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.
Am J Psychiatry. 2020 Nov 1;177(11):1048-1059. doi: 10.1176/appi.ajp.2020.19070703. Epub 2020 Aug 28.
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.
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.
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.
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.
酒精使用障碍（AUD）与大脑应激和奖励回路的神经适应性有关。目前尚不清楚这种神经适应性是否受戒酒天数的影响，以及它们是否会影响早期治疗阶段的重度饮酒。作者使用了一种新的功能磁共振成像（fMRI）方法，在两项相关研究中，评估了在持续暴露于标准化视觉刺激的应激、酒精线索和中性控制图像期间的大脑反应，以及早期门诊治疗期间饮酒结果的前瞻性评估。
在研究 1 中，44 名治疗开始的 AUD 患者和 43 名在人口统计学上匹配的健康对照者参加了 fMRI 实验，以确定与慢性酒精滥用相关的功能障碍反应。在研究 2 中，69 名治疗开始的 AUD 患者评估了治疗开始时的 fMRI 反应是否受酒精禁欲的影响，以及是否对早期重度饮酒结果有前瞻性预测。
与对照组相比，AUD 患者在对中性图像的反应中表现出明显的腹侧前额叶皮层（vmPFC）过度反应，但在对应激图像和酒精线索的反应中，vmPFC 和腹侧纹状体的激活明显降低，相对于对中性图像的反应。在研究 2 中，这种特定的前额叶-腹侧纹状体功能障碍与酒精禁欲天数较少有关，也预测了在随后的 2 周治疗期间更多的重度饮酒天数。
治疗开始时的酒精禁欲天数显著影响 AUD 患者对应激图像和酒精线索的前额-纹状体反应的功能障碍，这种障碍的严重程度反过来又预测了早期治疗期间更大的重度饮酒。针对这种功能性前额-纹状体病理的治疗方法可以改善 AUD 的早期治疗结果。
