# Neural Target Identification for Functional Disability Associated with Alcohol Related Characteristics Among Veterans with Co-occurring Alcohol Use Disorder and Traumatic Brain Injury

> **NIH VA I01** · EDWARD HINES JR VA HOSPITAL · 2020 · —

## Abstract

Alcohol use disorder (AUD) and mild traumatic brain injury (mTBI) impact functional abilities. AUD occurs in up
to 35% of Veterans with mTBI. Evidence suggests that co-occurrence of AUD and mTBI (AUD+mTBI) leads to
an exacerbation of brain dysfunction, symptom manifestation, and ultimately, functional disability. Alcohol-
related characteristics are operationally defined per AUD symptoms and outcomes including, but not limited to,
alcohol consumption, alcohol craving, and AUD severity. Repetitive transcranial magnetic stimulation (rTMS) is
a non-invasive neuromodulatory treatment that will soon be a treatment option at 30 VAs nationwide.
Preliminary rTMS efficacy is demonstrated for AUD alone and mTBI alone using a variety of neural targets.
rTMS is, thus, a promising treatment for AUD+mTBI. The objectives of this study are to 1) identify neural
targets (i.e. site of stimulation) associated with both alcohol-related characteristics and self-reported functional
disability, and 2) assess preliminary efficacy and sustainability of a high frequency rTMS protocol applied to
these customized neural targets relative to the commonly used left dorsolateral prefrontal cortex (DLPFC) site.
Addressing these objectives are essential steps towards our long-term research goal [to customize and
clinically implement a rTMS treatment] that can improve brain function resulting in optimal recovery for
Veterans with AUD+mTBI. To address the first study objective, Veterans will be recruited and classified into
one of two groups based on structured-interviews, self-report measures, and neuropsychological assessments:
1) AUD+mTBI, and 2) [Veteran controls] without a history or symptoms of mTBI or AUD. Alcohol-related
characteristics will be assessed through objective measures of alcohol use, self-report measures, and
structured interviews. Self-reported functional disability will be assessed using the World Health Organization
Disability Assessment Schedule 2.0 (WHODAS). Neuroimaging metrics will be assessed through a multi-
modal, functional and structural Magnetic Resonance Imaging (MRI) scan. Participants will complete a
functional MRI (fMRI) protocol where brain activation will be measured in response to viewing images related
to alcohol, compared to neutral images. Advanced neuroimaging procedures to determine the structural
integrity of white matter fibers in the brain and spontaneous activity in brain networks, a process called resting
state functional connectivity (rsFC), will also be conducted. To address the second study objective, AUD+mTBI
Veterans will receive rTMS at one site randomly assigned from a set of 4 sites: 3 customized neural targets
identified in this study, and the commonly used left DLPFC. AUD+mTBI Veterans will complete 10 PLACEBO,
then 10 ACTIVE rTMS sessions in a within-subjects design. Follow-up WHODAS assessments will occur at 2-
weeks, 1-month and 6-months post-ACTIVE rTMS. Aim 1 will identify unique neural targets for rTMS to treat
AUD+m...

## Key facts

- **NIH application ID:** 10020799
- **Project number:** 5I01RX002916-02
- **Recipient organization:** EDWARD HINES JR VA HOSPITAL
- **Principal Investigator:** Amy Herrold
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10020799

## Citation

> US National Institutes of Health, RePORTER application 10020799, Neural Target Identification for Functional Disability Associated with Alcohol Related Characteristics Among Veterans with Co-occurring Alcohol Use Disorder and Traumatic Brain Injury (5I01RX002916-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10020799. Licensed CC0.

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