Transfer of incentive salience from a first-order alcohol cue to a novel second-order alcohol cue among individuals at risk for alcohol use disorder: electrophysiological evidence

Mesocorticolimbic system reactivity to alcohol use-related visual cues as a function of alcohol sensitivity phenotype: A pilot fMRI study

Low sensitivity (LS) to alcohol is a risk factor for alcohol use disorder (AUD). Compared to peers with high sensitivity (HS), LS individuals drink more, report more problems, and exhibit potentiated alcohol cue reactivity (ACR). Heightened ACR suggests LS confers AUD risk via incentive sensitization, which is thought to take place in the mesocorticolimbic system. This study examined neural ACR in LS and HS individuals. Young adults (N = 32, M age=20.3) were recruited based on the Alcohol Sensitivity Questionnaire (HS: n = 16; LS: n = 16; 9 females/group). Participants completed an event-related fMRI ACR task. Group LS had higher ACR in left ventrolateral prefrontal cortex than group HS. In group LS, ACR in left caudomedial orbitofrontal cortex or left putamen was low at low alcohol use levels and high at heavier or more problematic alcohol use levels, whereas the opposite was true in group HS. Alcohol use level also was associated with the level of ACR in left substantia nigra among males in group LS. Taken together, results suggest elevated mesocorticolimbic ACR among LS individuals, especially those using alcohol at hazardous levels. Future studies with larger samples are warranted to determine the neurobiological loci underlying LS-based amplified ACR and AUD risk.

Variants of the P3 event-related potential operate as indicators of distinct mechanisms contributing to problematic alcohol use

Considerable research has linked relative reduction in the amplitude of the P3 event-related potential (ERP) during cognitive task performance (i.e., Target-P3) with increased risk of alcohol-related problems. A separate literature indicates that a relative increase in the amplitude of the P3 elicited by cues signaling alcohol availability (i.e., ACR-P3) also is associated with alcohol use and problems. To date, no research has integrated these seemingly discrepant findings. Here, we aimed to demonstrate that P3 amplitudes elicited in different task contexts reflect distinct domains of functioning relevant to problematic alcohol involvement (PAI), and therefore can inform heterogeneity in the etiology of PAI. 156 emerging adults (61% women; 88% White/Non-Hispanic) completed a mental rotation task and a picture-viewing task while ERPs were recorded. Participants also completed questionnaire measures of trait disinhibition, alcohol use, and alcohol-related problems. Findings from regression analyses indicated that (a) Target-P3 was negatively associated and ACR-P3 was positively associated with a PAI latent variable; (b) the two P3s accounted for unique variance in PAI, beyond that accounted for by recent drinking; and (c) the association between Target-P3 and PAI-but not ACR-P3 and PAI-was statistically mediated by trait disinhibition. The present findings highlight the unique contributions of distinct functional domains associated with disinhibition and incentive salience in the etiology of PAI. Moreover, findings are consistent with a nuanced understanding of the P3 ERP, whereby its specific meaning varies according to the task context in which it is elicited.

Risk-promoting effects of reward-paired cues in human sign- and goal-trackers

Animal research suggests trait-like individual variation in the degree of incentive salience attribution to reward-predictive cues, defined phenotypically as sign-tracking (high) and goal-tracking (low incentive salience attribution). While these phenotypes have been linked to addiction features in rodents, their translational validity is less clear. Here, we examined whether sign- and goal-tracking in healthy human volunteers modulates the effects of reward-paired cues on decision making. Sign-tracking was measured in a Pavlovian conditioning paradigm as the amount of eye gaze fixation on the reward-predictive cue versus the location of impending reward delivery. In Study 1 (Cherkasova et al., 2018), participants were randomly assigned to perform a binary choice task in which rewards were either accompanied (cued, n = 63) or unaccompanied (uncued, n = 68) by money images and casino jingles. In Study 2, participants (n = 58) performed cued and uncued versions of the task in a within-subjects design. Across both studies, cues promoted riskier choice. Sign-tracking was not associated with risky choice in either study. Goal-tracking rather than sign-tracking was significantly associated with greater risk-promoting effects of cues in Study 1 but not in Study 2, although the direction of findings was consistent across both studies. These findings are at odds with the notion of sign-trackers being preferentially susceptible to the influence of reward cues on behavior and point to the role of mechanisms besides incentive salience in mediating such influences.

