Psychiatric, Demographic, and Brain Morphological Predictors of Relapse After Treatment for an Alcohol Use Disorder

Abstract

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.

Changes of frontal cortical subregion volumes in alcohol dependent individuals during early abstinence: associations with treatment outcome

“…The structural integrity of components of circuits subserving fundamental aspects of executive functions, assignment of external and internal stimulus salience, and emotional/ mood regulation (Seeley et al, 2007;Volkow & Baler, 2014;Williams, 2016), as assessed by volumetric voxel-wise and ROI analyses, has been repeatedly shown to relate to treatment outcome [see (Durazzo & Meyerhoff, 2017;D. Seo & Sinha, 2015) and references therein].…”

“…Seo & Sinha, 2015) and references therein]. Correspondingly, dysfunction in executive skills, impulse control, and assignment of stimulus salience and mood disorders are associated with relapse in AUD (Bates, Buckman, & Nguyen, 2013;Durazzo & Meyerhoff, 2017;D. Seo & Sinha, 2014;S.…”

Cigarette Use Among Individuals with Alcohol Use Disorders in the United States, 2002 to 2016: Trends Overall and by Race/Ethnicity

“…Although there may be concerns about providing smoking treatment concurrent with alcohol treatment, most studies find that concurrent smoking and alcohol treatment do not yield worse outcomes than treating alcohol alone (for recent reviews, see McKelvey et al, 2017; Thurgood et al, 2016). As cigarette use increases craving to use alcohol (Cooney et al, 2007; Dermody and Hendershot, 2017; Verplaetse and McKee, 2017), is related to decreased cognitive recovery in adults with AUDs (Durazzo et al, 2006, 2014; Pennington et al, 2013), and is associated with poorer AUD outcomes (Durazzo and Meyerhoff, 2017; Weinberger et al, 2015), combined smoking and alcohol treatment may offer significant benefits for alcohol treatment outcomes.…”

Regional Brain Volume Changes in Alcohol‐Dependent Individuals During Short‐Term and Long‐Term Abstinence

“…Further analyses of structural imaging data from a similar cohort (Durazzo et al, 2017, Durazzo et al, 2015) revealed that ALC had significant increases in gray matter (GM) volumes in the frontal, parietal and occipital lobes between 1 week and 7.5 months of abstinence; the monthly GM volume change rates in the entire frontal and parietal lobes were significantly greater between 1 week and 1 month of abstinence than between 1 month and 7.5 months of abstinence, suggesting a non-linear trajectory of GM volume recovery in these lobes. Clinically relevant modulators of the degree of regional volume reduction in adult ALC and of the extent of volume recovery during abstinence have been identified, such as age, gender, genetic factors, family history of problem drinking, concurrent chronic cigarette smoking, and comorbid medical, psychiatric, and substance use disorders (Cardenas et al, 2005, Demirakca et al, 2011, Durazzo et al, 2007a, Durazzo et al, 2007b, Durazzo and Meyerhoff, 2017, Gazdzinski et al, 2005b, Hoefer et al, 2014, Mon et al, 2013, Pennington et al, 2015). However, it is unclear if the volume reductions and longitudinal change trajectories also exist in functionally distinct sub-regions within the lobar GM regions that are critically important to addictive behavior.…”