From childhood adversity to daily craving: Sex-specific neural alcohol cue reactivity

What is it about?

People with alcohol use disorder (AUD) often experience strong cravings when they see or smell alcohol. These reactions are linked to activity in brain reward and control circuits. We studied how adverse childhood experiences, such as abuse or neglect, relate to these alcohol‑related brain responses and to daily craving in everyday life. Using functional magnetic resonance imaging (fMRI), we measured neural cue reactivity to alcohol cues in 137 males and 94 females with mainly mild to moderate AUD who were not seeking treatment. Participants reported their alcohol use and craving in real time over 12 months using ecological momentary assessment (EMA). We analyzed craving during the first 90 days to obtain stable estimates of typical daily craving. We found that females with higher childhood trauma scores showed a stronger neural response to alcohol cues in the left superior frontal gyrus and anterior cingulate cortex compared to males. In females, this brain reactivity was associated with higher daily craving during this 90‑day period. The results suggest that early life stress leaves lasting, sex‑specific marks on how the brain responds to alcohol cues and on craving vulnerability in early AUD, especially in females.

Featured Image

Photo by Akhil Pawar on Unsplash

Photo by Akhil Pawar on Unsplash

Why is it important?

Most people with alcohol use disorder never seek treatment, and we lack clear biological markers of vulnerability. We show that adverse childhood experiences are linked to sex‑specific changes in alcohol cue reactivity in medial prefrontal brain regions and to real‑world craving, especially in females. This supports more personalized, trauma‑informed prevention and treatment approaches for alcohol use disorder.

Perspectives