Exploring Regulation and Function of Dopamine D3 Receptors in Alcohol Use Disorders: A [11C]-(+)-PHNO Study

Study Overview
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Brief Summary
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There is a need to better understand the mechanisms underlying alcohol use and dependence in order to advance the clinical treatment of alcohol dependence. Here, the investigators will use Positron Emission Tomography to determine if there is an up-regulation of D3 receptors in the brains of subjects with alcohol use disorders. The investigators will also investigate the relationship between D3 binding and major phenotypes associated with alcohol use disorders, namely: alcohol cue induced craving and motivation to self-administer alcohol in the laboratory.

Detailed Description
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Alcohol dependence is a devastating illness with social and medical costs estimated to be 180 billion dollars annually in the US. In the clinical treatment of alcoholism, reducing alcohol consumption in heavy drinkers is a major clinical challenge. As such, there has been much emphasis in both clinical and preclinical research to identify the substrates that mediate craving, excessive drinking and addiction. Identifying the neurobiological mechanisms of alcohol dependence may lead to the development of new and better treatment strategies. Preclinical studies indicate that the D3 receptor is involved in alcohol-cue response and in the motivation to drink alcohol. However, there is currently no data available in human subjects exploring the relationship between D3 and those behavioral responses in subjects with alcohol use disorders. Aim #1: To measure the [11C]-(+)-PHNO PET binding levels in the brains of subjects with alcohol use disorders. Aim #2: To determine the relationship between D3 receptor binding and alcohol cue induced craving and motivation to self-administer alcohol in the laboratory. To achieve designated goals, the investigators will recruit 25 male and female subjects who are non-treatment seekers. After a period of abstinence from alcohol, participants will come to the Centre for Addiction of Mental Health for a [11C]-(+)-PHNO PET scan. Participants will also have additional sessions during which other alcohol-related measures will be assessed (i.e. alcohol cue induced craving and motivation to self-administer alcohol in the laboratory).

Official Title
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Exploring Regulation and Function of Dopamine D3 Receptors in Alcohol Use Disorders: A [11C]-(+)-PHNO Study

Conditions
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Alcohol Use Disorder

Intervention / Treatment
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* Other: [11C]-(+)-PHNO PET scan
* Other: Alcohol Self-Administration
* Other: Craving Task
* Other: MRI scan
* Other: Neuropsychological Assessment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects will meet diagnostic criteria for alcohol use disorder (mild through severe). Willing to abstain from drugs and alcohol prior to study visits A negative urine screen for illicit psychoactive drug use Willing and capable to provide written informed consent Willing to participate in cue exposure and intravenous alcohol administration sessions Male and female adults (at least 19 years old) Exclusion Criteria: DSM diagnosis of drug dependence other than alcohol Any severe Axis I disorder aside from alcohol use disorder Any medical condition requiring immediate investigation History of seizures, past or current neurological illness or serious head trauma Suicidal ideation Pregnancy tested by urine or blood screen or lactation Current past or anticipated exposure to radiation exceeding permissible limits as set by the CAMH PET Centre Metal implants or paramagnetic objects within the body which may interfere with the MRI Claustrophobia or a history of panic attacks Any other problem that, in the investigators' opinion, would preclude participation in trial (i.e., complicated withdrawal). Currently seeking treatment or attempting to reduce/quit drinking History of negative responses to venipuncture procedures (e.g., fainting/vasovagal response) Medications or medical disorders for which alcohol consumption is contraindicated

Ages Eligible for Study
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Minimum Age: 19 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental<br>5 experimental sessions per participant: (1) [11C]-(+)-PHNO PET scan, (2), Alcohol Self-Administration, (3) Craving Task, (4) MRI scan and (5) Neuropsychological Assessment. | Other: [11C]-(+)-PHNO PET scan<br>* PET scan<br>Other: Alcohol Self-Administration<br>* Session for assessing motivation for consuming alcohol.<br>Other: Craving Task<br>* Cue exposure paradigm<br>Other: MRI scan<br>* MRI scan scan to analyze the PET data will be administered.<br>Other: Neuropsychological Assessment<br>* Cognitive questionnaires administered over course of study.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dopamine D2/D3 receptor occupancy | Dopamine D2/D3 receptor occupancy in the brains of individuals with Alcohol Use Disorders will be quantified using [11C]-(+)-PHNO Positron Emission Tomography (PET). [11C]-(+)-PHNO binding levels will be used to infer receptor occupancy. | One PET scan after 2-7 days of abstinence from alcohol;  2 hours in duration. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alcohol craving ratings | Participants' ratings for alcohol craving acquired during the validated Cue-Induced Craving Paradigm (using the Alcohol Urge Questionnaire: 8 items on a 11-point Likert scale) will be correlated to dopamine receptor occupancy (outcome 1). | Cue paradigm session is expected to take  1 hour and will occur on the PET day. | 
| Effort to obtain alcohol | Laboratory alcohol self-administration paradigm in which participants press a button to intravenously self-administer small doses of alcohol will be used to assess amount of effort expended to obtain alcohol (break point). The # of button presses required to obtain the alcohol will increase as per the Progressive Ratio schedule. Regression analysis between effort and [11C]-(+)-PHNO binding (outcome 1) will be applied. | Single self-administration session will occur on its own day with a time commitment of  6 hours. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Alcohol use, problem