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Alcohol-related cue-reactivity predicts abstinence duration in individuals with severe alcohol-use disorders

Published online by Cambridge University Press:  23 March 2020

S. Karthik ,
B. Holla ,
R.D. Bharath ,
G. Venkatasubramaniyan  and
V. Benegal
S. Karthik
Affiliation:
National Institute of Mental Health and Neurosciences, Psychiatry, Bangalore, Karnataka, India
B. Holla
Affiliation:
National Institute of Mental Health and Neurosciences, Psychiatry, Bangalore, Karnataka, India
R.D. Bharath
Affiliation:
National Institute of Mental Health and Neurosciences, Neuro Imaging and Interventional Radiology, Bangalore, Karnataka, India
G. Venkatasubramaniyan
Affiliation:
National Institute of Mental Health and Neurosciences, Psychiatry, Bangalore, Karnataka, India
V. Benegal
Affiliation:
National Institute of Mental Health and Neurosciences, Psychiatry, Bangalore, Karnataka, India

Abstract

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Introduction

Alcohol use disorder (AUD) is an important global public health problem with complex aetiology and relapsing remitting course. Clinical measures of alcohol dependence severity and alcohol-craving, are largely unreliable in identifying individuals at high-risk for relapse. Functional human neuroimaging methods that employ symptom provocation paradigms have shown promise in identifying critical brain regions with cue-elicited alcohol-craving response.

Objective

The present study aimed at examining the utility of fMRI cue-reactivity (CR) in predicting relapse risk.

Methods

The study was conducted on inpatients of a tertiary care neuropsychiatric hospital. Thirty-two treatment-seeking right-handed men were recruited for the study after informed consent. Following detoxification and 3-day drug-washout period, they underwent a task-based fMRI while viewing images of alcohol-related and control cues presented to them using a previously validated fMRI paradigm. All patients received anti-craving medications (baclofen: 60–80 mg/d, n = 16; naltrexone: 50–100 mg/d, n = 16) and were prospectively followed-up till their first alcohol lapse.

Results

Random-effect analysis using one-sample test revealed significant CR to alcohol-related cues (relative to implicit baseline) with activation in salience-reward related regions [insula, cingulate, dorsal striatum (DS)], visual-attention regions [occipito-temporal] and deactivation of default-mode regions [posterior cingulate (PCC)] (all significant at PFWE < 0.05, whole-brain corrected). Cox-proportional hazard regressions revealed that greater CR in Insula (Chi2 = 10.33; P = 0.001; HR = 3.1; 95% CI = 1.5–6.3) and DS (Chi2 = 10.87; P = 0.001; HR = 2.8; 95% CI = 1.5–5.2) predicts faster subsequent time to first drink after accounting for the role of clinical measures.

Conclusion

These findings indicate that CR can serve as potential marker to identify individuals at high-risk for relapse. Further examination of intervention-related CR change may aid in personalizing treatment of AUD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
e-Poster viewing: Substance related and addictive disorders
Information
European Psychiatry , Volume 41 , Issue S1: Abstract of the 25th European Congress of Psychiatry , April 2017 , pp. s877
Copyright
Copyright © European Psychiatric Association 2017
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