MPFC Theta Burst Stimulation as a Treatment Tool for Alcohol Use Disorder: Effects on Drinking and Incentive Salience

Last updated: March 25, 2025
Sponsor: Medical University of South Carolina
Overall Status: Active - Recruiting

Phase

N/A

Condition

Alcohol Use Disorder

Opioid Use Disorder

Substance Abuse

Treatment

Sham TBS to the mPFC

Real TBS to the mPFC

Clinical Study ID

NCT04998916
00102709
2P50AA010761-26
  • Ages 21-65
  • All Genders

Study Summary

The purpose of this study is to develop transcranial magnetic stimulation (TMS), specifically TMS at a frequency known as theta burst stimulation (TBS), to see how it affects the brain and changes the brain's response to alcohol-related pictures. TMS and TBS are stimulation techniques that use magnetic pulses to temporarily excite specific brain areas in awake people (without the need for surgery, anesthetic, or other invasive procedures). TBS, which is a form of TMS, will be applied over the medial prefrontal cortex, (MPFC), which has been shown to be involved with drinking patterns and alcohol consumption. This study will test whether TBS can be used as an alternative tool to reduce the desire to use alcohol and reducing the brain's response to alcohol-related pictures.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Age 21-65 (to maximize participation; note: Scalp-to-Cortex distance will beincluded as a covariate to calculate adjusted TMS dose given expected corticalatrophy in heavy alcohol users and older adults and the demonstrated effect50 onTMS-fMRI responses in addiction)

  • Alcohol Use Disorder, determined by DSM-V criteria, using the Structured ClinicalInterview for DSM-V

  • Consumption of more than 14 drinks (women) or 21 drinks (men) per week, with atleast 4 heavy drinking days (defined as ≥ 4 drinks for women and ≥ 5 for men) perweek during the 30-days prior to enrolling.

  • Able to read and understand questionnaires and informed consent.

Exclusion

Exclusion Criteria:

  • Has metal placed above the neck

  • Is at elevated risk of seizure (i.e., has a history of seizures, is currentlyprescribed medications known to lower seizure threshold)

  • Has a history of moderate to severe alcohol withdrawal or medicated alcoholwithdrawal

  • Has a history of claustrophobia

  • Has a history of chronic migraines

  • Has a history of traumatic brain injury, including a head injury that resulted inhospitalization, loss of consciousness for more than 10 minutes, or having ever beeninformed that they have an epidural, subdural, or subarachnoid hemorrhage

  • Has an unstable medical illness requiring planned medical/surgical intervention (e.g. chemotherapy, surgical procedure)

  • Medications: Is currently taking or initiates a new prescription for drugs known toimprove alcohol drinking treatment outcomes (e.g. naltrexone, acamprosate,topiramate) or taking psychiatric/sleeping medications except for stable (1 month)antidepressants/SSRI's. [Note: this criterion is for scientific rather than safetyor patient comfort reasons].

  • Has a history of substance use disorder (other than nicotine) by DSM-V criteria inthe past 6 months

  • Meets DSM V criteria for panic disorder, bipolar disorder, obsessive-compulsivedisorder, schizophrenia, dissociative disorders, eating disorders, and any otherpsychotic disorder. [Note: The inclusion of participants with other affective andanxiety disorders is essential because of the marked frequency of the co-existenceof mood and other anxiety disorders among patients with AUD at large]

  • Has current suicidal ideation or homicidal ideation

  • Females of childbearing potential who are pregnant (by urine HCG), nursing, or whoare not using a reliable form of birth control.

Study Design

Total Participants: 86
Treatment Group(s): 2
Primary Treatment: Sham TBS to the mPFC
Phase:
Study Start date:
July 06, 2021
Estimated Completion Date:
December 31, 2026

Study Description

With advances in optogenetic stimulation techniques, preclinical studies have demonstrated that activity in frontal-striatal neural circuits has a causal influence on heavy drinking and alcohol reinstatement. Clinically, however, this research has not yet been translated into a neural circuit based therapeutic technique for patients with alcohol use disorder (AUD). The long term goal of this multidisciplinary research study team is to determine the optimal parameters through which non-invasive transcranial magnetic stimulation can be used to improve alcohol drinking outcomes (abstinence, heavy drinking days) among individuals seeking behavioral treatment for AUD. Building on a foundation of several target identification studies and a small double-blinded clinical trial in treatment-engaged AUD patients performed by the study team in the Charleston Alcohol Research Center, here the investigator proposes a double-blind placebo controlled, randomized study to evaluate the efficacy of theta burst stimulation (TBS) to medial prefrontal cortex (mPFC) as a tool to decrease drinking and brain reactivity to alcohol cues among treatment-seeking individuals with AUD. Individuals will be screened initially by the Clinical Intake and Assessment core, then given an opportunity to enroll in this study, provide informed consent, and be randomized to receive real or sham TBS to the mPFC 36 sessions (3x/day on each of 3 days/week over 4 weeks, i.e., 12 days). The scientific premise of this 5 year proposal is that, by modulating the neural circuits that regulate alcohol cue-reactivity it will be possible to increase alcohol abstinence rates and decrease heavy drinking days over a 4 month period. With the combined scientific expertise in brain stimulation, neuroimaging, alcohol use disorder research in the Charleston Alcohol Research Center, and clinical practice at MUSC, the study team is uniquely suited to develop this critical line of research. The outcomes of the proposed Aims will provide an evidence-based foundation for a multisite clinical trial and will hasten progress towards developing a new neural circuit based treatment for patients with AUD.

Connect with a study center

  • Medical University of South Carolina

    Charleston, South Carolina 29401
    United States

    Active - Recruiting

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