Research on behavioral treatments for alcoholism has provided little definitive evidence about how treatment influences positive behavior change. Moreover, the difficulty of identifying how people change is not limited to treatment seekers but generalizes to non-treatment seekers. The identification of mechanisms of behavior change is emerging as one of the great challenges to addiction research. Recently, increased attention has been given to the need for cross-disciplinary research that views behavior change as the result of a complex interplay between one's environment, thoughts and behaviors, and brain function and biology. Such research provides tremendous opportunities to identify how people change their alcohol use behavior. This K02 application seeks to promote the applicant's progression into transdisciplinary research on recovery from alcoholism. Building on the applicant's background in studying the mechanisms of action of behavioral treatments, the goal of this application is to gain expertise in cognitive neuroscience as it relates to efforts to change one's alcohol use. The objectives of this proposal are to acquire sufficient knowledge of decision theory, neuroscience, and neuroimaging to permit the candidate to conduct independent research that examines linkages between thought processes and brain activity with changes in alcohol use among problem drinkers. To achieve these objectives a detailed career development plan will be followed that entails formal coursework, workshops, directed readings, ongoing consultations with experts in specific content areas, and experiential work on existing datasets. An important institutional resource that will facilitate the applicant's efforts towards achieving these objectives is the UCLA Consortium for Neuropsychiatric Phenomics (CNP). The CNP is an interdisciplinary, campus-wide effort comprised of 52 investigators with members from the fields of psychiatry, neurology, neurobiology, psychology and computer science collaborating and sharing data. The specific aspects of the CNP especially relevant to the proposed career development plan are its focus on impulse control as one of its two broad cognitive phenotypic domains, its collection of data on an fMRI battery for 500 individuals, and its collection of data on alcohol use by participants. The candidate will work with the CNP and collaborators to receive practical experience in performing decision making and fMRI procedures and analyzing data on relationships between alcohol use, decision making, and brain activity. As a first step in a programmatic line of research, a randomized controlled trial using a repeated measures longitudinal design is proposed to examine decreases in alcohol use among non-treatment seeking heavy drinkers as function of change in brain activity and sensitivity to reward during decision making. Participants (n=114) will include both men and women. A laboratory fMRI-based paradigm will be conducted at baseline, 1-month, and 3-month follow-ups to assess brain activity during decision making tasks. Daily monitoring procedures across the same 3-month period will be used to capture real-time decision making processes, alcohol use, and the perceived effects of alcohol use. After the baseline assessment participants will be randomly assigned to either a 4-session motivational intervention or a wait-list control group. Data will be analyzed with structural equation modeling and with advanced dynamic systems modeling. It is hypothesized that reductions in alcohol use will be predicted from a cascade of interrelated pro-change processes that include decreases in brain activity associated with craving and impulsivity, decreased reward value of alcohol during decision making, and increased non-drinking activities. This longitudinal study of complex systems offers great promise to dramatically improve our understanding of mechanisms of behavior change and to inform efforts to promote this change among heavy drinkers in the general population.
The identification of mechanisms of behavior change is emerging as one of the great challenges to alcoholism research. This project will promote important cross-disciplinary studies that integrates psychosocial intervention, behavior, and neuroscience. Findings from this research may further our understanding of the mechanisms through which individuals alter problem alcohol use, and may inform ways to promote positive behavior change.