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The Role of Unawareness, Volition and Neural Hyperconnectivity in Alcohol Use Disorder: A Functional Magnetic Resonance Imaging Study

  • Author Footnotes
    † These authors contributed equally to this work.
    Iasmina Livia Hornoiu
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany

    University of Heidelberg, Heidelberg, Germany
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  • Author Footnotes
    † These authors contributed equally to this work.
    Alycia M. Lee
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
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  • Haoye Tan
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
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  • Helmut Nakovics
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
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  • Patrick Bach
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany

    Mannheim Center of Translational Neuroscience (MCTN), University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
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  • Karl Mann
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
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  • Falk Kiefer
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany

    Mannheim Center of Translational Neuroscience (MCTN), University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
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  • Wolfgang Sommer
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany

    Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    Bethanien Hospital for Psychiatry, Greifswald, Germany
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  • Sabine Vollstädt-Klein
    Correspondence
    Corresponding author: Prof. (apl.) Dr. Sabine Vollstädt-Klein, RG Neuroimaging of Addictive Behavior, Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, J 5, 68159 Mannheim, Germany, , Phone: + 49 621 1703-3912
    Affiliations
    Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
    Search for articles by this author
  • Author Footnotes
    † These authors contributed equally to this work.
Published:December 22, 2022DOI:https://doi.org/10.1016/j.bpsc.2022.12.008

      Abstract

      Background

      Automated alcohol craving and habitual alcohol consumption characterize the later stages of alcohol use disorder (AUD). This study reanalyzes previously collected functional neuroimaging data in combination with the Craving Automated Scale for Alcohol (CAS-A) questionnaire to investigate the neural correlates and brain networks underlying automated drinking characterized by unawareness and non-volition.

      Methods

      We assessed 49 abstinent male AUD patients and 36 male healthy controls (HC) during a functional magnetic resonance imaging (fMRI)-based alcohol cue-reactivity task. We performed whole-brain analyses examining the associations between CAS-A scores and other clinical instruments and neural activation patterns in the alcohol versus neutral contrast. Furthermore, we performed psychophysiological-interaction (PPI) analyses to assess the functional connectivity between predefined seed regions and other brain areas.

      Results

      In AUD individuals, higher CAS-A scores correlated with greater activation in dorsal striatal, pallidal and prefrontal regions, including frontal white matter, and with lower activation in visual- and motor-processing regions. Between-group PPI analyses showed extensive connectivity between the seed regions IFG and angular gyrus and several frontal, parietal and temporal brain regions in AUD versus HC.

      Conclusions

      The present study applied a new lens to previously acquired alcohol cue-reactivity fMRI data by correlating neural activation patterns with clinical CAS-A scores to elucidate potential neural correlates of automated alcohol craving and habitual alcohol consumption. Our results support previous findings showing that alcohol addiction is associated with hyperactivation in habit-processing regions, with hypoactivation in areas mediating motor and attention processing, and with general hyperconnectivity.

      Keywords

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