A Response Modulation Hypothesis of Socioemotional Processing Associated With Alcohol Use Disorder

Investigating a Response Modulation Hypothesis of Socioemotional Processing Associated With Alcohol Use Disorder

Background:

Problem drinking affects nearly half the people who drink alcohol. Drinking alcohol affects a person's social behavior and brain structure, but researchers don't have a good understanding of how. They want to test a technique called neurofeedback to learn more about how to treat problem drinking.

Objectives:

• To study what happens in the brains of people who drink alcohol when they look at pictures of social things and of alcohol.
• To learn if people can control brain activity in a magnetic resonance imaging (MRI) scanner and if this helps people with drinking.

Eligibility:

• Adults ages 21 to 65 who have an alcohol use disorder.
• Healthy volunteers ages 21 to 65

Design:

Participants will be screened with

• Physical exam
• Medical history
• Blood, urine, and heart tests
• Mental health interview
• Questions about their alcohol drinking.

At each session, participants will have:

• A urine test for drugs and pregnancy. If they test positive, they cannot participate.
• A breath alcohol test and assessment for alcohol withdrawal.

Participants will complete surveys, talk to researchers about behaviors, and play games.

Participants will have MRI brain scans. The scanner is a metal cylinder in a strong magnetic field. They will lie on a table that slides in and out of the scanner for 1-2 hours.

Participants will do tasks in the scanner:

• They will look at pictures, sometimes of alcohol.
• They will try to hit a goal. Some participants will get feedback during this task. They will see how their brain activity changes or how someone else's changes.

Participants may have follow-up phone questions at least 3 times over about 6 months.

Study Overview

• Status: Completed
• Conditions: Alcohol-Related Disorders; Healthy Volunteers; Alcohol Drinking Related Problems
• Intervention / Treatment: Behavioral: Real time fMRI neurofeedback

Detailed Description

Study Description:

In the first stage, participants will undergo functional magnetic resonance imaging (fMRI) while looking at socioemotional stimuli and alcohol cues and will pilot a neurofeedback training protocol. Personality traits and executive function will also be investigated. This is the pilot stage that will be used to test and refine the neurofeedback parameters and procedure, and to compare neural responses and alcohol attention bias between participants with AUD and healthy controls.

In the second stage, inpatient participants with alcohol use disorder will be randomly assigned to receive active or sham neurofeedback. Participants will undergo two functional magnetic resonance imaging sessions including looking at socioemotional stimuli and alcohol cues, resting state fMRI, and real time neurofeedback during alcohol craving. Ability to inhibit attention to alcohol cues and craving will be assessed prior to and following the neurofeedback as well. Participants will be contacted approximately 1 month, 3 months, and 6 months post release from inpatient treatment to assess outcomes.

Objectives:

The purpose of this protocol is to understand the mechanism whereby neural processes of socioemotional cognition associated with alcohol use disorders lead to negative drinking consequences. This study is a two-stage procedure to both provide evidence of a response modulation deficit associated with socioemotional processing in individuals with alcohol use disorder and investigate how moderating that deficit affects socioemotional processing and negative drinking consequences.

Endpoints:

Brain engagement during exposure to socioemotional stimuli, alcohol cues, and neurofeedback training (fMRI-scan portion)

• Study Type: Interventional
• Enrollment (Actual): 101
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Bethesda, Maryland, United States, 20892
      • National Institutes of Health Clinical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

• INCLUSION AND EXCLUSION CRITERIA:

Stage 1:

INCLUSION CRITERIA:

1. 21 to 65 years old
2. Healthy volunteers only: Consuming on average 7 or less standard drinks/week if female; 14 or less standard drinks/week if male (as determined by the most recent measurement within the past 90 days Alcohol Timeline Followback)
3. Alcohol use disorder (AUD) participants only: Diagnosed with current moderate to severe alcohol use disorder according to most recent Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (SCID-5) diagnosis

EXCLUSION CRITERIA:

1. Significant history of head trauma or cranial surgery.
2. History of neurological disease based on self-report and neuromotor physical exam, conducted by a health care provider, that would interfere with neuroimaging research. Posthoc, clinical MRI scans done according to NIH Clinical Center policy may be reviewed and if there is evidence from that scan of past or current neuro-abnormalities that, in the PI or MAI's expert opinion, interfere with research neuroimaging data, the subject may be excluded from data analysis.
3. Physical health concern that would significantly impair or increase the risk of study participation
4. Healthy volunteers only: Have fulfilled the DSM-5 criteria for a current substance or alcohol use disorder
5. Female participants only: Currently pregnant
6. Presence of any ferromagnetic objects in the body that may be aversively affected by or contraindicated for MRI as determined by the NIAAA MRI Safety Screening Questionnaire
7. Any flag on the NIAAA MRI Safety Screening Questionnaire, unless cleared by medically responsible staff (MD/NP)
8. History of non-substance related psychosis
9. Lack of experience with alcohol (defined as less than three lifetime drinks reported in history and physical or on Lifetime Drinking History)

