Neural correlates of correct and failed response inhibition in heavy versus light social drinkers: an fMRI study during a go/no-go task by healthy participants

Neural underpinnings of response inhibition in substance use disorders: weak meta-analytic evidence for a widely used construct

RATIONALE

Substance use disorders (SUDs) rank among the most severely debilitating psychiatric conditions. Among others, decreased response inhibition capacities could make it more difficult for patients to abstain from drug use and maintain abstinence. However, meta-analyses on the neural basis of response inhibition in SUDs yielded conflicting results.

OBJECTIVE

In this study, we revisited the neuroimaging research field and summarized the existing fMRI literature on overt response inhibition (Go/NoGo and stop-signal paradigms) across different SUDs.

METHODS

We performed a systematic literature review and an activation likelihood estimation (ALE) meta-analysis to investigate the actual convergence of functional deviations observed in SUD samples. Results were further supplied by consecutive robustness measures and a post-hoc random-effects meta-analysis of behavioural data.

RESULTS

We identified k = 21 eligible studies for our analysis. The ALE analysis indicated a significant cluster of convergence with its statistical peak in the right anterior insula. Consecutive analyses, however, indicated this result was not robust and susceptible towards publication bias. Additionally, a post-hoc random effects meta-analysis of the behavioural parameters of Go/NoGo and stop-signal paradigms reported by the included studies revealed no significant differences in task performance comparing SUD samples and controls.

CONCLUSION

We discuss that the role of task-based response inhibition may require some refinement as an overarching marker for SUD pathology. Finally, we give a few prospects for future research that should be further explored in this context.

Adolescent brain maturation and the neuropathological effects of binge drinking: A critical review

Adolescence is a transitional stage marked by continued brain development. This period is accompanied by physical and neurochemical modifications in the shape and function of the hippocampus, prefrontal cortex, and other limbic system structures. Brain maturation during adolescence, which is typically governed by intrinsic factors, can be dramatically altered by environmental influences such as drugs and alcohol. Unlike many other addictive substances, binge drinking is very common and normative among teenagers and young adults. This repeated pattern of excessive alcohol consumption in adolescents has been shown to cause behavioral changes and neurocognitive impairments that include increased anxiety, risky decision-making, and learning deficits, which could lead to the development of alcohol use disorder (AUD). This manuscript highlights factors that lead to adolescent binge drinking, discusses maturational changes that occur in an adolescent's brain, and then evaluates the effect of adolescent alcohol consumption on brain structure, function, and neurocognitive abilities in both human studies and animal models. The impact of gender/sex and COVID-19 are briefly discussed. Understanding the factors that promote the onset of adolescent binge drinking and its undesirable consequences could serve as a catalyst for developing therapeutic agents that would decrease or eradicate the damaging effects of alcohol on an adolescent brain.

The role of left insula mediating impaired error processing in response inhibition in adult heavy drinkers

Identification of neurobiological mechanisms underlying development of alcohol use disorder is critical to ensuring the appropriate early-phase treatment and prevention of the disorder. To this aim, we tried to elucidate the disturbance of neural functions in heavy drinking, which can lead to alcohol use disorder. Because response inhibition is affected by alcohol use disorder, we examined neural activation and task performance for response inhibition using the Go/No-Go task in an fMRI paradigm in adult non-dependent heavy and light drinkers. We examined the neural activation for error processing and inhibitory control, components of response inhibition. We then investigated the mediating effect of the relevant neural substrate on the relationship between the level of alcohol drinking and task performance using mediation analysis. We found that heavy drinking significantly decreased activation in the left insula during error processing and increased the mean commission error rate for No-Go trials compared with light drinking. Mediation analysis demonstrated full mediation of the left insula activation during error processing for the relationship between drinking level and commission error rate. Our results suggested that left insula activation may be a neural marker pivotal for potential conversion to alcohol use disorder in individuals with high clinical risk such as heavy drinking.

Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Visual Selective Attention in Male Patients With Alcohol Use Disorder After the Acute Withdrawal

Objective

To investigate the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on attention cue reactivity in male patients with alcohol use disorder (AUD) after acute withdrawal.

