Neurocognitive and Neurobehavioral Mechanisms of Change Following Psychological Treatment for Alcohol Use Disorder

Conditions:Psychiatric, Psychiatric
Therapuetic Areas:Psychiatry / Psychology
Age Range:22 - 55
Start Date:November 14, 2018
End Date:March 31, 2023
Contact:Barbara McCrady, PhD

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Neurocognitive and Neurobehavioral Mechanisms of Change Following Psychological

Alcohol Use Disorder (AUD) is a significant public health problem, with prevalence rates of
13.9% for current and 29.1% for lifetime diagnosis (Grant et al., 2015). AUD creates harm at
the individual, familial, and societal level, with an estimated societal cost of $249 billion
(Sacks et al., 2015) per year. The course of AUD typically is characterized by periods of
relapse to problematic drinking (Maisto et al., 2014), signaling a need for better treatments
and understanding of mechanisms of behavior change.

The goal of this research is to conduct a randomized clinical trial with 140 participants who
have an Alcohol Use Disorder (AUD). Each participant will complete behavioral assessments,
self-report surveys and brain imaging before and after receiving psychotherapy treatment to
change their drinking behaviors. Various aspects of behavior change will be looked at to
better understand changes in brain function and emotional reactivity when someone changes
their patterns of alcohol use. The two treatment used in this study have been found to be
helpful in reducing alcohol use. Participants will be randomly assigned to either
Mindfulness-Based Relapse Prevention (MBRP) or Cognitive Behavior Therapy (CBT) that will be
completed in 12 weekly therapy sessions.

It is anticipated that there will be numerous changes in brain function that are found when
someone reduces or stops their alcohol use after the completion of 12 weeks of treatment.

Although pharmacological and psychosocial treatments for alcohol use disorders (AUDs) exist
that improve outcomes over natural recovery (Finney et al., 2013), outcomes are still modest.
Identifying mechanisms of behavior change (MOBCs) that lead to successful outcomes may be
critical for efforts to improve existing treatments or to better match patients with
particular treatments. The goal of the proposed research is to conduct a randomized clinical
trial to systematically examine pretreatment neurocognitive and behavioral characteristics
and changes in brain function over time during two empirically supported treatments for AUD.
One hundred forty treatment-seeking individuals with an AUD will be randomized to receive
either 8 weeks of Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT)
after receiving 4 weeks of a platform treatment that focuses on enhancing motivation to
change. Neurocognitive and behavioral characteristics will be measured using neuroimaging,
comprehensive behavioral assessments, and patient self-reports. To establish the temporal
relationship between changes in drinking and changes in these MOBCs, patients will be
assessed at: (a) baseline; (b) four weeks into treatment; (c) immediately post-treatment; and
(d) 9- and 15-months post-baseline. Self-report measures and behavioral tasks will be
administered at monthly intervals during treatment; and fMRI will be collected at baseline,
and at 3, and 9-months post baseline. The primary aim of the study is to examine the effects
of the treatments on three hypothesized mechanisms: craving/regulation of craving, cognitive
and behavioral control, and regulation of affect/arousal. The secondary aim will identify
neurocognitive and behavioral baseline characteristics predictive of reductions in drinking
over time and differential patterns of response to CBT or MBT.

Inclusion Criteria:

1. Age 22-55 years

2. Self-identify as a heavy/binge/weekly drinker

3. Engage in "hazardous and harmful alcohol use" (Babor et al., 2001) based on an AUDIT
score > 8 for men and > 7 for women

4. Breath alcohol level of 0.00 at in-person screening

5. Right handed

6. Explicitly be seeking help for their drinking

7. Alcohol use during the past 30 days

Exclusion Criteria:

1. History of brain injury or neurological diagnoses

2. Evidence of current psychosis

3. Past-year substance dependence other than nicotine or marijuana

4. Evidence of recent illicit drug (other than marijuana) use on a urine screen

5. Contraindications for MRI (e.g., medical devices in the body)

6. Female participants who think they may be pregnant must pass a urine pregnancy screen
prior to each MRI scanning session

7. Estimated IQ < 80

8. Unable to read or speak English fluently

9. History of major alcohol withdrawal

10. Currently in treatment for alcohol use (or within the past 6 months)
We found this trial at
Albuquerque, New Mexico 87131
(505) 277-0111
Principal Investigator: Barbara McCrady, PhD
University of New Mexico Founded in 1889 as New Mexico’s flagship institution, the University of...
Albuquerque, NM
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Albuquerque, New Mexico 87131
Principal Investigator: Eric Claus, PhD
Albuquerque, NM
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