Alcohol Approach Bias Is Associated With Both Behavioral and Neural Pavlovian-to-Instrumental Transfer Effects in Alcohol-Dependent Patients

Ke Chen; Maria Garbusow; Miriam Sebold; Sören Kuitunen-Paul; Michael N Smolka; Quentin J M Huys; Ulrich S Zimmermann; Florian Schlagenhauf; Andreas Heinz

doi:10.1016/j.bpsgos.2022.03.014

Alcohol Approach Bias Is Associated With Both Behavioral and Neural Pavlovian-to-Instrumental Transfer Effects in Alcohol-Dependent Patients

Biol Psychiatry Glob Open Sci. 2022 Apr 14;3(3):443-450. doi: 10.1016/j.bpsgos.2022.03.014. eCollection 2023 Jul.

Authors

Ke Chen¹, Maria Garbusow¹, Miriam Sebold^{1

2}, Sören Kuitunen-Paul^{3

4}, Michael N Smolka⁵, Quentin J M Huys^{6

7}, Ulrich S Zimmermann^{8

9}, Florian Schlagenhauf¹, Andreas Heinz¹

Affiliations

¹ Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
² Department for Social and Preventive Medicine, University of Potsdam, Potsdam, Germany.
³ Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Dresden, Germany.
⁴ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
⁵ Department of Psychiatry, Technische Universität Dresden, Dresden, Germany.
⁶ Division of Psychiatry, University College London, London, United Kingdom.
⁷ Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom.
⁸ University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁹ Department of Addiction Medicine and Psychotherapy, kbo Isar-Amper-Klinikum Region, München, Germany.

Abstract

Background: Even after qualified detoxification, alcohol-dependent (AD) patients may relapse to drinking alcohol despite their decision to abstain. Two mechanisms may play important roles. First, the impact of environmental cues on instrumental behavior (i.e., Pavlovian-to-instrumental transfer [PIT] effect), which was found to be stronger in prospectively relapsing AD patients than in abstaining patients. Second, an automatic approach bias toward alcohol stimuli was observed in AD patients, and interventions targeting this bias reduced the relapse risk in some studies. Previous findings suggest a potential behavioral and neurobiological overlap between these two mechanisms.

Methods: In this study, we examined the association between alcohol approach bias and both behavioral and neural non-drug-related PIT effects in AD patients after detoxification. A total of 100 AD patients (17 females) performed a PIT task and an alcohol approach/avoidance task. Patients were followed for 6 months.

Results: A stronger alcohol approach bias was associated with both a more pronounced behavioral PIT effect and stronger PIT-related neural activity in the right nucleus accumbens. Moreover, the association between alcohol approach bias and behavioral PIT increased with the severity of alcohol dependence and trait impulsivity and was stronger in patients who relapsed during follow-up in the exploratory analysis.

Conclusions: These findings indicate partial behavioral and neurobiological overlap between alcohol approach bias and the PIT effect assessed with our tasks. The association was stronger in patients with more severe alcohol dependence.

Keywords: Alcohol approach bias; Alcohol use disorder; Pavlovian-to-instrumental transfer; Relapse; Trait impulsivity; fMRI.