The Neurobiological Mechanism of Chemical Aversion (Emetic) Therapy for Alcohol Use Disorder: An fMRI Study

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

A recent NIH epidemiology study found the lifetime prevalence of alcohol use disorder in the United States to be 29%. Alcohol drinking behavior is strongly "learned" via pleasure center activation/reinforcement. Alcohol craving is a powerful desire to drink alcoholic beverages. Craving was added as one of the defining criteria for alcohol use disorder in DSM5, and craving reduction is becoming an increasingly important treatment 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. The treatments included five chemical aversion conditioning sessions that associated alcohol cues (and alcohol) with nausea and emesis. All patients met DSM4 criteria for alcohol use disorder, 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 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-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 nuerobiological mechanism of chemical aversion therapy treatment for alcohol use disorder, and other substance use disorder for which chemical aversion therapy is used (e.g., opiod dependence and cocaine dependence). Substance use disorder are estimated to affect well over on billion people worldwide.

Open Access

Edited by:
Antonella Gasbarri, University of L'Aquila, Italy

Reviewed by:
Eun Lee, Yonsei University, South Korea
Gabriel Rubio, Hospital Universitario 12 De Octubre, Spain

Hunter G. Hoffman,

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.
doi: 10.3389/fnbeh.2017.00182