Background
Relapse in alcohol use disorders (AUD) is related to a complex interplay among multiple biological, psychiatric, psychological and psychosocial factors, which may change dynamically during and after treatment. At treatment entry for AUD, morphological abnormalities in anterior frontal regions and the insula have been observed in those who ultimately relapse following treatment. The goal of this study was to determine if measures anterior frontal and insula measures of regional brain thickness, surface area and volume predict post-treatment drinking status (i.e., relapser or abstainer) over an extended period after outpatient treatment for AUD, while concurrently considering common psychiatric, psychological and psychosocial factors previously associated with relapse.
Methods
Alcohol dependent individuals (n = 129) were followed for 18 months after treatment to determine post-treatment drinking status [Abstainers (n = 47) or Relapsers (n = 82)]. Brain morphometrics were derived from FreeSurfer. Receiver operator characteristic (ROC) curve analysis was used to identify the regional brain thickness, surface area and volume (all scaled to intracranial volume), demographic, psychiatric, other substance use (e.g., cigarette smoking) and alcohol consumption variables, obtained at entry into treatment, that best predicted post-treatment drinking status. Survival analyses determined variables that were related to duration of abstinence after treatment.
Results
ROC analyses indicated that mood disorders, education, and volumes of the right caudal ACC, right rostral ACC and total right frontal gray matter were significant predictors of post-treatment drinking status. Among Relapsers, survival analyses showed smokers and individuals with a comorbid medical condition relapsed earlier after treatment. Additionally, a greater frequency of smokers relapsed within 6 months of treatment.
Conclusions
Results reinforce that relapse in AUD is a function of multiple biological, psychiatric, psychological and psychosocial factors. Effective treatment of depressive disorders and cigarette smoking concurrent with AUD-focused interventions may promote better treatment outcomes.