Self-control and motivation in addictions
Lead Research Organisation:
University of Cambridge
Department Name: Psychiatry
Abstract
Harmful alcohol use is one of the most pressing public health issues internationally. In the United Kingdom, alcohol misuse represents 10% of the burden of disease and death costing in excess of £21 billion per year. Despite this, these disorders remain poorly treated emphasizing the urgent need to develop novel therapeutic approaches. This proposal aims to understand the interaction between impulsivity and motivation, processes fundamental to regulating behavior and crucial to understanding the risk for and relapse in addictions. Impulsivity or self-control is the tendency towards rapid poorly considered decisions or the inability to stop actions. There are multiple types of impulsivity. Here I focus on a specific form known as waiting impulsivity, or the tendency to act too early. Waiting impulsivity has robust evidence in animal studies for an association with addictions, and is less well understood in humans. I propose that waiting impulsivity in humans involves two processes: voluntary stopping and motivation. Voluntary stopping involves the internal decision to stop. Motivation involves the role of rewards to influence actions or energize behavior. I use a novel task and multiple innovative techniques to understand this relationship between voluntary stopping and motivation and the relationship between prefrontal cortical brain regions and the basal ganglia. I then develop an intervention based on these processes to train voluntary self-control in alcohol use disorders paired with stimulation of the underlying brain network. Finally I extend this to a population level and ask how these processes along with other factors predict alcohol misuse. Together these studies emphasize a testable theory-driven model of waiting impulsivity with immediate translational treatment for addictions.
Technical Summary
Harmful alcohol use is a major international public health issue. It remains poorly treated emphasizing the need for novel therapeutic approaches. Understanding the interaction of self-control and motivation is crucial to the capacity to regulate behavior and to the risk for and relapse underlying substance use disorders. Impulsivity or self-control is a heterogeneous construct with multiple subtypes. Waiting impulsivity, a subtype of impulsivity, characterized by anticipatory early responses, has a robust preclinical history and association with addictions but is poorly understood in humans. Waiting impulsivity itself is comprised of multiple components. Here I propose a model of waiting impulsivity involving intentional inhibition and motivation mediated by opponent dorsomedial and ventral prefrontal processes. Intentional inhibition is a uniquely human construct involving the inhibition of responding based on internal and voluntary processes which are likely highly relevant to the real world self-control of addictions. I use a novel task developed in my group and multimodal techniques in healthy controls to interrogate the underlying neural architecture of intentional inhibition and motivation. I then uniquely capitalize on patient populations who have undergone deep brain stimulation to allow direct modulation and dissociation of these relevant networks to understand the underlying cognitive neuroanatomy. I then test a mechanistically-informed intervention for alcohol use disorders combining a behavioural intervention to train self-control and non-invasive neuromodulation to enhance network activity. Finally, I seek to contextualize these measures at the population neuroscience level and ask how these factors predict addiction behaviours on a data-driven dimensional population level. Together these studies emphasize a testable theory-driven neurobiologically coherent model of waiting impulsivity with immediate translational treatment for addictions.
Planned Impact
Potential beneficiaries of this proposal include academic researchers, clinicians, government and non-government organizations and charities and patient support groups involved in optimizing the recognition and treatment of addictions. The research output from understanding the basic neuroscience of intentional inhibition and motivation will benefit academic researchers. The research output from the intervention and population-level predictors will benefit academic researchers, clinicians and organizations and patient support groups. The intervention, if successful, can be adapted to an accessible online task that can be disseminated on a much wider basis. The use of pharmacological management for the treatment of addictions, while effective in therapeutic trials, has not translated into widespread use. The development of novel non-pharmacological therapeutic strategies that isolate specific behavioural interventions and seek to optimize the underlying neural network using a safe non-interventional technique may be more likely to be utilized. This research, along with other research on behavioural intervention training, should if effective, potentially lead to changes in therapeutic guidelines for addictions. Understanding predictors for alcohol misuse can lead to the development of algorithmic predictors to early identification of those at risk for alcohol misuse leading to earlier interventions. Were the development of such an algorithm possible, this could lead to important public health policies and benefits.
The researchers on the project will acquire skills in optimizing task development, imaging and neuromodulation skills, recruitment and interactions with patient population, management of clinical research and advanced statistical techniques.
The researchers on the project will acquire skills in optimizing task development, imaging and neuromodulation skills, recruitment and interactions with patient population, management of clinical research and advanced statistical techniques.
People |
ORCID iD |
Valerie Voon (Principal Investigator / Fellow) |
Publications
Baek K
(2017)
Impaired awareness of motor intention in functional neurological disorder: implications for voluntary and functional movement
in Psychological Medicine
Baek K
(2017)
Disrupted resting-state brain network properties in obesity: decreased global and putaminal cortico-striatal network efficiency.
in Psychological medicine
Baldermann J
(2021)
Connectomic Deep Brain Stimulation for Obsessive-Compulsive Disorder
in Biological Psychiatry
Baslet G
(2021)
Evidence-Based Practice for the Clinical Assessment of Psychogenic Nonepileptic Seizures: A Report From the American Neuropsychiatric Association Committee on Research.
in The Journal of neuropsychiatry and clinical neurosciences
Cavanna AE
(2017)
Neurobiology of the Premonitory Urge in Tourette's Syndrome: Pathophysiology and Treatment Implications.
in The Journal of neuropsychiatry and clinical neurosciences
Chen X
(2022)
Common and differential connectivity profiles of deep brain stimulation and capsulotomy in refractory obsessive-compulsive disorder.
in Molecular psychiatry
Chendo I
(2021)
High frequency of psychosis in late-stage Parkinsons disease.
