Role of Pavlovian Mechanisms for Control Over Substance Use

Recruiting

• Conditions: Alcohol Use Disorder (AUD); Alcoholism; Substance Use Disorders; Cannabis Use Disorder; Methamphetamine-dependence; Amphetamine Use Disorder; Cocaine Use Disorder
• Interventions: Biological: fMRI imaging (BOLD); Biological: sMRI (structure); Behavioral: Pavlovian-to-instrumental transfer (PIT) paradigm; Diagnostic Test: Basic psychological assessment (interview); Diagnostic Test: Basic psychological assessment (questionnaires); Behavioral: Neuropsychological tests

• Registration Number: NCT06701487
• Lead Sponsor: Technische Universität Dresden

Brief Summary

During the first funding period (1st FP), the investigators developed a novel full Pavlovian-to-instrumental transfer (PIT) task that allows assessing both, general and specific PIT to investigate whether specific PIT differs between alcohol use disorder (AUD) and control subjects. Preliminary analyses of the full transfer task indicate that AUD participants exhibit a stronger specific PIT effect compared to controls. Based on these findings, the investigators want to compare specific and general PIT effects in patients with moderate to severe substance use disorders (alcohol, cannabis, methamphetamine, amphetamine and cocaine) to healthy controls on the behavioral and neural level (fMRI).

Detailed Description

This projects research aim:

1. The investigators aim to compare general and specific PIT effects in patients with moderate to severe substance use disorder (Alcohol, Methamphetamine, Amphetamine and Cocaine) and healthy controls using the newly developed (1st FP) full transfer task and fMRI The investigators expect enhanced general PIT effects in patients compared to controls at the behavioral level, and at the neuronal level enhanced PIT-associated activations in the striatum, and lower activation in the prefrontal cortex (e.g., dlPFC).

The investigators expect enhanced general PIT effects in patients with multiple SUD compared to patients with single SUD.

The investigators expect increased behavioral and neuronal alcohol-specific PIT effects in patients groups that also meet AUD criteria compared to controls and to patients without AUD.

The investigators expect stronger behavioral and neural PIT effects (both general and specific) to predict more substance use at 3-month follow-up.

Therefore, the investigators aim to conduct the Experiments with the following Hypotheses:

Here the investigators assess on a behavioral and neural level a general and specific PIT task by using the full transfer task which was developed in the 1st FP and allows the assessment of both PIT tasks in one paradigm. This task consists of 4 parts: instrumental training, Pavlovian conditioning, Pavlovian-to-instrumental transfer phase and query trials to test participants' explicit knowledge.

The investigators will investigate HCs and three patient groups of high clinical relevance: Patients with (1) AUD without comorbid SUD (cannabis, methamphetamine, amphetamine or cocaine), (2) AUD with comorbid SUD (cannabis and/or methamphetamine and/or amphetamine and/or cocaine), (3) SUD (cannabis and/or methamphetamine and/or amphetamine and/or cocaine) without AUD. The investigators will recruit patients through the addiction outpatient clinic of the Charité (mainly cannabis), the special outpatient clinic for MUD at the University Hospital Dresden as well as the investigators' strategic partner clinic in Radebeul und Städtisches Klinikum Dresden. Furthermore, the investigators will be recruiting from the general population using advertisement. On site, they undergo the comprehensive assessment implemented for the TRR cohort during the 1st FP. The full PIT paradigm is applied as described in Figure 3. Three months after the examination, an online follow-up on the clinical course will be done by using redcap-based questionnaires.

Methods:

WP1 will follow an ANOVA with four groups, including post-hoc group differences.

Functional imaging data will be conducted using a 3 T MR scanner to acquire gradient echo t2\*-weighted echo-planar images (EPI) and analyzed with SPM12. EPI images will be preprocessed and analyzed as implemented during the 1st FP.

Expected results:

The investigators expect that general PIT effects are increased in all patient groups vs. HCs. Moreover, the investigators expect that patients with AUD + comorbid SUD have greater general PIT effects than patients with AUD alone. Concerning alcohol specific PIT, the investigators expect that both AUD groups, but not patients with SUD without AUD have greater effects than HCs. Moreover, the investigators expect that patients with AUD + comorbid SUD have greater alcohol specific PIT effects than patients with AUD alone. Concerning neuroimaging, the investigators expect greater activations in striatum and reduced activation in the DLPFC during PIT in all patient groups vs. HCs. Moreover, the investigators expect greater activations in striatum and reduced activation in the DLPFC in patients with AUD + comorbid SUD as well as in patients with AUD alone. Of note, the investigators expect similar neural activations during specific PIT in HCs and patients with SUD without AUD.

Hypothesis 1a.:

General PIT effects are increased in all patient groups vs. HCs. Specifically, patients with AUD + comorbid SUD will show greater general PIT effects than patients with AUD alone. At the neuronal level patients will show enhanced PIT-associated activations in the striatum, and lower activation in the prefrontal cortex (e.g., dlPFC).