Methods

A total of 90 male patients with AUD who were hospitalized were enrolled and divided into study and waiting groups by a random number table. During the study, 18 patients dropped out. After the alcohol withdrawal symptoms were eliminated, the study group received high-frequency rTMS at 10 Hz for 14 consecutive days, and the waiting group was administrated by sham rTMS. All subjects were evaluated for attention cue reactivity, impulsiveness, cognitive function by oddball paradigm, Barratt Impulsiveness Scale version II (BIS-II), and the Montreal Cognitive Assessment (MoCA) at baseline and after true or sham rTMS.

Results

1. There was no significant difference between the study and the waiting groups regarding the drinking level, cognition level, and demographic data at baseline. 2. In the oddball paradigm, both for alcohol-related and non-alcohol-related cues, the response times were significantly shorter in the study group after rTMS treatment than in the waiting-for-treatment group, either between the two groups or within the study group. There was no significant difference in the accuracy rate for alcohol-related and non-alcohol-related cues between the two groups or within the study group after rTMS intervention. 3. The total score of MoCA was significantly increased, and the total score of BIS-II was significantly decreased in the study group after rTMS treatment, either between the two groups or within the study group.

Conclusion

The results suggested that high-frequency rTMS could improve the attention bias of alcohol-related cues and impulsivity for patients with AUD.

Local and network-level dysregulation of error processing is associated with binge drinking

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Go/NoGo performance does not differ between binge (BDs) and light drinkers.

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BDs show greater BOLD activity to inhibition errors primarily in prefrontal areas.

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Greater functional connectivity in the frontal cortex correlates with drinking.

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Observed increase in error-related activity may serve a compensatory role.

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This is consistent with allostatic hyperexcitability reflecting neuroadaptation.

Binge drinking refers to the pattern of alcohol consumption that brings blood alcohol levels to or above legal intoxication levels. Commonly practiced by young adults, it is associated with neurofunctional alterations, raising health-related concerns. Executive deficits may contribute to the inability to refrain from excessive alcohol intake. As a facet of cognitive control, error processing allows for flexible modification of behavior to optimize future outcomes. It is highly relevant to addiction research, as a failure to inhibit excessive drinking results in relapses, which is a hallmark of alcohol use disorder. However, research on local and system-level neural underpinnings of inhibition failures as a function of binge drinking is limited. To address these gaps, functional magnetic resonance imaging (fMRI) was used to examine local changes and interregional functional connectivity during response inhibition errors on a Go/NoGo task. Young adult binge drinkers (BDs) performed equally well as light drinkers (LDs), a group of demographically matched individuals who drink regularly but in low-risk patterns. In contrast, BDs exhibited greater fMRI activity to inhibition errors contrasted with correct NoGo trials in the rostral anterior (rACC) and posterior cingulate cortices (PCC), as well as right middle frontal gyrus (R-MFG). Furthermore, BDs showed increased connectivity between the rACC and right lateral prefrontal cortex, in addition to greater connectivity between the R-MFG and the left ventrolateral and superior frontal cortices. Imaging indices were positively correlated only with alcohol-related measures, but not with those related to moods, disposition, or cognitive capacity. Taken together, greater error-related activity and expanded functional connectivity among prefrontal regions may serve a compensatory role to maintain efficiency of inhibitory control. Aligned with prominent models of addiction, these findings accentuate the importance of top-down control in maintaining low-risk drinking levels. They provide insight into potentially early signs of deteriorating cognitive control functions in BDs and may help guide intervention strategies aimed at preventing excessive drinking habits.

Event-related potential (ERP) measures of error processing as biomarkers of externalizing disorders: A narrative review

