Effect of rTMS combined with CBT on alcohol craving and cognitive function in patients with alcohol dependence / 中华行为医学与脑科学杂志

Objective:To explore the effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapies (CBT) on the cognitive function and alcohol craving in patients with alcohol dependence.Methods:From March 2019 to September 2021, a total of 150 patients with alcohol dependence were enrolled and randomly divided into rTMS treatment group (rTMS+ sham CBT, n=41), CBT treatment group (CBT+ sham rTMS, n=34), rTMS+ CBT treatment group( n=36) and control group (sham rTMS+ sham CBT, n=39). At baseline (before treatment), 2nd week, 8th week, 12th week and 24th week, alcohol dependence scale (ADS) was used to evaluate the degree of alcohol dependence, the obsessive compulsive drinking scale (OCDS) was used to assess patients' drinking craving, and Montreal cognitive assessment scale (MoCA) was used to assess the overall cognitive level of patients.SPSS 23.0 statistical software was used to compare the differences of ADS, OCDS and MoCA scale scores of the four groups by repeated measure ANOVA and simple effect analysis. Results:(1)The patients in the four groups were evaluated with ADS scale at baseline, 12th week and 24th week respectively.The interaction of group×time( F=1.279, P=0.279) and the main effect of group were not significant ( F=0.882, P=0.454), and the main effect of time was significant ( F=12.925, P<0.001) .Further simple effect analysis showed that the ADS score of rTMS+ CBT group was lower than that of baseline(14.48±5.70, 10.00±6.51) ( P=0.01) at 24th week.(2)Patients in the four groups were assessed with OCDs scale at baseline, 2nd week, 8th week, 12th week and 24th week, and the interaction of group×time was significant ( F=2.015, P=0.042). Further simple effect analysis showed that the OCDs scores of rTMS group and rTMS+ CBT group at each follow-up time node were lower than those at baseline period (all P<0.05). (3)Patients in the four groups were assessed with MoCA scale at baseline, 8th week, 12th week and 24th week, and the interaction of group×time was not significant ( F=1.660, P=0.106), and the main effect of group and the main effect of time were significant ( F=2.964, P=0.038; F=14.239, P<0.001). Further simple effect analysis showed that the score of MoCA scale in CBT group at the 24th week was higher than that at baseline (21.73±5.81, 24.60±3.98)( P=0.029), the score of MoCA scale in rTMS+ CBT group at the 24th week was higher than that at the 8th week (23.50±6.01, 25.95±2.87) ( P=0.006), and the score of MoCA scale in rTMS group at the 12th week was higher than that in control group (22.08±6.64, 26.64±2.46)( P=0.009). Conclusion:rTMS combined with CBT can be effective in improving alcohol craving and cognitive function in patients with alcohol dependence, and has a good long-term effect.

A Study of the Reliability and Validity of the Korean Version of the Penn Alcohol Craving Scale for Alcohol-Dependent Patients

OBJECTIVE: The Penn Alcohol Craving Scale (PACS) is a stronger predictor of subsequent drinking and relapse of alcohol dependence that can be administered more quickly and easily than other craving scales. The goal of this study was to develop the Korean version of the Penn Alcohol Craving Scale (PACS-K). METHODS: To examine the psychometric properties of the PACS-K, responses were chosen from 80 patients admitted to a treatment facility for alcohol dependence. RESULTS: The PACS-K possesses good psychometric properties, as assessed by Cronbach's alpha estimates (Cronbach's alpha=0.91). The test-retest reliability of the PACS-K showed high correlation (p<0.01) when the retest interval was 1 day. When the validity of the PACS-K was investigated using correlation analysis with two other craving scales (the Obsessive Compulsive Drinking Scale (OCDS) and the Visual Analogue Scale (VAS), high correlations were obtained between total PACS scores and total OCDS scores, and between total PACS scores and VAS scores (p<0.01, respectively). CONCLUSION: The PACS-K is a reliable and valid measure of alcohol cravings, and it could be useful for predicting which individuals are at risk for subsequent relapse.