Hypothesis 1b:

Concerning alcohol specific PIT, it is expected that both AUD groups, but not patients with SUD without AUD have greater effects than HC. Moreover, patients with AUD + comorbid SUD will have greater alcohol specific PIT effects than patients with AUD alone. Moreover, the investigators expect greater activations in striatum and reduced activation in the DLPFC in patients with AUD + comorbid SUD as well as in patients with AUD alone.

Hypothesis 1c:

The investigators expect that enhanced specific and general PIT effects are associated with increased substance use at the 3-month follow-up.

Alternative strategies: In case of doubt about the extent to which gustatory alcohol and juice rewards increase the PIT effect in subjects with comorbid SUD, the investigators might alternatively develop and pilot a specific PIT paradigm with substance-related pictures.

Study Timeline

• Study Start: 2024-08-05
• Status Verified: 2024-09
• Study First Submitted: 2024-09-25
• Study First Submitted QC: 2024-11-19
• Last Update Submitted: 2024-11-19
• Study First Posted: 2024-11-22
• Last Update Posted: 2024-11-22
• Primary Completion: 2027-06-30
• Study Completion: 2027-06-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 200

Inclusion Criteria

• Men and women between 18-65 years of age,
• AUD, and/or SUD subjects only: meet 4 or more criteria for DSM-5 alcohol-related and/or substance-related (cannabis, amphetamine, methamphetamine or cocaine disorder (not requiring withdrawal as assessed by an independent psychiatrist),
• Currently using alcohol without a desire for abstinence
• Ability to consent to the study and complete the questionnaires.
• Sufficient language(German) and motor skills for using PC
• existing health insurance