Previous studies have shown that electrophysiological measures of error processing are affected in patients at risk or diagnosed with internalizing disorders, hence, suggesting that error processing could be a suitable biomarker for internalizing disorders. In this narrative review, we will evaluate studies that address the role of event-related potential (ERP) measures of error-processing in externalizing disorders and discuss to what extend these can be considered a biomarker for externalizing disorders. Currently, there is evidence for the notion that electrophysiological indices of error processing such as the error-related negativity (ERN) and error positivity (Pe) are reduced in individuals with substance use disorders, attention-deficit/hyperactivity disorder, and in forensic populations. However, it remains unclear whether this is also the case for other understudied disorders such as behavioral addiction. Furthermore, to fully understand how these deficits affect day to day behavior, we encourage research to focus on testing current theories and hypotheses of ERN and Pe. In addition, we argue that within an externalizing disorder, individual differences in error processing deficits may be related to prognosis and gender of the patient, methodological issues and presence of comorbidity. Next, we review studies that have related treatment trajectories with ERP measures of error processing, and we discuss the prospect of improving error processing as a treatment option. We conclude that ERP measures of error processing are candidate biomarkers for externalizing disorders, albeit we strongly urge researchers to continue looking into the predictive value of these measures in the etiology and treatment outcome through multi-method and longitudinal designs.

Segregating domain-general from emotional context-specific inhibitory control systems - ventral striatum and orbitofrontal cortex serve as emotion-cognition integration hubs

Inhibitory control hierarchically regulates cognitive and emotional systems in the service of adaptive goal-directed behavior across changing task demands and environments. While previous studies convergently determined the contribution of prefrontal-striatal systems to general inhibitory control, findings on the specific circuits that mediate emotional context-specific impact on inhibitory control remained inconclusive. Against this background we combined an evaluated emotional Go/No Go task with fMRI in a large cohort of subjects (N=250) to segregate brain systems and circuits that mediate domain-general from emotion-specific inhibitory control. Particularly during a positive emotional context, behavioral results showed a lower accuracy for No Go trials and a faster response time for Go trials. While the dorsal striatum and lateral frontal regions were involved in inhibitory control irrespective of emotional context, activity in the ventral striatum (VS) and medial orbitofrontal cortex (mOFC) varied as a function of emotional context. On the voxel-wise whole-brain network level, limbic and striatal systems generally exhibited highest changes in global brain connectivity during inhibitory control, while global brain connectivity of the left mOFC was less decreased during emotional contexts. Functional connectivity analyses moreover revealed that negative coupling between the VS with inferior frontal gyrus (IFG)/insula and mOFC varied as a function of emotional context. Together these findings indicate separable domain- general as well as emotional context-specific inhibitory brain systems which specifically encompass the VS and its connections with frontal regions.

Stop What You're Doing!-An fMRI Study on Comparisons of Neural Subprocesses of Response Inhibition in ADHD and Alcohol Use Disorder

Rationale: Both attention deficit-/hyperactivity disorder (ADHD) and alcohol use disorder (AUD) are accompanied by deficits in response inhibition. Furthermore, the prevalence of comorbidity of ADHD and AUD is high. However, there is a lack of research on whether the same neuronal subprocesses of inhibition (i.e., interference inhibition, action withholding and action cancellation) exhibit deficits in both psychiatric disorders. Methods: We examined these three neural subprocesses of response inhibition in patient groups and healthy controls: non-medicated individuals with ADHD (ADHD; N = 16), recently detoxified and abstinent individuals with alcohol use disorder (AUD; N = 15), and healthy controls (HC; N = 15). A hybrid response inhibition task covering interference inhibition, action withholding, and action cancellation was applied using a 3T functional magnetic resonance imaging (fMRI). Results: Individuals with ADHD showed an overall stronger hypoactivation in attention related brain areas compared to AUD or HC during action withholding. Further, this hypoactivation was more accentuated during action cancellation. Individuals with AUD recruited a broader network, including the striatum, compared to HC during action withholding. During action cancellation, however, they showed hypoactivation in motor regions. Additionally, specific neural activation profiles regarding group and subprocess became apparent. Conclusions: Even though deficits in response inhibition are related to both ADHD and AUD, neural activation and recruited networks during response inhibition differ regarding both neuronal subprocesses and examined groups. While a replication of this study is needed in a larger sample, the results suggest that tasks have to be carefully selected when examining neural activation patterns of response inhibition either in research on various psychiatric disorders or transdiagnostic questions.

