Deficits in proactive avoidance and neural responses to drinking motives in problem drinkers

TL;DR

This study shows that problem drinkers struggle with avoiding harmful outcomes and have specific brain activity patterns linked to drinking motives like pain and negative emotions.

Contribution

The study experimentally identifies proactive avoidance deficits and their neural correlates in problem drinkers linked to distinct drinking motives.

Findings

Problem drinkers show proactive avoidance deficits in learning and accuracy, which correlate with increased alcohol use.

Negative emotions as a drinking motive are linked to reduced right insula activation during proactive avoidance in problem drinkers.

Physical pain as a motive correlates with reduced right putamen activation, which is associated with drinking severity and avoidance performance.

Abstract

Physical pain and negative emotions represent two distinct drinking motives that contribute to harmful alcohol use. Proactive avoidance which can reduce problem drinking in response to these motives appears to be impaired in problem drinkers. However, proactive avoidance and its underlying neural deficits have not been assessed experimentally. How these deficits inter-relate with drinking motives to influence alcohol use also remains unclear. The current study leveraged neuroimaging data collected in forty-one problem and forty-one social drinkers who performed a probabilistic learning go/nogo task that involved proactive avoidance of painful outcomes. We characterized the regional brain responses to proactive avoidance and identified the neural correlates of drinking to avoid physical pain and negative emotions. Behavioral results confirmed problem drinkers’ proactive avoidance deficits in learning rate and performance accuracy, both which were associated with greater alcohol use. Imaging findings in problem drinkers showed that negative emotions as a drinking motive predicted attenuated right insula activation during proactive avoidance. In contrast, physical pain motive predicted reduced right putamen response. These regions’ activations as well as functional connectivity with the somatomotor cortex also demonstrated a negative relationship with drinking severity and positive relationship with proactive avoidance performance. Path modeling further delineated the pathways through which physical pain and negative emotions, along with alcohol use severity, influenced the neural and behavioral measures of proactive avoidance. Taken together, the current findings provide experimental evidence for proactive avoidance deficits in problem drinkers and establish the link between their neural underpinnings and alcohol misuse.

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