Exclusion Criteria

• Lifetime diagnosis of DSM-5 bipolar disorder or schizophrenia or schizophrenia spectrum disorder (if induced by drugs, it should happen more than a month ago)
• Current threshold DSM-5 diagnosis of major depressive disorder, or presence of suicidal intention
• High risk (≤ 26) ASSIST scores in other substances other than alcohol, amphetamine, methamphetamine, cannabis, cocaine, tobacco
• History of traumatic brain injury or severe neurological disease (such as Dementia, Parkinson's disease, multiple sclerosis, Epilepsy, Meningitis, Stroke)
• Pregnancy or breastfeeding,
• Ingestion of medications known to interact with the dopamine system in the 10-day period prior to study participation or less than 4 half-lives after last ingestion (rapid urine test); A detailed list of permitted medication can be added upon request
• MR contraindications (e.g., pacemakers, metallic or electronic implants, metallic splinters, surgical staples)
• Color vision deficiency
• sensorineural hearing loss of 30 dB or greater,
• Tinnitus and
• Acute alcohol, substance (cannabis, or methamphetamine, amphetamine, cocaine) intoxication at assessement day verified by breath alcohol tests and drug intoxication verified by rapid urine test.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Control group	fMRI imaging (BOLD)	Healthy participants without AUD or SUD
Control group	sMRI (structure)	Healthy participants without AUD or SUD
Alcohol use disorder (AUD)	fMRI imaging (BOLD)	Participants with alcohol use disorder (moderate to severe if no withdrawal symptoms) and no other substance use disorder (SUD)
Alcohol use disorder (AUD)	sMRI (structure)	Participants with alcohol use disorder (moderate to severe if no withdrawal symptoms) and no other substance use disorder (SUD)
Alcohol use disorder (AUD)	Pavlovian-to-instrumental transfer (PIT) paradigm	Participants with alcohol use disorder (moderate to severe if no withdrawal symptoms) and no other substance use disorder (SUD)
Alcohol use disorder (AUD)	Basic psychological assessment (interview)	Participants with alcohol use disorder (moderate to severe if no withdrawal symptoms) and no other substance use disorder (SUD)
Alcohol use disorder (AUD)	Basic psychological assessment (questionnaires)	Participants with alcohol use disorder (moderate to severe if no withdrawal symptoms) and no other substance use disorder (SUD)
Alcohol use disorder (AUD)	Neuropsychological tests	Participants with alcohol use disorder (moderate to severe if no withdrawal symptoms) and no other substance use disorder (SUD)
Alcohol use disorder (AUD) and Substance use disorder (SUD)	fMRI imaging (BOLD)	Participants with Alcohol use disorder (AUD) and comorbid Substance use disorder (SUD) (moderate to severe cases without withdrawal symptoms) including: Participants with alcohol use disorder (AUD) and/or cannabis use disorder and/or methamphetamine use disorder and/or amphetamine use disorder and/or cocaine use disorder.
Alcohol use disorder (AUD) and Substance use disorder (SUD)	sMRI (structure)	Participants with Alcohol use disorder (AUD) and comorbid Substance use disorder (SUD) (moderate to severe cases without withdrawal symptoms) including: Participants with alcohol use disorder (AUD) and/or cannabis use disorder and/or methamphetamine use disorder and/or amphetamine use disorder and/or cocaine use disorder.
Alcohol use disorder (AUD) and Substance use disorder (SUD)	Pavlovian-to-instrumental transfer (PIT) paradigm	Participants with Alcohol use disorder (AUD) and comorbid Substance use disorder (SUD) (moderate to severe cases without withdrawal symptoms) including: Participants with alcohol use disorder (AUD) and/or cannabis use disorder and/or methamphetamine use disorder and/or amphetamine use disorder and/or cocaine use disorder.
Alcohol use disorder (AUD) and Substance use disorder (SUD)	Basic psychological assessment (interview)	Participants with Alcohol use disorder (AUD) and comorbid Substance use disorder (SUD) (moderate to severe cases without withdrawal symptoms) including: Participants with alcohol use disorder (AUD) and/or cannabis use disorder and/or methamphetamine use disorder and/or amphetamine use disorder and/or cocaine use disorder.
Alcohol use disorder (AUD) and Substance use disorder (SUD)	Basic psychological assessment (questionnaires)	Participants with Alcohol use disorder (AUD) and comorbid Substance use disorder (SUD) (moderate to severe cases without withdrawal symptoms) including: Participants with alcohol use disorder (AUD) and/or cannabis use disorder and/or methamphetamine use disorder and/or amphetamine use disorder and/or cocaine use disorder.
Alcohol use disorder (AUD) and Substance use disorder (SUD)	Neuropsychological tests	Participants with Alcohol use disorder (AUD) and comorbid Substance use disorder (SUD) (moderate to severe cases without withdrawal symptoms) including: Participants with alcohol use disorder (AUD) and/or cannabis use disorder and/or methamphetamine use disorder and/or amphetamine use disorder and/or cocaine use disorder.
Non-AUD Substance use disorder (SUD)	fMRI imaging (BOLD)	Participants with substance use disorder (moderate to severe cases without withdrawal symptoms) without alcohol use disorder (AUD) including: Participants with methamphetamine use disorder and/or cannabis use disorder and/or amphetamine use disorder and/or cocaine use disorder
Non-AUD Substance use disorder (SUD)	sMRI (structure)	Participants with substance use disorder (moderate to severe cases without withdrawal symptoms) without alcohol use disorder (AUD) including: Participants with methamphetamine use disorder and/or cannabis use disorder and/or amphetamine use disorder and/or cocaine use disorder
Non-AUD Substance use disorder (SUD)	Pavlovian-to-instrumental transfer (PIT) paradigm	Participants with substance use disorder (moderate to severe cases without withdrawal symptoms) without alcohol use disorder (AUD) including: Participants with methamphetamine use disorder and/or cannabis use disorder and/or amphetamine use disorder and/or cocaine use disorder
Non-AUD Substance use disorder (SUD)	Basic psychological assessment (interview)	Participants with substance use disorder (moderate to severe cases without withdrawal symptoms) without alcohol use disorder (AUD) including: Participants with methamphetamine use disorder and/or cannabis use disorder and/or amphetamine use disorder and/or cocaine use disorder
Non-AUD Substance use disorder (SUD)	Basic psychological assessment (questionnaires)	Participants with substance use disorder (moderate to severe cases without withdrawal symptoms) without alcohol use disorder (AUD) including: Participants with methamphetamine use disorder and/or cannabis use disorder and/or amphetamine use disorder and/or cocaine use disorder
Non-AUD Substance use disorder (SUD)	Neuropsychological tests	Participants with substance use disorder (moderate to severe cases without withdrawal symptoms) without alcohol use disorder (AUD) including: Participants with methamphetamine use disorder and/or cannabis use disorder and/or amphetamine use disorder and/or cocaine use disorder
Control group	Pavlovian-to-instrumental transfer (PIT) paradigm	Healthy participants without AUD or SUD
Control group	Basic psychological assessment (interview)	Healthy participants without AUD or SUD
Control group	Basic psychological assessment (questionnaires)	Healthy participants without AUD or SUD
Control group	Neuropsychological tests	Healthy participants without AUD or SUD

Primary Outcome Measures

Name	Time	Method
Neural PIT effect	1 day	Blood oxygenation level dependent (BOLD) response, investigation of neuronal activation of the mesolimbic system in AUD patients and controls using 3 Tesla magnetic resonance imaging
Behavioral full-lever specific and general PIT effect	1 day	Strength of specific and general PIT effect assessed with the full-lever PIT paradigm.; Specific: average percentage of alcohol choice difference during the presentation of alcohol or non-alcohol Pavlovian background. General: differences in number of button presses during the presentation of positive (+10 Euro) and negative (-10 Euro) Pavlovian backgrounds.

Secondary Outcome Measures

Name	Time	Method
Alcohol and Substance (cannabis, stimulant/cocaine) consumption after 3 months	3 months after testing for behavioral and neural PIT effects	Alcohol drinking amount and substance (cannabis, amphetamine, cocaine) consuming amount (quantity, frequency) during a follow-up period of 3 months

Trial Locations

Locations (1)

Department of Psychiatry and Psychotherapy, Technische Universität Dresden; 🇩🇪 Dresden, Germany