Creativity on demand - Hacking into creative problem solving

How can creative problem solving be enhanced? The paper identifies and examines modulatory approaches from the cognitive and neuroscientific literature that have been made to make creative problem solving better. We review neuromodulatory approaches of both global and local effects. Through a 2-process model of creative problem solving that involves both automatic and controlled processes, we demonstrate how these approaches could be used and what potential they may have for enhancing creative problem solving. We conclude that direct neuromodulation will be best used in unison with behavioral manipulations of cognition, and that better understanding of these manipulations should inform and guide research on direct neuromodulatory procedures.

Response Inhibition and Binge Drinking During Transition to University: An fMRI Study

BACKGROUND

Binge Drinking (BD), a highly prevalent drinking pattern among youth, has been linked with anomalies in inhibitory control. However, it is still not well characterized whether the neural mechanisms involved in this process are compromised in binge drinkers (BDs). Furthermore, recent findings suggest that exerting inhibitory control to alcohol-related stimuli requires an increased effort in BDs, relative to controls, but the brain regions subserving these effects have also been scarcely investigated. Here we explored the impact of BD on the pattern of neural activity mediating response inhibition and its modulation by the motivational salience of stimuli (alcohol-related content).

METHODS

Sixty-seven (36 females) first-year university students, classified as BDs (n = 32) or controls (n = 35), underwent fMRI as they performed an alcohol-cued Go/NoGo task in which pictures of alcoholic or non-alcoholic beverages were presented as Go or NoGo stimuli.

RESULTS

During successful inhibition trials, BDs relative to controls showed greater activity in the bilateral inferior frontal gyrus (IFG), extending to the anterior insula, a brain region usually involved in response inhibition tasks, despite the lack of behavioral differences between groups. Moreover, BDs displayed increased activity in this region restricted to the right hemisphere when inhibiting a prepotent response to alcohol-related stimuli.

CONCLUSIONS

The increased neural activity in the IFG/insula during response inhibition in BDs, in the absence of behavioral impairments, could reflect a compensatory mechanism. The findings suggest that response inhibition-related activity in the right IFG/insula is modulated by the motivational salience of stimuli and highlight the role of this brain region in suppressing responses to substance-associated cues.

Design of a randomized controlled trial examining the efficacy of oxytocin to enhance alcohol behavioral couple therapy

Combining pharmacological interventions with evidence-based behavioral interventions may help optimize treatment outcomes for alcohol use disorder (AUD). While several effective behavioral interventions for AUD have been developed, the vast majority target individual patients, despite evidence that behavioral interventions for couples have the ability to outperform individual treatments for AUD. Alcohol Behavioral Couples Therapy (ABCT) is an evidence-based behavioral intervention for couples that has been shown to significantly reduce AUD severity as well as improve relationship functioning. Accumulating evidence suggests that the neuropeptide oxytocin has the ability to reduce alcohol craving and consumption, symptoms of tolerance and withdrawal, and ameliorate neurobiological deficits associated with AUD. Furthermore, oxytocin has demonstrated the ability to increase prosocial behavior and cognition, and restore sensitivity to natural rewards such as interpersonal relationships. No study to date has examined the ability of oxytocin to enhance ABCT. Thus, the primary objective of this Phase II study is to examine the effects of oxytocin versus placebo in combination with ABCT in reducing AUD severity and improving relationship functioning. We also will utilize neuroimaging techniques before and after treatment to investigate the underlying pathophysiology of AUD among couples and identify prognostic indicators of treatment outcome. The findings from this study might provide critical new information to help inform clinical practice and accelerate research on the pharmacological treatment of AUD.

Increased Neural Activity in Hazardous Drinkers During High Workload in a Visual Working Memory Task: A Preliminary Assessment Through Event-Related Potentials

Despite equated behavioral performance levels, hazardous drinkers generally exhibited increased neural activity while performing simple cognitive tasks compared to light drinkers. Here, 49 participants (25 hazardous and 24 light drinkers) participated in an event-related potentials (ERPs) study while performing an n-back working memory task. In the control zero-back (N0) condition, the subjects were required to press a button when the number "2" or "6" was displayed. In the two-back and three-back (N2; N3) conditions, the subjects had to press a button when the displayed number was identical to the number shown two/three trials earlier. To assess for the impact of alcohol consumption on the updating of working memory processes under various cognitive loads, difference waveforms of "N2 minus N0" and "N3 minus N0" were computed by subtracting waveforms in the N0 condition from waveforms in the N2 and N3 conditions, for the light and the hazardous drinkers. Three main ERP components were noted for both groups: a P200/N200 complex, a P300 component, and an N400/P600 activity. The results show that, to perform the task at the same level as the light drinkers, the hazardous drinkers exhibited larger amplitude differences, mainly around the P300 and P600 components. These data may be considered, at the preventive level, as vulnerability factors for developing adult substance use disorders, and they stress the importance, at a clinical level, to consider such working memory processes in the management of alcohol dependence.