Stage 2:

INCLUSION CRITERIA:

1. 21 to 65 years old
2. Inpatient currently seeking treatment for alcohol use disorder

EXCLUSION CRITERIA:

1. Significant history of head trauma or cranial surgery,
2. History of neurological disease based on self-report and neuromotor physical exam, conducted by a health care provider, that would interfere with neuroimaging research.
3. Physical health concern that would significantly impair or increase the risk of study participation.
4. Presence of any ferromagnetic objects in the body that may be aversively affected by or contraindicated for MRI as determined by the NIAAA MRI Safety Screening Questionnaire
5. Any flag on the NIAAA MRI Safety Screening Questionnaire, unless cleared by medically responsible staff (MD/NP)
6. History of non-substance related psychosis
7. Female participants only: Currently pregnant

Inpatients who have been admitted into the behavioral unit at the Clinical Center for AUD treatment, maybe considered for this study. Upon completion of consenting procedure, any data necessary (but not readily available) to determine eligibility maybe collected under this study. However, to avoid undue discomfort, burden, and inconvenience, this information, if available, can be gathered from routine clinical care or other NIAAA clinical studies and data up to 30 days prior to the consenting date. Participants who do not satisfy any of the above criteria will not participate in the study procedures at the time. They may be re-scheduled for a future date(s) when they fulfill all inclusion/exclusionary criteria.

We will utilize SCID diagnoses (from other studies such as 14-AA-0181) to determine AUD diagnosis and any potential Axis I disorders. However, for inpatients, since the nursing practice is initially focused on patient detoxification and treatment, the SCID diagnoses might not always take place within the first week of the patient admission to the alcohol unit. This could seriously hamper the subject recruitment in the second stage of this study. We will conduct the MR scan of eligible participants (based on the above inclusion/exclusion criterion) according to study timeline regardless of the availability of SCID diagnoses.