Differences of Photographs Inducing Craving Between Alcoholics and Non-alcoholics

Many researchers have used cue reactivity paradigm to study alcohol craving. But the difference of craving response to drinks between alcoholic patients and social drinkers was little evaluated. To investigate characteristics of alcohol-related visual cues which induce alcohol craving in alcoholism, we examined the response of subjects to alcohol-related cues considering qualitative aspects. The authors developed 27 photographs related to alcohol as candidate visual cues. Thirty five patients with alcohol dependence, 35 heavy drinkers and 35 social drinkers were shown these pictures and asked to rate these 6 pictures in order of inducing alcohol craving the most. 'A glass of Soju' and 'A Party scene' were chosen as the alcohol-related visual cues which induced craving the most in the patients and heavy drinkers, respectively. The results suggest that the patients with alcohol dependence are more absorbed by alcohol without drinking context such as an atmosphere or situation involving drinking. Heavy drinkers may experience craving in anticipation of being in a drinking situation.

Effect of Naltrexone on Acute Alcohol Response in Social Drinker / 신경정신의학

OBJECTIVES: We investigated the effects of naltrexone on acute alcohol response, stimulant and sedative, in healthy social drinkers using two doses of alcohol intake. METHODS : Twenty four healthy male medical students were voluntarily participated. The experimental method was crossover design. Subjects received 25 mg/day or 50 mg/day of naltrexone on the experimental days. Biphasic Alcohol Effects Scale (BAES), alcohol craving, and blood alcohol concentration (BAC) were measured before drinking and at 15, 30, 45, 60, 90, and 120 min after drinking. RESULTS : 1) Group of 0.6 mg/kg of alcohol intake. When the scores of stimulative subscale of BAES were compared between the naltrexone and control group, the scores were significantly lower in the naltrexone group at 15 and 90 min after drinking. Alcohol induced sedative effect was significantly higher in the naltrexone group at 90 min after drinking. The alcohol induced alcohol craving at 45 and 60 min after drinking was significantly lower in the naltrexone group as compared to the control. 2) Group of 0.3 mg/kg of alcohol intake. The alcohol induced stimulative effect evident in the control group seen in the time span of 15 to 45 min after drinking was not seen in the naltrexone group. The increase of alcohol induced alcohol craving noticed at 30 min after drinking in the control group was not seen in the naltrexone group. BAC at 15 min after drinking was lower in the naltrexone group compared to the control. CONCLUSION : Naltrexone is suggested to attenuate stimulative effect, to intensify sedative effect, and to block alcohol induced alcohol craving. These triple actions might be utilized for treatment and prevention of relapse of alcohol dependence.

Development of the Alcohol-Related Visual Stimuli Inducing Alcohol Craving / 신경정신의학

OBJECTIVES: Craving is the subjectively experienced motivational states inducing ongoing drug use in addicts. It also proceeds or precipitates relapse episode in drug addicts. Alcohol craving may be triggered by exposure to an object, environment, or emotion that a person has come to associate with alcohol consumption. Such stimuli are called alcohol-related cues. Among alcohol-related cues, alcohol-related visual stimuli are simple and reliable methods in inducing alcohol craving. The object of this study is to develop alcohol-related visual stimuli which induce alcohol craving reliably and to investigate the characteristics of alcohol-related visual stimuli in alcoholics. METHODS: First, the authors developed 27 alcohol and drinking color photos as candidate stimuli. Then, 3 photos which induce alcohol craving most were chosen as alcohol-related visual stimuli respectively by alcoholics, alcoholism high risk group and normal control group. The authors compared characteristics, situation and complexity of selected alcohol-related visual stimuli among three groups. RESULTS: 1) 'A glass of Soju', 'Drinking together' and 'A glass of beer, a bottle of beer and a sidedish' were chosen as alcohol-related visual stimuli which induce most craving in alcoholics, alcoholism high risk group and normal control group respectively. 2) Alcohol photo(stationary object) induced craving most in alcoholics in contrast with drinking photo(situation) in social drinkers. Alcoholics clung to alcohol per se, not to atmosphere or situation of drinking, and alcoholism high risk group felt craving by the expectation of drinking situation. Normal control group showed no consistent finding in choosing alcohol-related visual stimuli. CONCLUSION: With these results, the author suggests classical conditioning as psychopathological model of alcohol craving with alcoholics. In contrast with alcoholics, alcohol craving of alcoholism high risk group may be related to alcohol specific memory or positive expectancies about alcohol use. These finding may support different neurobiological mechanisms of alcohol craving between alcoholics and social drinkers.

