Research into understanding alcohol dependence receives a major boost

A man nurses an alcoholic drink

The Virginia Tech Carilion Research Institute has received a five-year, $2.8-million grant to study interventions aimed at enhancing self-control among problem drinkers.

Two institute scientists—Warren Bickel, an addiction expert, and Stephen LaConte, a biomedical engineer—are teaming up across specialties to explore the promise of brain training and neurofeedback for people battling alcohol dependency.

“Alcohol-dependent people often have deficits in self-control,” said Bickel, a professor at the Virginia Tech Carilion Research Institute, where he also directs the Addiction Recovery Research Center. “The impulse to consume alcohol prevails over the rewards associated with abstinence. By examining the brain regions that underlie impaired self-control, we hope to provide insights into the neurobiology of self-control and, ultimately, to help people overcome their addictions.”

The study, funded by the National Institute of Alcohol Abuse and Alcoholism, will tackle a major source of mortality and morbidity in the United States. According to the institute, an estimated 18 million people in the United States have an alcohol-use disorder. The costs of alcohol abuse are high, particularly among the young. The institute estimates that each year alcohol contributes to the deaths of more than 5,000 people under the age of 21. In that same age group, alcohol-related injuries led to more than 190,000 emergency room visits in 2008 alone.

“Our research has found that people with addictions – whether to alcohol, other substances, or destructive behaviors – significantly value immediate rewards over future ones,” said Bickel, who is also a professor of psychology at Virginia Tech. “If you’re preoccupied with your immediate future, you’re not going to worry about the long-term consequences of your actions.”

Bickel believes such deficits in self-control result from a disruption in the regulatory balance between two interacting systems in the brain: the executive system, which is found in the prefrontal and parietal cortices and is responsible for valuing delayed rewards for long-term gains, and the impulsive system, which is found in the limbic and paralimbic areas and is associated with instant gratification.

Bickel’s previous research has demonstrated that working memory training can help repair self-control, perhaps, he believes, by restoring the regulatory balance between these systems.

“Just as a piano needs retuning,” said Bickel, “the addicted brain needs recalibration.”

In the first part of the new study, Bickel’s team will explore the effects of working memory training on a range of measures, including not just working memory, but also self-control and such clinical indicators as craving. Working with 200 local volunteers, the scientists will seek to determine both how many training sessions are needed for optimal improvement and how sustainable that training is.

In the second part of the study, LaConte, an assistant professor at the Virginia Tech Carilion Research Institute, will lead an effort to use real-time functional magnetic resonance imaging to explore the neural mechanisms of working memory training and any concomitant increases in self-control.

“Real-time brain imaging will allow us to look at self-control in action,” said LaConte, who is also an assistant professor in the Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences. “Is there a region or network in the brain that is critically important and that people can learn to modulate using neurofeedback? And would that modulation have an impact on their valuation of the future, decision-making, and/or self-control?”

LaConte and Bickel believe a greater understanding of these mechanisms could lead to refined treatments for the detrimental decision-making associated with alcohol dependence. They also hope any insights gleaned will extend beyond alcohol addiction.

“Our first step, which is the focus of this grant, will explore alcohol,” LaConte said. “Our long-term dream, though, is to discover something that generalizes beyond alcohol and is applicable to all addictions. We want to better understand the mechanisms of impulsivity and to develop rehabilitative strategies that will allow people to free themselves from whatever their addictions may be.”