Alcohol abuse and dependence Experimental and clinical evidence
Alcohol abuse and dependence. Experimental and clinical evidence Salvatore Campanella University of Brussels, Belgium – Laboratory of Psychological Medicine and Addiction Brescia – 08 Aprile 2017
Alcohol is THE social drug!!!
Consume alcohol is funny! Why?
And even more during adolescence!!!
During adolescence, • Brain is still maturing; • Limbic emotional zones are welldevelopped; • Contrary to more « rationale » frontal zones… « When passion faced with rationality » Period in which youths privilegied sensation seeking, immediate rewarding despite long-
A major problem: the relapse rate There is an urgent need to identify neurocognitive mechanisms that may help to identify people at « high risk » to relapse…. .
Two main neuro-cognitive mechanisms triggering addictions • (1) An Attentional Bias towards drug cues; • (2) A lack of Inhibitory resources
Need to focus on the attentional bias Drug cues have a huge motivational salience
Need to focus on the inhibition process
Overall: • Alcoholic patients are more attracted by alcohol cues and they also displayed less inhibitory skills; • We have no idea about a potential effect of anti-craving medication on these processes; • Our main idea: use cognitive ERPs as biomarkers of relapse
Amplitude = Intensity of processing Latency = Speed of processing
Our study based on two cognitive ERP tasks
(1) A Contextual Go-No. Go Task 80% of Go trials: M 20% of No. Go trials: W 3 contexts
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M
M
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W
M
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(2) An oddball alcohol-related task
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Drinker typology based on AUDIT scores Possible Dependence Heavy Drinkers Light Drinkers
Follow-up at 3 months
The Go Nogo task
BUT THE ERROR RATE IS SIMILAR BETWEEN Relapsers and Non Relapsers!
However, when we look at ERPs… Relapsers vs Controls: p =. 026 Non Relap vs Controls: p =1
• Patients made more commissions errors than controls; • No more errors in alcohol context; • The error rate did not predict relapse; Flaudias et al. , 2013 • However, at the ERP level, the No. Go P 3 of Relapsers disclosed higher amplitude than the one of Non Relapsers = Controls : patients who need higher neural resources to perform correct inhibition are more
The oddball task Reduced processing of alcohol cues predicts abstinence in recently detoxified alcoholic patients in a threemonth follow up period: an ERP study Behavioural Brain Research Petit et al. 2015
• Compared to relapsers, abstainers showed a decreased P 3 amplitude for alcohol related compared to non alcohol related pictures (p = . 009). Through hierarchical regression, this difference between alcohol and non alcohol related cues was shown to be the best predictor of relapse vulnerability (p =. 013). • A devaluation of the motivational significance of stimuli related to alcohol, only measurable through electrophysiology, could protect from a relapse within three months following detoxification in alcohol dependent patients.
Conclusions
• Is the No. Go P 3 a biological marker of relapse? Clinical impact: increase cognitive control through neuropsychological retraining? • Is the P 3 a biological marker of abstinence? Clinical impact: decrease motivational salience of alcohol cues through neuropsychological retraining? • What is the impact of anti-craving medications on these processes? ? ?
Our project: t. DCS and cognitive training: still to develop….
… even if we are aware that chronic alcoholism is a multi-factorial disease….
Thank you for your attention!
- Slides: 74