Effect of Haloperidol on Alcohol Craving in Patients with Alcohol Dependence / 신경정신의학

OBJECTIVES: This study was aimed at investigating the effect of haloperidol on alcohol craving in patients wih alcohol dependence. METHODS: Eighteen patients with alcohol dependence were divided randomly into two groups of nine patients each: one haloperidol group and the other, placebo group. The medication for each group was done for 14 days. Alcohol craving and difficulty in resisting drinking were measured on day 1 and day 14, each consisting of a series of four assessments. Assessment 0 was basal levels. Assessment 1 was made 3 hours after medication. Assessment 2 was made after alcohol intake in a dose of 0.4gm of 100% alcohol/kg body weight and assessment 3 was done after the second alcohol intake in the same amount. RESULTS: The results were as follows: 1) With acute treatment, placebo group showed a significant increase in alcohol craving whereas haloperidol group did not show any change after the first and second alcohol intake. 2) With chronic treatment, both groups showed significant increase in the alcohol craving after alcohol intake. 3) Haloperidol did not increase difficulty in resisting drinking after acute treatment, however, with chronic treatment, it resulted in a significant increase of the difficulty in resisting drinking. CONCLUSIONS: From these results, the authors suggest that an acute treatment of haloperidol lowers alcohol craving in patients with alcohol dependence, but the effect does not maintain itself with chronic treatment.

Effect of Radix Puerariae on Alcohol Craving and Regional Cerebral Blood Flow in the Patients with Alcohol Dependence / 신경정신의학

In light of recent reports of the effectiveness of Radix puerariae in the alcoholics and recent formulation of a hypothesis that craving far alcohol In the alcohol-dependent individual is mediated by a limbic circuit involving the fronto-thalamic and fronto-striatoaccumbal region, the authors studied the effect of Radix puerariae on craving for alcohol and cerebral blood flow(rCBF) of these regions. The subjects were hospitalized patients with alcohol dependence recovered from acute intoxication and withdrawal symptoms. On the first day of experiment, rCBF in the areas of caudate nuclei, thalamus and orbitofrontal cortices was measured by Single-Photon Emission Computed nomography. On the third day, the same procedure was repeated artier intake of a small priming dose of alcohol. Radix puerariae in dose of 12gm/day for 10 days was given from fourth day of experiment to the thirteenth day and on the eleventh and thirteenth days, the measurements of rCBF were repeated in the same method as in the first and third day, respectively. Immediately before measurements of the rCBF in each experiment, craving far alcohol was measured by means of Visual Analogue Scale. The results were as follows: 1) Before the treatment of radix puerariae, the alcohol-dependent patients developed a significant alcohol-induced alcohol craving and a concomitant increase of rCBF in the right head of caudate nucleus. 2) Radix puerariae significantly lowered alcohol crating and significantly increased rCBF In the right head of caudate nucleus and the left orbitofrontal cortex in alcohol-free, basal condition. 3) After the treatment of radix puerariae, the rCBF after alcohol intake in bilateral caudate nuclei and bilateral hemithalami was significantly decreased. 4) Radix puerariae did not induce post-alcohol craving for alcohol and significantly decreased post-alcohol rCBF in bilateral caudate nuclei. From these results, it is suggested that Radix puerariae decreases basal alcohol craving in the alcohol-dependent patients, and further that there ma!~ exist a significant association between these changes of alcohol craving and concomitant changes of rCBF in the limbic striatim, especially caudate nucleus.