Association of Prefrontal-Striatal Functional Pathology With Alcohol Abstinence Days at Treatment Initiation and Heavy Drinking After Treatment Initiation

What is it about?

Individuals initiating recovery from Alcohol Use Disorder (AUD) struggle with poor treatment adherence, early dropout, and high relapse risk. While patients with AUD enter outpatient treatment with varying lengths of abstinence, from less than 24 hours up to a few weeks, little is known about how the brain functions during the early abstinent period and whether the early alcohol abstinent state of the brain recovery initiation and alcohol intake during early treatment. Here we used a novel Functional Magnetic Resonance Imaging (fMRI) approach to assess brain responses to a series of challenging alcohol-related and stressful stimuli as well as neutral control visual images and also assessed alcohol drinking levels during early outpatient treatment. In Study 1, we compared patients with AUD to demographically matched healthy controls (HC) to assess brain functioning during the early alcohol abstinent state after chronic alcohol abuse. In study 2, we examined whether functional brain responses at treatment initiation were influenced by alcohol abstinence and were related to heavy drinking during early treatment. We found specific disrupted brain functioning in response to stress, cue and neutral stimuli in the lower medial frontal and a reward-related brain region in AUD relative to controls. Also, greater dysfunctional brain responses in these regions were related to shorter days of alcohol abstinence, and were also related to greater number heavy drinking days during the first 2 weeks of treatment engagement. These novel findings show that extent of alcohol abstinence at treatment initiation significantly affects how well the brain functions in response to challenge, and worse the brain dysfunction, greater the heavy drinking days during early treatment recovery. This suggests that while each day of abstinence helps the brain recover from chronic alcohol use, the recovery occurs “one day at a time”, and that disrupted brain function due to chronic alcohol use may jeopardize early treatment recovery and increase the risk of relapse. New treatments that can improve the rate of early brain functional recovery could improve treatment drop out and early risk of relapse.

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