A recent NIH epidemiology study found the lifetime prevalence of alcohol addiction in the United States to be 29%. Alcoholism is strongly “learned” via pleasure center activation/reinforcement. Alcoholism is a powerful desire to drink alcoholic beverages. Along with other alcohol withdrawal symptoms, craving was added as one of the defining criteria for alcohol addiction in DSM5, and craving reduction is becoming an increasingly important alcoholism recovery goal. In the current study, patients with alcohol use disorder received 10 days of inpatient multi-modal treatments at Schick Shadel Hospital (SSH) of Seattle. Schick Shadel Hospital’s alcohol addiction treatment and alcoholism recovery include five chemical aversion conditioning sessions that associated alcohol cues (and alcohol) with nausea and emesis. All patients met DSM4 criteria for alcohol addiction, were heavy drinkers, and reported craving alcohol pre-treatment. Craving reduction was one of the primary treatment goals. This is the first fMRI study to measure the effects of chemical aversion therapy on alcohol craving-related brain activity. Patients were recruited as subjects for the University of Washington (UW) brain scan study following SSH admission but before treatment onset. Prior to treatment, patients reported craving/desire for alcohol. After alcohol addiction treatment (after four SSH chemical aversion treatments, again after five SSH chemical treatments, 30 and 90-days post discharge), these same patients reported avoidance/aversion to alcohol. Most of the participants (69%) reported being still sober 12 months post- alcoholism treatment. Consistent with a craving reduction mechanism of how chemical aversion therapy facilitates sobriety, results of the UW fMRI brain scans showed significant pre- to post-treatment reductions in craving-related brain activity in the occidental cortex. Additional fMRI brain scan studies are needed to further explore the neurobiological mechanism of chemical aversion therapy and alcoholism treatment for alcohol use disorder, and other substance use disorder for which chemical aversion therapy is used (e.g., opioid dependence and cocaine dependence). Substance use disorder are estimated to affect well over on billion people worldwide.
Ralph L. Elkins1, Todd L. Richards2, Robert Nielsen1, Richard Repass1,
Henriettae Stahlbrandt2, and Hunter G. Hoffman2,3*
1Department of Medical Research, Schick Shadel Hospital, Seattle, WA, United States, 2 Department of Radiology, Integrated Brain Imaging Center, University of Washington, Seattle, WA, United States, 3 Human Photonics Lab, Mechanical Engineering, University of Washington, Seattle, WA, United States
Antonella Gasbarri, University of L’Aquila, Italy
Eun Lee, Yonsei University, South Korea
Gabriel Rubio, Hospital Universitario 12 De Octubre, Spain
Hunter G. Hoffman, [email protected]
Received: 30 July 2017
Accepted: 13 September 2017
Published: 28 September 2017
Elkings RL, Richards TL, Nielsen R, Repass R, Stahlbrandt H and Hoffman HG(2017) The Nuerobiological Mechanism of Chemical Aversion (Emetic) Therapy for Alcohol Use Disorder: An fMRI Study.
Front. Behav.Nuerosci. 11:182.