When an alcoholic sees the red dot of an ABC liquor store, it sets off a trigger in the brain.

With that in mind, MUSC’s Center for Drug and Alcohol Programs is using brain scans to determine what images challenge recovering alcoholics and how medication reduces those neurological cravings.

Functional Magnetic Resonance Imaging (fMRI) charts changes in blood flow through the brain. MUSC is one of only a dozen or so medical campuses in the world that apply this science to what’s going on in the head of someone desperate for a drink.

“Basically what we began wanting to understand is what happens in the brain of someone with alcoholism,” says Dr. Hugh Myrick, an associate professor of psychiatry and medical chief of the center.

A subject’s brain is scanned to see whether or not certain sections light up when shown alcohol-related pictures. Real-world exposure to these images can lead to a relapse for a recovering alcoholic, so it’s important to understand triggers that may impact treatment.

By having the subject tap a finger for 10 seconds, doctors can identify the motor strip of the brain. That information can then be used to deduce cravings by providing triggers.

“You can have them smell something they might crave, you can play back a recording of the last time maybe they went into a bar, talk about the feelings they were having,” he says.

Over several minutes, Myrick presents a stream of pictures that would remind the subject of beer and then charts the neurological response. Basically, Myrick is looking for parts of the brain to light up on the screen with the release of Dopamine, a pleasure chemical in the head.

“When they even just see cues, or reminders, of alcohol use, such as a billboard, some of our pictures have just a beer just sitting there, someone pouring the beer, etc., something very different happens in the brain of that individual,” Myrick says.

Results have shown a sharp difference between alcoholics and social drinkers. For a more pronounced difference, subjects are injected with a small amount of alcohol (five milliliters).

Myrick says the results prove the need for medication to treat alcoholism.

“We do bite the stigma that this is a character pathology: ‘You need to get over it. You need to stop drinking,'” he says.

Comparing the frequency of alcoholism to depression, Myrick notes that medication for depression is pervasive, while only about 10 percent of alcoholics take medicine to treat alcoholism.

Myrick is using the fMRI technology to study the effectiveness of Naltrexone in targeting the areas of the brain flooded with Dopamine when an alcoholic sees triggers. Results have shown a decrease in cravings after a week on the drug.

“That goes a long way to proving medications that we have that are approved for treatment of alcoholism do actually work,” Myrick says.

Participants have to experience problems with their drinking in order to be eligible for the study. They should not be seeking treatment for their alcoholism at the time. People are not pressured to enter some sort of treatment program upon entering the study.

“Actually we exclude people who have any type of legal involvement with treatment, because this is not treatment,” Myrick says. “This is strictly to help us better understand alcoholism and to help us better understand treatments for alcoholism.”

The fMRI technology isn’t used to just identify alcoholic cravings either. The machine can also be used to see when people are craving a cigarette, candy, or methamphetamine.

The next step is to identify genetic predisposition toward alcoholism and to determine how a person’s DNA might lead them to respond differently to medications like Naltrexone. —Mike Fabbrini

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