Le Thang M, Hughes F AnNa, Oba Takeyuki, Li Chiang-Shan R
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Psychology, Villanova University, Villanova, Pennsylvania, USA.
Addict Biol. 2025 Feb;30(2):e70020. doi: 10.1111/adb.70020.
Drinking as a coping method in response to pain is a complex behaviour, involving multiple neural, motivational, and psychological factors. Among these factors, pain sensitivity and pain-related drinking motive can significantly promote alcohol use. In contrast, proactive avoidance - a beneficial strategy of initiating overt actions to avoid negative outcomes - reduces harmful consumption. Yet, these factors have not been assessed as potential predictors of future drinking behaviour. Here, in a longitudinal study we collected fMRI data in 50 drinkers who, at baseline, performed a probabilistic learning go/nogo task that involved proactive avoidance of painful electric shocks. Pain-related psychological measures and the neural correlates of proactive avoidance were examined in relation to participants' alcohol use and craving in the following 12 months. We found that deficits in proactive avoidance were associated with future drinking severity. Importantly, diminished activation of the dorsal anterior cingulate cortex (dACC) during proactive avoidance also predicted subsequent percentage of heavy drinking days. Using Bayesian network modelling, we established a potential pathway in which drinkers' heightened pain sensitivity led to greater pain-avoidance drinking motive and alcohol craving. Both craving and weakened dACC activation to proactive avoidance predicted higher levels of drinking during the follow-up period. Taken together, our study identified pain sensitivity, pain-avoidance drinking motive, and impaired proactive avoidance as predictors of future alcohol use severity. These findings highlight the roles of pain response, thus potentially informing interventions for individuals at risk of alcohol use disorders.
将饮酒作为应对疼痛的一种方式是一种复杂的行为，涉及多种神经、动机和心理因素。在这些因素中，疼痛敏感性和与疼痛相关的饮酒动机可显著促进酒精使用。相比之下，主动回避——一种通过采取公开行动来避免负面结果的有益策略——可减少有害饮酒。然而，这些因素尚未被评估为未来饮酒行为的潜在预测指标。在此，在一项纵向研究中，我们收集了50名饮酒者的功能磁共振成像（fMRI）数据，这些饮酒者在基线时进行了一项概率学习的“去/不去”任务，该任务涉及主动回避痛苦的电击。我们考察了与疼痛相关的心理测量指标以及主动回避的神经关联与参与者在接下来12个月中的酒精使用和渴望之间的关系。我们发现主动回避缺陷与未来饮酒严重程度相关。重要的是，在主动回避过程中背侧前扣带回皮质（dACC）激活减弱也预测了随后重度饮酒天数的百分比。使用贝叶斯网络建模，我们建立了一条潜在途径，即饮酒者增强的疼痛敏感性导致更大的为避免疼痛而饮酒的动机和酒精渴望。渴望以及dACC对主动回避的激活减弱均预测了随访期间更高的饮酒水平。综上所述，我们的研究确定疼痛敏感性、为避免疼痛而饮酒的动机以及受损的主动回避是未来酒精使用严重程度的预测指标。这些发现突出了疼痛反应的作用，从而可能为有酒精使用障碍风险的个体提供干预依据。