Elevated Amygdala Responses During De Novo Pavlovian Conditioning in Alcohol Use Disorder Are Associated With Pavlovian-to-Instrumental Transfer and Relapse Latency

Background

Contemporary learning theories of drug addiction ascribe a key role to Pavlovian learning mechanisms in the development, maintenance, and relapse of addiction. In fact, cue-reactivity research has demonstrated the power of alcohol-associated cues to activate the brain's reward system, which has been linked to craving and subsequent relapse. However, whether de novo Pavlovian conditioning is altered in alcohol use disorder (AUD) has rarely been investigated.

Methods

To characterize de novo Pavlovian conditioning in AUD, 62 detoxified patients with AUD and 63 matched healthy control participants completed a Pavlovian learning task as part of a Pavlovian-to-instrumental transfer paradigm during a functional magnetic resonance imaging session. Patients were followed up for 12 months to assess drinking behavior and relapse status.

Results

While patients and healthy controls did not differ in their ability to explicitly acquire the contingencies between conditioned and unconditioned stimuli, patients with AUD displayed significantly stronger amygdala responses toward Pavlovian cues, an effect primarily driven by stronger blood oxygen level-dependent differentiation during learning from reward compared with punishment. Moreover, in patients compared with controls, differential amygdala responses during conditioning were positively related to the ability of Pavlovian stimuli to influence ongoing instrumental choice behavior measured during a subsequent Pavlovian-to-instrumental transfer test. Finally, patients who relapsed within the 12-month follow-up period showed an inverse association between amygdala activity during conditioning and relapse latency.

Conclusions

We provide evidence of altered neural correlates of de novo Pavlovian conditioning in patients with AUD, especially for appetitive stimuli. Thus, heightened processing of Pavlovian cues might constitute a behaviorally relevant mechanism in alcohol addiction.

Are medication effects on subjective response to alcohol and cue-induced craving associated? A meta regression study

RATIONALE

Alcohol administration and cue-reactivity paradigms are frequently used to screen for the initial efficacy of medications for alcohol use disorder (AUD). While medication effects on the primary outcomes for these paradigms are assumed to be qualitatively related, there is a critical lack of quantitative evidence to support this hypothesis.

OBJECTIVES

The study aims to test the relationship between medication effect sizes on subjective response to alcohol administration and medication effect sizes for cue-induced craving to cue exposure, using meta-analysis.

METHODS

Systematic literature searches were conducted to identify randomized trials, wherein AUD medications were tested using the alcohol administration and/or cue-reactivity paradigms. From these studies, descriptive statistics were collected to compute medication effect sizes on the primary outcomes for each respective paradigm. With medication as the unit of analysis, medication effect sizes in alcohol administration studies were compared with medication effect sizes in cue-reactivity studies using the Williamson-York regression which allows for meta-regression across independent samples.

RESULTS

Medication effect sizes on alcohol-induced stimulation and alcohol-induced craving were not significantly associated with medication effect sizes on cue-induced alcohol craving (k stimulation = 10 medications, [Formula: see text] and k craving = 11 medications, [Formula: see text] (SE = 0.237), [Formula: see text]), respectively. Medication effect sizes on alcohol-induced sedation were significantly associated with medication effects on cue-induced craving (k = 10 medications, [Formula: see text] (SE = 0.258), [Formula: see text]), such that medications that increased alcohol-induced sedation were more likely to reduce cue-induced alcohol craving.

CONCLUSIONS

With the exception of alcohol-induced sedation, there is little quantitative evidence of medication effects on subjective response domains measured during alcohol administration parallel medication effects on cue-induced alcohol craving. To provide additional context to the current study, future work should examine whether cue-reactivity findings predict clinical trial outcomes.

