Editors' ChoiceAlcohol Dependency

The Brains Behind Alcohol Relapse

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Science Translational Medicine  15 May 2013:
Vol. 5, Issue 185, pp. 185ec82
DOI: 10.1126/scitranslmed.3006522

“Hello, my name is Bill W. and I am an alcoholic. I have been sober for 34 days…” These are words spoken often at Alcoholics Anonymous (AA) meetings, but what predicts whether an alcoholic will stay sober or relapse? Recidivism is a pervasive problem for the 18 million Americans who suffer with alcoholism. Studies have shown that external factors such as stress, alcohol-related environmental cues, or even a taste of alcohol can increase the risk of relapse to alcohol abuse. Behavioral strategies aim to diminishing these factors, yet markers identifying who may be at highest risk for relapse are lacking, impeding targeted individual prevention and treatment.

In a forward-thinking recent study, Seo et al. set out to identify neural markers that may predict relapse to alcohol use. Using functional magnetic resonance imaging (MRI), the authors examined neural responses to guided-imagery of personal stressful, relaxing, and alcohol-cue–related conditions of 45 recovering alcoholics who had completed a 12-step in-patient alcohol-treatment program and compared them with neural responses of healthy nonalcoholic subjects. The recovering alcoholics were subsequently followed for 3 months and assessed for recidivism. When exposed to alcohol-related cues or stressful conditions, alcoholics, as compared with nonalcoholics, had less brain activity in the prefrontal cortex (PFC) and anterior cingulate cortex (ACC)—brain regions that are important for decision-making, suggesting that recovering alcoholics may be less able to determine the best course of action in response to a given stressful or alcohol-enticing stimulus. Conversely, during exposure to relaxing cues, recovering alcoholics had increased activity in the PFC/ACC as well as motivation-reward brain regions; in fact, the greater the activation, the greater the risk of relapse. The authors’ findings suggest that in recovering alcoholics, the decision-making areas of the brain may not be functioning properly: quiet when they should be active, and active—along with motivation-reward brain regions—when they should be calm.

Importantly, this study provides the first neural markers that may be predictive of relapse to alcohol use in humans and suggests regional brain targets for behavioral and pharmacologic interventions to reduce recidivism. Perhaps at future AA meetings we may hear, “… I have been sober for 34 days. According to my brain scan, I am at high risk for relapse, so my doctor prescribed a new medication to help my brain work appropriately, diminish my cravings, and decrease my risk for relapse.”

D. Seo et al., Disrupted ventromedial prefrontal function, alcohol craving, and subsequent relapse risk. JAMA Psychiatry, published online 1 May 2013 (10.1001/jamapsychiatry.2013.762). [Full text ]

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