Chendo I
(2021)
High frequency of psychosis in late-stage Parkinsons disease.
in Clinical parkinsonism & related disorders
Chendo I
(2022)
Frequency and Characteristics of Psychosis in Parkinson's Disease: A Systematic Review and Meta-Analysis
in Journal of Parkinson's Disease
Davies KA
(2021)
Interferon and anti-TNF therapies differentially modulate amygdala reactivity which predicts associated bidirectional changes in depressive symptoms.
in Molecular psychiatry
Dowell NG
(2019)
Interferon-alpha-Induced Changes in NODDI Predispose to the Development of Fatigue.
in Neuroscience
Doñamayor N
(2018)
The involuntary nature of binge drinking: goal directedness and awareness of intention.
in Addiction biology
Doñamayor N
(2018)
Distal Functional Connectivity of Known and Emerging Cortical Targets for Therapeutic Noninvasive Stimulation.
in Cerebral cortex (New York, N.Y. : 1991)
Ducharme S
(2017)
Psychiatric Presentations of C9orf72 Mutation: What Are the Diagnostic Implications for Clinicians?
in The Journal of neuropsychiatry and clinical neurosciences
Dudas RB
(2017)
Amygdala and dlPFC abnormalities, with aberrant connectivity and habituation in response to emotional stimuli in females with BPD.
in Journal of affective disorders
Ekanayake V
(2017)
Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism.
in Journal of psychosomatic research
Espay AJ
(2018)
Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders.
in JAMA neurology
Evans AH
(2019)
Scales to assess impulsive and compulsive behaviors in Parkinson's disease: Critique and recommendations.
in Movement disorders : official journal of the Movement Disorder Society
Feinstein A
(2021)
Understanding conversion disorder: How contemporary brain imaging is shedding light on an early Freudian concept.
in Journal of psychiatric research
Description | German Research Foundation studentship (PhD student) |
Amount | £72,000 (GBP) |
Organisation | German Research Foundation |
Sector | Charity/Non Profit |
Country | Germany |
Start | 01/2018 |
End | 01/2021 |
Title | Data supporting "Avoiding monetary loss: a human habenula functional MRI ultra-high field study" |
Description | This file set includes all the data used for the corresponding publication: MRI, fMRI, behavioural, the group MNI template, the physiological data (cardiac and respiration), as well as all the ROIs created for the habenulae per participant and on the group level. The experimental task was programmed in presentation and the here included files contain the .sce and .pcl files used to create the task converted into word documents. Matlab analyses files for all analyses incorporated in the corresponding publication are also included. The file set is subdivided into the respective folders. The data of 18 participants was collected at Cambridge University, Wolfson Brain Imaging Centre, Cambridge Biomedical Campus, Cambridge CB2 0QQ. Assessment took place in the second half of 2019. The data was collected as part of a research grant for 7T imaging by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014) awarded to Valerie Voon. The anonymised dataset is being released to allow reuse by others aligned with the open science Cortex TOP guidelines. |
Type Of Material | Database/Collection of data |
Year Produced | 2021 |
Provided To Others? | Yes |
URL | https://www.repository.cam.ac.uk/handle/1810/319242 |
Description | Fudan University, Shanghai China |
Organisation | Fudan University |
Country | China |
Sector | Academic/University |
PI Contribution | I have started a Distinguished Professorship at Fudan University |
Collaborator Contribution | Support of research staff |
Impact | There are several manuscripts that have been published and are underway from this collaboration. The collaboration is multi-disciplinary and includes neurosciences (cognitive and computational, neuroimaging, neurophysiology), neurosurgery, psychiatry and neuroscience-engineering. |
Start Year | 2021 |
Description | Ruijin Hospital and Institute of Neuroscience, Shanghai, China |
Organisation | Chinese Academy of Sciences |
Department | Institute of Neuroscience |
Country | China |
Sector | Academic/University |
PI Contribution | Planned collaboration to develop biomarkers for invasive and non-invasive neuromodulation over 3 years |
Collaborator Contribution | Studies planned over the next 3 years |
Impact | Matching contributions $50000 USD for travel costs for my collaborations with my research group. Studies commencing. Multi-disciplinary with neurosurgery, psychiatry, neuroimaging. |
Start Year | 2018 |
Description | Ruijin Hospital and Institute of Neuroscience, Shanghai, China |
Organisation | Ruijin Hospital |
Country | China |
Sector | Hospitals |
PI Contribution | Planned collaboration to develop biomarkers for invasive and non-invasive neuromodulation over 3 years |
Collaborator Contribution | Studies planned over the next 3 years |
Impact | Matching contributions $50000 USD for travel costs for my collaborations with my research group. Studies commencing. Multi-disciplinary with neurosurgery, psychiatry, neuroimaging. |
Start Year | 2018 |