Objective Although several risk factors have been identified for alcohol use disorder, many individuals with these factors do not go on to develop the disorder. Identifying early phenotypic differences between vulnerable individuals and healthy controls could help identify those at higher risk. Binge drinking, defined as reaching a blood alcohol level of 80 mg%, carries a risk of negative legal and health outcomes and may be an early marker of vulnerability. Using a carefully controlled experimental paradigm, we tested the hypothesis that risk factors for alcohol use disorder, including family history of alcoholism, male sex, impulsivity, and low level of response to alcohol, would predict rate of binging during an individual alcohol consumption session. Method This cross-sectional study included 159 young social drinkers who completed a laboratory session in which they self-administered alcohol intravenously. Cox proportional hazards models were used to determine whether risk factors for alcohol use disorder were associated with the rate of achieving a binge-level exposure. Results A greater percentage of relatives with alcoholism (hazard ratio 1.04, 95% CI 1.02 to 1.07), male sex (hazard ratio 1.74, 95% CI 1.03 to 2.93), and higher impulsivity (hazard ratio 1.17, 95% CI 1.00 to 1.37), were associated with a higher rate of binging throughout the session. Participants with all 3 risk factors had the highest rate of binging throughout the session compared to the lowest risk group (hazard ratio 5.27, 95% CI 1.81 to 15.30). Conclusions Binge drinking may be an early indicator of vulnerability to alcohol use disorder and should be carefully assessed as part of a thorough clinical evaluation.
Background Substance use disorders (SUDs) can be conceptualized as a form of risk-taking behavior with the potential for highly aversive outcomes such as health or legal problems. Risky decision-making likely draws upon several related brain processes involved in estimations of value and risk, executive control, and emotional processing. SUDs may result from a dysfunction in one or more of these cognitive processes. Methods We performed a systematic literature review of functional neuroimaging studies examining risk-related decision making in individuals with SUDs. A quantitative meta-analysis tool (GingerALE) and qualitative approach was used to summarize the imaging results. Results Meta-analysis findings indicate that individuals with SUDs exhibit differences in neural activity relative to healthy controls during risk-taking in the anterior cingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex, striatum, insula, and somatosensory cortex. In addition, a qualitative review of the literature suggests that individuals with SUDs may have altered function in the amygdala and ventromedial prefrontal cortex. Conclusions The neuroimaging literature reveals that several neural substrates involved in the computation of risk may function suboptimally in SUDs. Future research is warranted to elucidate which computational processes are affected, whether dysfunctional risk-related processing recovers with sobriety, and whether different drugs of abuse have specific effects on risk-taking.
Aims To determine if methamphetamine-dependent (MD) individuals exhibit behavioral or neural processing differences in risk-taking relative to healthy comparison participants (CTL). Design This was a cross-sectional study comparing two groups’ behavior on a risk-taking task and neural processing as assessed using functional magnetic resonance imaging (fMRI). Settings The study was conducted in an inpatient treatment center and a research fMRI facility in the United States. Participants Sixty-eight recently abstinent MD individuals recruited from a treatment program and forty CTL recruited from the community completed the study. Measurements The study assessed risk-taking behavior (overall and post-loss) using the Risky Gains Task (RGT), sensation-seeking, impulsivity and blood-oxygenation level dependent activation in the brain during the decision phase of the RGT. Findings Relative to CTL, MD displayed decreased activation in the bilateral rostral anterior cingulate cortex (ACC) and greater activation in the left insula across risky and safe decisions (p<.05). Right mid insula activation among CTL did not vary between risky and safe decisions, but among MD it was higher during risky relative to safe decisions (p<.05). Among MD, lower activation in the right rostral ACC (r=−.39, p<.01) and higher activation in the right mid insula (r=.35, p<.01) during risky decisions were linked to a higher likelihood of choosing a risky option following a loss. Conclusions Methamphetamine-dependent individuals show disrupted risk-related processing in both anterior cingulate and insula, brain areas that have been implicated in cognitive control and interoceptive processing. Attenuated neural processing of risky options may lead to risk-taking despite experiencing negative consequences.
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