The Effects of Theta Burst Stimulation on the Brain Response to Drug and Alcohol Cues
Condition: Alcoholism; Cocaine Addiction; Drug Addiction
MeSH terms: Alcoholism; Cocaine-Related Disorders; Substance-Related Disorders; Behavior, Addictive
Study type: Interventional
Phase: Early Phase 1

Summary: 
      High relapse rates among substance dependent individuals are likely due to a combination of
      factors that involve limbic circuits in the brain involved in craving, including
      vulnerability to salient cues. Emerging data suggests that non-invasive, targeted brain
      stimulation may be able to modulate activity in these circuits and decrease craving. The
      primary goal of this pilot study is to determine the extent to which a single session of
      continuous theta burst stimulation to the medial prefrontal cortex can attenuate limbic
      circuitry involved in craving among cocaine users and alcohol users. This will be tested
      through a double-blind,sham-controlled brain stimulation and brain imaging study in a cohort
      of polysubstance abusers and alcohol users.
    

Detailed description: 
      This parent protocol contains two components - one of which is targeting cocaine users, the
      other of which is targeting heavy alcohol users (who will also serve as an appropriate
      control group for the cocaine users - who typically have comorbid alcohol use disorders). All
      participants will receive one session of real and one session of sham (randomized) continuous
      theta burst stimulation (TBS).TBS is a form of non-invasive transcranial magnetic stimulation
      (TMS).Continuous TBS is designed to lower cortical excitability, and requires a shorter
      stimulation period than typical low frequency TMS. The investigators will test the hypotheses
      that stimulation over the medial prefrontal cortex will attenuate activity in the medial
      prefrontal cortex (Aim 1), using single pulse TMS in the magnetic resonance imaging scanner.
      Through this innovative technique it is possible to apply a single pulse of TMS to the medial
      prefrontal cortex and model the hemodynamic response at the stimulation site as well as
      monosynaptic target regions, including the striatum. The investigators will also investigate
      the effect of TBS on neural response to drug cues (Aim 2). The results of these aims will be
      further correlated with self-reported assessments of craving throughout each experimental
      visit. These data will be preliminary data for a subsequent R01 focused on the sustained
      effects of multiple sessions of TBS and their efficacy in lowering craving for extended
      periods of time in treatment-seekers.
    

Intervention name(s): Real continuous Theta Burst Stimulation; Sham continuous Theta Burst Stimulation
Intervention type(s): Device; Device
Intervention description(s): Continuous Theta Burst stimulation delivered; active sham Continuous Theta Burst stimulation delivered
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Basic Science
Keywords: Transcranial Magnetic Stimulation; Magnetic Resonance Imaging; MRI, Functional