Alcohol Use Disorder
Conditions
Keywords
fMRI, disulfiram, withdrawal, anxiety, abstinence
Brief summary
The goal of this study is to better understand the underlying neurobiological basis of anxiety that emerges during abstinence in patients with alcohol use disorder (AUD). The main questions it aims to answer are: 1. To characterize anxiety itself as well as anxiety related-neurobiological circuitry in early abstinence in AUD 2. To examine how anxiety and anxiety related-neurobiological circuitry change over the course of abstinence in AUD Researchers will recruit both participants with AUD and healthy volunteers. The participants with AUD will be prescribed disulfiram, a medication that helps participants with AUD stay abstinent. Healthy volunteers will not receive antabuse. Patients with AUD will undergo fMRI scanning both after 1 week and 3 months of disulfiram treatment. Healthy volunteers will undergo fMRI once.
Detailed description
This study will recruit 40 treatment-seeking participants with AUD ("AUDP") and 20 age matched healthy volunteer participants (HVP). AUDP will be initiated on disulfiram, a medication FDA approved for alcohol use disorder that is a first line treatment for maintenance of abstinence from alcohol, to facilitate and help ensure abstinence from alcohol and will undergo functional MRI scanning at two timepoints: 1) 8-14 days after the last drink ("early abstinence") and 2) after three months of abstinence ("protracted abstinence"). HVP will be scanned once. The investigators will examine the functioning of the Anterior Insula (AI), Bed Nucleus of the Stria Terminalis (BNST), and Dorsolateral Prefrontal Cortex (DLPFC) during a task that evokes anxiety while anticipating an uncertain threat ("threat-anxiety") as well as resting state functional connectivity (RSFC) between AI-BNST and AI-DLPFC to measure whether there are neuroplastic changes in these circuits that occur during abstinence. These changes in anxiety circuit activity and connectivity will be related to changes in current anxiety symptoms.
Interventions
Disulfiram will be used in Participants with Alcohol Use Disorder only to facilitate abstinence.
DIAGNOSTIC_TESTfunctional MRI
Participants will undergo fMRI scanning. Participants with alcohol use disorder will undergo scanning after 1 week and 3 months of disulfiram maintenance. Healthy volunteer participants will undergo scanning once.
Sponsors
Columbia University
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Intervention model description
Participants with alcohol use disorder (n=40) will be administered disulfiram for 3 months, which will serve to facilitate abstinence from alcohol in order to study the mechanisms of anxiety during early and protracted abstinence in alcohol use disorder. The will undergo fMRI scanning after 1 week and 3 months of disulfiram. Participants will be observed taking disulfiram both remotely (4/5 work days/week) and in person 1 day/week. Healthy volunteer participants (n=20) will not receive disufiram and will only be scanned once.
Eligibility
Sex/Gender
ALL
Age
21 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
(Participants with Alcohol use Disorder): 1. Between the ages of 21 and 55 2. Right-handed 3. Able to perform informed consent and comply with study 4. Seeking treatment for AUD 5. Meets The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for AUD of at least moderate severity (\>3 symptoms) Inclusion Criteria (Healthy Volunteer Participants): 1. Between the ages of 21 and 55 2. Right-handed 3. Able to perform informed consent and comply with study 4. Report drinking an average of fewer than 8/15 standard drinks per week for women/men and no more than 1 HDD (heavy drinking days) during the previous 28 days.
Exclusion criteria
(Participants with Alcohol use Disorder): 1. Neurological, medical or other conditions that would interfere with MRI scanning (e.g., history of stroke, seizure, brain tumor, brain infection, traumatic brain injury, multiple sclerosis, dementia, non MRI-compliant metal device in body, pregnancy, claustrophobia, color blindness, severe hearing impairment, weight\>300 lbs., wheelchair-bound, tattoos as indicated by the guidelines established by the Zuckerman Institute MRI unit: https://mr.research.columbia.edu/ 2. DSM 5 diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder 3. Any non-AUD psychiatric disorder that may, according to the investigator's judgment, require treatment over the course of the study 4. Significant suicide or violence risk 5. Currently taking psychotropic medication 6. Current substance use disorder other than AUD, tobacco use disorder or mild cannabis use disorder 7. Currently pregnant, attempting to become pregnant or nursing 8. Sufficiently socially unstable as to preclude participation (e.g. homeless). 9. Known history of allergy, intolerance, or hypersensitivity to disulfiram or its derivates 10. Contraindications to disulfiram treatment (e.g. liver disease, kidney disease, cardiac disease, seizure disorder, hypothyroidism, diabetes mellitus, pregnancy or lactation, allergy to disulfiram or thiuram derivatives) 11. Currently taking medications containing alcohol, metronidazole, isoniazid, paraldehyde, phenytoin, warfarin, or theophylline. 12. Treatment with concomitant medications that might interfere with disulfiram 13. A history of alcohol withdrawal seizures, delirium tremens or resistant alcohol withdrawal 14. Current moderate or severe alcohol withdrawal (CIWA \>9 with BAL\<0.05) 15. History of prior disulfiram treatment failure 16. Being abstinent for \> 7 days at the time of screening
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| AI-BNST Resting state functional connectivity correlation (R) value | 1 week and 3 months | Resting state functional connectivity between the bed nucleus of the stria terminalis and anterior insula resting state functional connectivity. Correlation values range from -1 to +1, with higher values indicating stronger connectivity. |
| AI-BNST task activation t statistic | 1 week and 3 months | Unpredictable threat task activation of the bed nucleus of the stria terminalis and anterior insula. T statistics range from negative infinity to positive infinity. The farther the t statistic is away from zero (positively), this indicates a larger magnitude in brain activation |
| State trait anxiety inventory score | 1 week and 3 months | The State-Trait Anxiety Inventory (STAI) score ranges from 20-80, with higher scores indicating greater anxiety |
Countries
United States
Contacts
CONTACTA B Srivastava, MD
Outcome results
None listed