Thalamic Cortical Error-Related Responses in Adult Social Drinkers: Sex Differences and Problem Alcohol Use

BACKGROUND

Error-related brain activities are altered in individuals with substance use disorders. Here we examined error-related activities in relation to problem drinking in nondependent alcohol drinkers. In particular, we investigated sex differences and whether altered error responses are related to post-error behavioral control.

METHODS

A sample of 145 nondependent drinkers (77 women) performed the stop-signal task during functional magnetic resonance imaging. Imaging data were processed and modeled using statistical parametric mapping. Independent sample t test and linear regression were employed to examine sex differences in error response and relationship between error response and problem drinking.

RESULTS

Compared with men, women showed greater error-related (stop error > go success) activations in the bilateral thalamus, right middle/superior temporal cortex, and bilateral dorsal anterior cingulate cortex. In whole-brain linear regression of error responses against the Alcohol Use Disorders Identification Test score, a wide swath of cortical and subcortical regions, including the thalamus, showed decreased activation in association with problem drinking in women but not in men. However, men and women were not different in the extent of post-error slowing and decreased thalamic error response in association with problem drinking was not related to the extent of post-error slowing in women.

CONCLUSIONS

The results suggest sex differences in error-related activations with heavier drinking associated with reduced error activations in women but not in men. These differences in cerebral activations may reflect higher physiological arousal in response to errors and greater vulnerability of saliency-related arousal response to problem drinking in female as compared with male social drinkers.

Impulsive personality dimensions are associated with altered behavioral performance and neural responses in the monetary incentive delay task

Individual differences in dimensions of impulsivity personality including disinhibition and sensation seeking modulate approach responses to reinforcing stimuli, such as drugs and money. The current study examined the effects of monetary incentive on both behavioral performance and electrophysiological activity among individuals varying in disinhibition and sensation seeking. The monetary incentive delay (MID) task was completed under electroencephalogram (EEG) recording. Behavioral data showed that higher disinhibition and sensation-seeking were associated with lower performance accuracy. Event-related potential (ERP) data showed that high reinforcement cues elicited a larger late positive component (LPC) than other conditions among high disinhibition participants, indicating its strong emotional influence. Additionally, in the neutral incentive condition, the feedback-related negativity (FRN) elicited by correct outcomes was larger than that elicited by incorrect outcomes in the high disinhibition group only. This novel finding indicates that high disinhibition participants were less likely to expect correct outcomes compared to incorrect outcomes in the neutral incentive condition. Finally, the P3 component elicited by outcome presentation showed an interaction between two impulsivity dimensions; when disinhibition level was low, the P3 was larger among high than low sensation seeking participants.

The Burden of Binge and Heavy Drinking on the Brain: Effects on Adolescent and Young Adult Neural Structure and Function

Introduction: Adolescence and young adulthood are periods of continued biological and psychosocial maturation. Thus, there may be deleterious effects of consuming large quantities of alcohol on neural development and associated cognition during this time. The purpose of this mini review is to highlight neuroimaging research that has specifically examined the effects of binge and heavy drinking on adolescent and young adult brain structure and function. Methods: We review cross-sectional and longitudinal studies of young binge and heavy drinkers that have examined brain structure (e.g., gray and white matter volume, cortical thickness, white matter microstructure) and investigated brain response using functional magnetic resonance imaging (fMRI). Results: Binge and heavy-drinking adolescents and young adults have systematically thinner and lower volume in prefrontal cortex and cerebellar regions, and attenuated white matter development. They also show elevated brain activity in fronto-parietal regions during working memory, verbal learning, and inhibitory control tasks. In response to alcohol cues, relative to controls or light-drinking individuals, binge and heavy drinkers show increased neural response mainly in mesocorticolimbic regions, including the striatum, anterior cingulate cortex (ACC), hippocampus, and amygdala. Mixed findings are present in risky decision-making tasks, which could be due to large variation in task design and analysis. Conclusions: These findings suggest altered neural structure and activity in binge and heavy-drinking youth may be related to the neurotoxic effects of consuming alcohol in large quantities during a highly plastic neurodevelopmental period, which could result in neural reorganization, and increased risk for developing an alcohol use disorder (AUD).

