Neural correlates of instrumental responding in the context of alcohol-related 
cues index disorder severity and relapse risk

Schad, Daniel J.; Garbusow, Maria; Friedel, Eva; Sommer, Christian; Sebold, Miriam; Hägele, Claudia; Bernhardt, Nadine; Nebe, Stephan; Kuitunen-Paul, Sören; Liu, Shuyan; Eichmann, Uta; Beck, Anne; Wittchen, Hans-Ulrich; Walter, Henrik; Sterzer, Philipp; Zimmermann, Ulrich S.; Smolka, Michael N.; Schlagenhauf, Florian; Huys, Quentin J. M.; Heinz, Andreas; Rapp, Michael A.

doi:10.1007/s00406-017-0860-4

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Neural correlates of instrumental responding in the context of alcohol-related cues index disorder severity and relapse risk

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Schlagenhauf, Florian
Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany;
Max Planck Fellow Group Cognitive and Affective Control of Behavioural Adaptation, MPI for Human Cognitive and Brain Sciences, Max Planck Society;

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Citation

Schad, D. J., Garbusow, M., Friedel, E., Sommer, C., Sebold, M., Hägele, C., et al. (2019). Neural correlates of instrumental responding in the context of alcohol-related cues index disorder severity and relapse risk. European Archives of Psychiatry and Clinical Neuroscience, 269(3), 295-308. doi:10.1007/s00406-017-0860-4.

Cite as: https://hdl.handle.net/21.11116/0000-0003-8C27-4

Abstract

The influence of Pavlovian conditioned stimuli on ongoing behavior may contribute to explaining how alcohol cues stimulate drug seeking and intake. Using a Pavlovian-instrumental transfer task, we investigated the effects of alcohol-related cues on approach behavior (i.e., instrumental response behavior) and its neural correlates, and related both to the relapse after detoxification in alcohol-dependent patients. Thirty-one recently detoxified alcohol-dependent patients and 24 healthy controls underwent instrumental training, where approach or non-approach towards initially neutral stimuli was reinforced by monetary incentives. Approach behavior was tested during extinction with either alcohol-related or neutral stimuli (as Pavlovian cues) presented in the background during functional magnetic resonance imaging (fMRI). Patients were subsequently followed up for 6 months. We observed that alcohol-related background stimuli inhibited the approach behavior in detoxified alcohol-dependent patients (t = − 3.86, p < .001), but not in healthy controls (t = − 0.92, p = .36). This behavioral inhibition was associated with neural activation in the nucleus accumbens (NAcc) (t(30) = 2.06, p < .05). Interestingly, both the effects were only present in subsequent abstainers, but not relapsers and in those with mild but not severe dependence. Our data show that alcohol-related cues can acquire inhibitory behavioral features typical of aversive stimuli despite being accompanied by a stronger NAcc activation, suggesting salience attribution. The fact that these findings are restricted to abstinence and milder illness suggests that they may be potential resilience factors.