Association of Prefrontal-Striatal Functional Pathology With Alcohol Abstinence Days at Treatment Initiation and Heavy Drinking After Treatment Initiation.

Tytuł:: Association of Prefrontal-Striatal Functional Pathology With Alcohol Abstinence Days at Treatment Initiation and Heavy Drinking After Treatment Initiation.
Autorzy:: Blaine SK; Department of Psychology, Auburn University, Auburn, Ala. (Blaine); Department of Psychiatry (Wemm, Fogelman, Seo, Sinha) and Department of Radiology and Biomedical Imaging (Lacadie, Scheinost), Yale University School of Medicine, New Haven, Conn.
Wemm S; Department of Psychology, Auburn University, Auburn, Ala. (Blaine); Department of Psychiatry (Wemm, Fogelman, Seo, Sinha) and Department of Radiology and Biomedical Imaging (Lacadie, Scheinost), Yale University School of Medicine, New Haven, Conn.
Fogelman N; Department of Psychology, Auburn University, Auburn, Ala. (Blaine); Department of Psychiatry (Wemm, Fogelman, Seo, Sinha) and Department of Radiology and Biomedical Imaging (Lacadie, Scheinost), Yale University School of Medicine, New Haven, Conn.
Lacadie C; Department of Psychology, Auburn University, Auburn, Ala. (Blaine); Department of Psychiatry (Wemm, Fogelman, Seo, Sinha) and Department of Radiology and Biomedical Imaging (Lacadie, Scheinost), Yale University School of Medicine, New Haven, Conn.
Seo D; Department of Psychology, Auburn University, Auburn, Ala. (Blaine); Department of Psychiatry (Wemm, Fogelman, Seo, Sinha) and Department of Radiology and Biomedical Imaging (Lacadie, Scheinost), Yale University School of Medicine, New Haven, Conn.
Scheinost D; Department of Psychology, Auburn University, Auburn, Ala. (Blaine); Department of Psychiatry (Wemm, Fogelman, Seo, Sinha) and Department of Radiology and Biomedical Imaging (Lacadie, Scheinost), Yale University School of Medicine, New Haven, Conn.
Sinha R; Department of Psychology, Auburn University, Auburn, Ala. (Blaine); Department of Psychiatry (Wemm, Fogelman, Seo, Sinha) and Department of Radiology and Biomedical Imaging (Lacadie, Scheinost), Yale University School of Medicine, New Haven, Conn.
Źródło:: The American journal of psychiatry [Am J Psychiatry] 2020 Nov 01; Vol. 177 (11), pp. 1048-1059. Date of Electronic Publication: 2020 Aug 28.
Typ publikacji:: Journal Article; Research Support, N.I.H., Extramural
Język:: English
Imprint Name(s):: Original Publication: Arlington, VA : American Psychiatric Association
MeSH Terms:: Alcohol Abstinence*
Alcoholism/*pathology
Prefrontal Cortex/*pathology
Ventral Striatum/*pathology
Adult ; Alcoholism/physiopathology ; Alcoholism/therapy ; Brain/diagnostic imaging ; Case-Control Studies ; Craving/physiology ; Female ; Humans ; Hydrocortisone/blood ; Magnetic Resonance Imaging ; Male ; Oximetry ; Prefrontal Cortex/diagnostic imaging ; Prefrontal Cortex/physiopathology ; Treatment Outcome ; Ventral Striatum/diagnostic imaging ; Ventral Striatum/physiopathology
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Grant Information:: R01 AA013892 United States AA NIAAA NIH HHS; T32 DA022975 United States DA NIDA NIH HHS; R01 AA026844 United States AA NIAAA NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS; K99 AA025401 United States AA NIAAA NIH HHS; R01 AA026514 United States AA NIAAA NIH HHS; R00 AA025401 United States AA NIAAA NIH HHS; KL2 TR001862 United States TR NCATS NIH HHS
Contributed Indexing:: Keywords: Alcohol Use Disorder; Cue Reactivity; Early Abstinence; Treatment Initiation; Ventral Striatum; Ventromedial Prefrontal Cortex
Substance Nomenclature:: WI4X0X7BPJ (Hydrocortisone)
Entry Date(s):: Date Created: 20200829 Date Completed: 20201214 Latest Revision: 20211102
Update Code:: 20240105
PubMed Central ID:: PMC7606814
DOI:: 10.1176/appi.ajp.2020.19070703
PMID:: 32854534
: Czasopismo naukowe

Objective: Alcohol use disorder (AUD) is associated with neuroadaptations in brain stress and reward circuits. It is not known whether such neuroadaptations are affected by number of days of alcohol abstinence and whether they influence heavy drinking during the early treatment phase. The authors used a novel functional MRI (fMRI) approach to assess brain responses during sustained exposure to standardized visual stimuli of stressful, alcohol cue, and neutral control images combined with prospective assessment of drinking outcomes during early outpatient treatment, in two related studies.
Methods: In study 1, 44 treatment-entering patients with AUD and 43 demographically matched healthy control subjects participated in the fMRI experiment to identify dysfunctional responses associated with chronic alcohol abuse. In study 2, 69 treatment-entering patients with AUD were assessed for whether fMRI responses at treatment initiation were influenced by alcohol abstinence and were prospectively predictive of early heavy drinking outcomes.
Results: Relative to control subjects, patients with AUD showed significant hyperreactivity in the ventromedial prefrontal cortex (vmPFC) in response to neutral images, but significant hypoactivation in the vmPFC and ventral striatum in response to stress images and to alcohol cues relative to response to neutral images. In study 2, this specific prefrontal-ventral striatal dysfunction was associated with fewer days of alcohol abstinence and also predicted greater number heavy drinking days during the subsequent 2 weeks of treatment engagement.
Conclusions: Number of days of alcohol abstinence at treatment initiation significantly affected functional disruption of the prefrontal-striatal responses to stress images and to alcohol cues in patients with AUD, and the severity of this disruption in turn predicted greater heavy drinking during early treatment. Treatments that target this functional prefrontal-striatal pathology could improve early treatment outcomes in AUD.

Comment in: Am J Psychiatry. 2020 Nov 1;177(11):1022-1024. (PMID: 33135471)

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