Inpatients are admitted based on the clinical opinion of medical staff that the individual has a pattern of alcohol use disorder. We will enroll inpatients with this opinion but the SCID diagnoses will be completed in order to have consistent research data on symptomology and severity, and to use any potential Axis I disorder as a study confound. Additionally, we will collect information on medications being taken by patients currently or within the last month, including dose, schedule, and timeline. This will be used as a covariate in the statistical design to control for variation associated with these medications.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Pilot: Stage 1, Participants with Alcohol Use Disorder; Treatment-seeking adults meeting DSM-5 criteria for alcohol use disorder (AUD). Participants underwent a single fMRI brain scan during which they performed the socioemotional processing task while in the MRI scanner, prior to real time active neurofeedback (displaying the participant's own neural signal).	Behavioral: Real time fMRI neurofeedback; During fMRI study, display feedback of brain activity to practice and reinforce control of alcohol craving.
Experimental: Pilot: Stage 1, Healthy Control Volunteer; Medically and psychologically healthy control volunteers, without alcohol use disorder. Participants underwent a single fMRI brain scan during which they performed the socioemotional processing task while in the MRI scanner, prior to real time active neurofeedback (displaying the participant's own neural signal).	Behavioral: Real time fMRI neurofeedback; During fMRI study, display feedback of brain activity to practice and reinforce control of alcohol craving.
Experimental: Stage 2, Participants with Alcohol Use Disorder, Neurofeedback; Treatment-seeking adults meeting DSM-5 criteria for alcohol use disorder (AUD). Participants underwent two fMRI brain scans week 1 and week 4 of the study. During the week 1, participants underwent the fMRI brain scan during which they performed the socioemotional processing task while in the MRI scanner prior to the real time active neurofeedback (displaying the participant's own neural signal). During week 4, participants underwent the fMRI brain scan during which they performed the socioemotional processing task while in the MRI scanner, after the real time active neurofeedback (displaying the participant's own neural signal).	Behavioral: Real time fMRI neurofeedback; During fMRI study, display feedback of brain activity to practice and reinforce control of alcohol craving.
Sham Comparator: Stage 2, Participants with Alcohol Use Disorder, Sham; Treatment-seeking adults meeting DSM-5 criteria for alcohol use disorder (AUD). Participants underwent two fMRI brain scans week 1 and week 4 of the study. During the week 1, participants underwent the fMRI brain scan during which they performed the socioemotional processing task while in the MRI scanner prior to the real time sham neurofeedback (displaying a different participant's neural signal). During week 4, participants underwent the fMRI brain scan during which they performed the socioemotional processing task while in the MRI scanner, after the real time sham neurofeedback (displaying a different participant's neural signal).	Behavioral: Real time fMRI neurofeedback; During fMRI study, display feedback of brain activity to practice and reinforce control of alcohol craving.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Alcohol Attention Bias Signal - Stage 1	Contrast in the estimated blood-oxygen-level-dependent (BOLD) response between the conditions of # 1) negative socioemotional cue paired with an alcohol cue, and #2) negative Socioemotional cue paired with a neutral cue during the fMRI brain scan. The contrast value was calculated by subtracting the BOLD response value for condition #1 from the BOLD response value from condition #2.	On day of fMRI scan
Change in Alcohol Craving - Stage 1	Alcohol craving was measured using a modified version of the Alcohol Craving Questionnaire Short Form (ACQ-SF-R). The ACQ-SF-R is a 12-item assessment measuring craving for alcohol among alcohol users in the current context. Each item is scored on the scale of 1 (strongly disagree) to 7 (strongly agree). The total general craving score is derived by summing the score of all 12 items, then dividing by 12. Higher score indicates higher craving. The change measure was calculated as craving measured prior to the fMRI scan subtracted from craving measured post-scan.	On day of fMRI scan
Change in Alcohol Attention Bias - Stage 2	Contrast in the estimated blood-oxygen-level-dependent (BOLD) response between the conditions of # 1) negative socioemotional cue paired with an alcohol cue, and #2) negative Socioemotional cue paired with a neutral cue during the fMRI brain scan. The contrast value was calculated by subtracting the BOLD response value for condition #1 from the BOLD response value from condition #2 for week one and week four. Analysis is the pre-post difference in BOLD contrast value from the pre-neurofeedback scan (week 1 scan) subtracted from the BOLD contrast value from the post-neurofeedback scan (week 4 scan).	Week 4 - week 1
Change in Alcohol Craving - Stage 2	Alcohol craving was measured using a modified version of the Alcohol Craving Questionnaire Short Form (ACQ-SF-R). The ACQ-SF-R is a 12-item assessment measuring craving for alcohol among alcohol users in the current context. Each item is scored on the scale of 1 (strongly disagree) to 7 (strongly agree). The total general craving score is derived by summing the score of all 12 items, then dividing by 12. Higher score indicates higher craving. The change measure was calculated as craving measured prior to the fMRI scan subtracted from craving measured post-scan.	On day of scan during week 1 and week 4
Mean Alcohol Craving Score	Alcohol craving was measured using a modified version of the Alcohol Craving Questionnaire Short Form (ACQ-SF-R). The ACQ-SF-R is a 12-item assessment measuring craving for alcohol among alcohol users in the current context. Each item is scored on the scale of 1 (strongly disagree) to 7 (strongly agree). The total general craving score is derived by summing the score of all 12 items, then dividing by 12. Higher score indicates higher craving. Analysis was done as the mean value for participants.	1, 3, & 6 months after discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Alcohol consumption	Measured by alcohol timeline followback	1, 3, 6 months
Community functioning	Measured by Drinker Inventory of Consequences, self-reported employment and residential stability	1, 3, 6 months
Antisocial behavior	Specifically, self-reported crime and police contacts, and intimate partner aggression	1, 3, 6 months

Collaborators and Investigators

• Sponsor: National Institutes of Health Clinical Center (CC)
• Collaborators: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
• Investigators: Principal Investigator: Melanie L Schwandt, Ph.D., National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Publications and helpful links

Helpful Links

• NIH Clinical Center Detailed Web Page

Study record dates

Study Major Dates

• Study Start (Actual): September 20, 2018
• Primary Completion (Actual): March 23, 2025
• Study Completion (Actual): March 23, 2025

Study Registration Dates

• First Submitted: May 23, 2018
• First Submitted That Met QC Criteria: May 23, 2018
• First Posted (Actual): May 24, 2018

Study Record Updates

• Last Update Posted (Actual): April 23, 2026
• Last Update Submitted That Met QC Criteria: April 7, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Alcohol; Functional Magnetic Resonance Imaging (fMRI); Neurofeedback; Socioemotional; Drug Relapse
• Additional Relevant MeSH Terms: Mental Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Alcohol-Related Disorders
• Other Study ID Numbers: 180098; 18-AA-0098

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Study results will be posted on ClinicalTrials.gov and published in peer-reviewed journals. De-identified data from this study may be shared with NIH collaborators and qualified researchers after completion of the primary analyses.
• IPD Sharing Time Frame: Data from this study may be requested by other researchers after the completion of the primary endpoint and publication of results.
• IPD Sharing Access Criteria: Data from this study may be requested by other researchers after the completion of the primary endpoint by contacting the principal investigator. De-identified data may be uploaded directly alongside publications as possible.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No