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

Iasmina Livia Hornoiu; Alycia M Lee; Haoye Tan; Helmut Nakovics; Patrick Bach; Karl Mann; Falk Kiefer; Wolfgang H Sommer; Sabine Vollstädt-Klein

doi:10.1016/j.bpsc.2022.12.008

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

Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Jun;8(6):660-671. doi: 10.1016/j.bpsc.2022.12.008. Epub 2022 Dec 22.

Authors

Iasmina Livia Hornoiu¹, Alycia M Lee¹, Haoye Tan¹, Helmut Nakovics¹, Patrick Bach², Karl Mann¹, Falk Kiefer², Wolfgang H Sommer³, Sabine Vollstädt-Klein⁴

Affiliations

¹ Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
² Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany; Mannheim Center of Translational Neuroscience (MCTN), University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany.
³ Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany; Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Bethanien Hospital for Psychiatry, Greifswald, Germany.
⁴ Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany. Electronic address: s.vollstaedt-klein@zi-mannheim.de.

PMID: 36948909
DOI: 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 reanalyzed 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 nonvolition.

Methods: We assessed 49 abstinent male patients with AUD and 36 male healthy control participants during a functional magnetic resonance imaging-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 analyses to assess the functional connectivity between predefined seed regions and other brain areas.

Results: In patients with AUD, 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 psychophysiological interaction analyses showed extensive connectivity between the seed regions inferior frontal gyrus and angular gyrus and several frontal, parietal, and temporal brain regions in AUD versus healthy control participants.

Conclusions: The present study applied a new lens to previously acquired alcohol cue-reactivity functional magnetic resonance imaging 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: Alcohol use disorder; Automated craving; CAS-A; Habitual alcohol consumption; Unawareness; Volition.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Alcohol Drinking
Alcoholism* / pathology
Brain
Humans
Magnetic Resonance Imaging / methods
Male
Volition