Preserved Crossmodal Integration of Emotional Signals in Binge Drinking

Binge drinking is an alcohol consumption pattern with various psychological and cognitive consequences. As binge drinking showed qualitatively comparable cognitive impairments to those reported in alcohol-dependence, a continuum hypothesis suggests that this habit would be a first step toward alcohol-related disorders. Besides these cognitive impairments, alcohol-dependence is also characterized by large-scale deficits in emotional processing, particularly in crossmodal contexts, and these abilities have scarcely been explored in binge drinking. Emotional decoding, most often based on multiple modalities (e.g., facial expression, prosody or gesture), yet represents a crucial ability for efficient interpersonal communication and social integration. The present study is the first exploration of crossmodal emotional processing in binge drinking, in order to test whether binge drinkers already present the emotional impairments described among alcohol-dependent patients, in line with the continuum hypothesis. Twenty binge drinkers and 20 matched controls performed an experimental task requiring the identification of two emotions (happiness or anger) presented in two modalities (visual or auditory) within three conditions (unimodal, crossmodal congruent or crossmodal incongruent). In accordance with previous research in binge drinking and alcohol-dependence, this study was based on two main hypotheses. First, binge drinkers would present a reduced facilitation effect (i.e., classically indexed in healthy populations by faster reaction times when two congruent modalities are presented simultaneously). Second, binge drinkers would have higher difficulties to inhibit interference in incongruent modalities. Results showed no significant difference between groups in emotional decoding ability, whatever the modality or condition. Control participants, however, appeared slower than binge drinkers in recognizing facial expressions, also leading to a stronger facilitation effect when the two modalities were presented simultaneously. However, findings did not show a disrupted facilitation effect in binge drinkers, whom also presented preserved performance to inhibit incongruence during emotional decoding. The current results thus suggest that binge drinkers do not demonstrate a deficit for emotional processing, both in unimodal and crossmodal contexts. These results imply that binge drinking might not be characterized by impairments for the identification of primary emotions, which could also indicate that these emotional processing abilities are well-preserved at early stages of excessive alcohol consumption.

Do alcohol-dependent patients show different neural activation during response inhibition than healthy controls in an alcohol-related fMRI go/no-go-task?

RATIONALE

Alcohol dependence is associated with impaired response inhibition and heightened cue reactivity towards alcohol-related stimuli. Several brain areas, but mainly prefrontal structures, have been linked to response inhibition in addiction. This study aimed at combining both aspects: salience of drug-associated cues and response inhibition using a go/no-go task with alcohol-associated stimuli during functional magnetic resonance imaging (fMRI).

OBJECTIVES

Nineteen abstinent alcohol-dependent patients (ADP) and 21 healthy control subjects (HC) were compared on blood oxygen level-dependent (BOLD) responses during successful inhibition of no-go stimuli and successful reactions to go stimuli.

RESULTS

ADP and HC did not significantly differ in their behavioural performance in the task. However, both groups performed worse during the inhibition of alcoholic-associated stimuli compared to neutral stimuli. On the neural level, ADP displayed enhanced BOLD activity relative to HC during successful response inhibition in several areas involved in visual processing, cognitive and impulse control, including occipital structures, anterior cingulate gyrus, medial frontal gyrus and medial orbitofrontal cortex.

CONCLUSIONS

We interpret these findings as a possible compensation strategy for impaired cognitive processing. Furthermore, the results underline the impact of salience of alcohol-related stimuli on response inhibition, which seems to affect both ADP and HC.