title: Visual Image-Induced Craving for Ethanol (VICE): Development, Validation, and a Pilot fMRI Study.
abstract: BACKGROUND
  Craving induction in a controlled environment is helpful in the research of craving mechanism and its role in development of alcohol dependence (AD). We describe a novel tool Visual Image-induced Craving for Ethanol (VICE) and its effects on brain activation with pilot functional magnetic resonance imaging (fMRI).
  
  
  METHODS
  Alcohol-related visual cues (ARCs) in 5 scenarios were photographed, which included pictures of bars, alcoholic beverage bottles, pouring of alcohol into glasses, glasses filled with alcohol, and scenes of people sipping alcohol, counterbalanced with neutral pictures (involving water, milk etc.,). Craving scores were obtained from 15 hospitalized patients with AD to validate this tool. In the pilot fMRI (3-Tesla) study, 5 patients were examined using VICE in a symptom provocation model. Group level-fixed effect analysis of brain activation differences was done using SPM8.
  
  
  RESULTS
  VICE showed a high internal consistency with Cronbach's α coefficient of 0.86, which confirmed its reliability. Concurrent validity of VICE was demonstrated via its convergence with the Penn Alcohol Craving Scale. ARCs had significantly greater mean craving scores than neutral cues in all the 5 scenarios (intentional validity). In the pilot fMRI, patients were found to have greater activation while viewing ARCs compared to the neutral cues in right insular cortex and deficient activation in right orbitofrontal cortex.
  
  
  CONCLUSIONS
  The VICE is a reliable and valid measure of alcohol craving with promising clinical and translational research implications. Preliminary fMRI findings indicate it can be used as a symptom provocation tool for fMRI experiments.
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India.
authors.forename: Bharath
authors.initials: B
authors.lastname: Holla
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India.
authors.forename: Biju
authors.initials: B
authors.lastname: Viswanath
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India.
authors.forename: Sri Mahavir
authors.initials: SM
authors.lastname: Agarwal
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India.
authors.forename: Sunil Vasu
authors.initials: SV
authors.lastname: Kalmady
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Ami Sebastian
authors.initials: AS
authors.lastname: Maroky
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Jayarajan
authors.affiliation: Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Rose Dawn
authors.initials: RD
authors.lastname: Bharath
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India.
authors.forename: Ganesan
authors.initials: G
authors.lastname: Venkatasubramanian
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Benegal
keywords: Alcohol; craving; imaging; neurobiology; symptom provocation