. This technique was adjusted and applied as an intervention on AUD patients in the Systems Biology of Alcohol Addiction (SyBil-AA) study. Participants were randomly assigned to three experimental groups, which had either to regulate the VS, or the right inferior frontal gyrus (rIFG), or the auditory cortex during presentation of pictures of alcoholic beverages (Gerchen et al., 2018).

Results Preliminary results show a significant difference in activation of the two target ROIs combined (VS and rIFG) in comparison to the sham ROI (auditory cortex) with p = 0.043 one-sided fixed effect of combined groups in a linear mixed model with random intercept for subject and session.

Discussion This demonstrates the potential of rtfMRI-NF to downregulate VS cue-reactivity and reduce craving and the risk of relapse in patients.