The ReCoDe addiction research consortium: Losing and regaining control over drug intake-Findings and future perspectives

Abstract

Substance use disorders (SUDs) are seen as a continuum ranging from goal-directed and hedonic drug use to loss of control over drug intake with aversive consequences for mental and physical health and social functioning. The main goals of our interdisciplinary German collaborative research centre on Losing and Regaining Control over Drug Intake (ReCoDe) are (i) to study triggers (drug cues, stressors, drug priming) and modifying factors (age, gender, physical activity, cognitive functions, childhood adversity, social factors, such as loneliness and social contact/interaction) that longitudinally modulate the trajectories of losing and regaining control over drug consumption under real-life conditions. (ii) To study underlying behavioural, cognitive and neurobiological mechanisms of disease trajectories and drug-related behaviours and (iii) to provide non-invasive mechanism-based interventions. These goals are achieved by: (A) using innovative mHealth (mobile health) tools to longitudinally monitor the effects of triggers and modifying factors on drug consumption patterns in real life in a cohort of 900 patients with alcohol use disorder. This approach will be complemented by animal models of addiction with 24/7 automated behavioural monitoring across an entire disease trajectory; i.e. from a naïve state to a drug-taking state to an addiction or resilience-like state. (B) The identification and, if applicable, computational modelling of key molecular, neurobiological and psychological mechanisms (e.g., reduced cognitive flexibility) mediating the effects of such triggers and modifying factors on disease trajectories. (C) Developing and testing non-invasive interventions (e.g., Just-In-Time-Adaptive-Interventions (JITAIs), various non-invasive brain stimulations (NIBS), individualized physical activity) that specifically target the underlying mechanisms for regaining control over drug intake. Here, we will report on the most important results of the first funding period and outline our future research strategy.

Keywords: addiction; alcohol; alternative rewards; ambulatory assessment (AA); animal models; behavioural control; cocaine; cognitive control; computational models; craving; decision‐making; ecological momentary assessment (EMA); habit formation; relapse; tobacco.

FIGURE 1

The losing and regaining control over drug intake (ReCoDe) framework. The projects are divided into three research domains. Research domain A relates to trajectories of alcohol and drug use; research domain B relates to mechanisms (e.g. cue reactivity) on different system levels (behavioural, neural and molecular); and research domain C focuses on the modification of mechanisms (e.g., by increasing cognitive control via physical activity or neurofeedback). Pavlovian‐to‐instrumental transfer (PIT).

FIGURE 2

The INF infrastructure provides central storage for all ReCoDe projects. For participant management, PAMS (participant management system) was developed. The PAMS serves as a central system for the administration of personal data and pseudonymization. REDCap, a web‐based system for managing projects, studies, online surveys, interviews, standardized documentation, metadata and other types of data has also been implemented. In addition, an extensible neuroimaging archive toolkit (XNAT) server is used to store all types of image files generated by MRI scanners and the corresponding log files of task‐related fMRI experiments. DICOM = digital imaging and Communications in Medicine; ORSEE = online recruitment system for economic experiments.

FIGURE 3

Shows the multi‐site recruitment of the ReCoDe cohort. The recruitment aim during the first funding period was N = 900 patients with AUD. As of today (May 2024), after accounting for drop‐outs we still have 746 (291 female/455 male) patients with AUD and 269 controls (131 female/138 male) for follow‐up assessments. Mostly mild to moderate cases (with 4.1 ± 1.7 SD AUD criteria) were recruited, as those patients are suggested to demonstrate higher disease dynamics in terms of losing and regaining control than severe cases. A broad age range is covered in three age sub‐cohorts in order to draw conclusions on disease trajectories and mechanisms across the entire lifetime. S01, S02, etc., relate to different projects of the ReCoDe consortium.

FIGURE 4

Media reports from the CIMH during the first funding period FP (as of March 2023). The number of printed reports, online reports and social media are shown with a total reach of approx. 140 million interactions. ReCoDe PIs also wrote several posts for the German website “Das Gehirn” – www.dasGehirn.info ‐ which has millions of visits and has set itself the goal of presenting the brain, its functions and its importance for our feelings, thoughts and actions ‐ comprehensively, understandably, attractively and clearly in words, images and sound.