Affective imagery boosts the reward related delta power in hazardous drinkers

The Reward Positivity (RewP) is an event-related potential component with a delta band spectral representation that is elicited by reward receipt. Evidence suggests that RewP is modulated by both reward probability as well as affective valuation ("liking"). Here we determined whether RewP is a marker of enhanced hedonic salience of alcohol images in hazardous drinkers. We recruited 54 participants (Hazardous Drinkers = 28, Control = 26) who completed a reinforcement learning task with affective versus alcohol imagery during feedback. The learning task used images of puppies vs. alcohol paired with reinforcing feedback. Both groups rated categories of affective images (puppies, scenery, babies, neutral) similarly, but the hazardous drinking group rated alcohol significantly higher. There were no group differences in performance or in RewP amplitudes, even as a function of alcohol imagery. Contrary to prior findings, we did not observe a significant correlation between alcohol image rating and alcohol-specific RewP amplitude, although we did observe this relationship with the alcohol-specific delta band spectral representation of RewP. Within hazardous drinking group, there was significant correlation between hazardous drinking (AUDIT score) and alcohol-specific RewP indicating an inter-individual influence of drinking habits on affect specific RewP. These findings suggest a domain-specific enhancement of reward responsiveness in hazardous drinkers.

Alcohol craving in the natural environment: Moderating roles of cue exposure, drinking, and alcohol sensitivity

Effects of cue exposure and alcohol consumption (e.g., priming doses) on craving for alcohol have been examined in largely separate literature, limiting what is known about their potential interaction. Individuals with low alcohol sensitivity, a known risk factor for alcohol use disorder (AUD), exhibit stronger cue-elicited craving than their higher-sensitivity (HS) peers in both laboratory and real-world contexts. Here, underage drinkers (N = 155) completed a 21-day ecological momentary assessment (EMA) protocol in which they recorded exposure to alcohol cues and levels of craving during both nondrinking and postdrinking moments. Multilevel modeling detected a significant interaction of cue exposure and postdrinking status on craving. Cue-induced craving was increased in postdrinking moments compared to nondrinking moments. Contrary to prediction, cue-elicited increase in craving during nondrinking moments was stronger in participants reporting higher sensitivity to alcohol. In the presence of cues, lower sensitivity was robustly related to craving intensity in the postdrinking state but unrelated to craving during nondrinking moments. Craving during drinking episodes in the natural environment is magnified by the presence of alcohol cues, potentially contributing to the maintenance or acceleration of drinking episodes. Moreover, lower-sensitivity drinkers may be particularly susceptible to the combined effects of cue exposure and postdrinking status on alcohol craving. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Acute sensitization of the P3 event-related potential response to beverage images and the risk for alcohol use disorder

Previous research suggests the amplitude of the P3 event-related potential (ERP) response reflects the incentive value of the eliciting stimulus, and that individuals with trait-like lower sensitivity (LS) to the acute effects of alcohol, a potent risk factor for alcohol use disorder (AUD), tend to show exaggerated P3 ERP responses to alcohol beverage cues (compared to their peers with higher sensitivity; HS). No prior research has examined trajectories of the cue-elicited P3 response across repeated trials of nonreinforced cue presentations. Characterizing these trajectories can be informative as to potential mechanisms linking LS with increased AUD risk. Here, we tested whether individual differences in alcohol sensitivity are associated with different trial-by-trial trajectories of the P3 elicited by alcohol and nonalcohol reward cues (infrequent oddball/target stimuli) using a large sample of emerging adults (M _age = 19.53; N = 287; 55% female; 86% White; 90% right-handed) stratified for alcohol sensitivity. Multilevel models adjusted for age, sex, handedness, and alcohol use indicated that: (i) the P3 response to alcohol and nonalcohol reward cues alike sensitized (i.e., increased) across trials; (ii) across the task, the P3 response to alcohol cues was larger for the LS than the HS phenotype; and (iii) the P3 difference score (alcohol - nonalcohol) was larger for the LS than HS phenotype only across the first half of task. Findings suggest that whereas incentive value attribution may be a mechanism for alcohol cue-triggered attentional biases for both LS and HS individuals, LS individuals more consistently over-attribute incentive value to alcohol cues.

Behavioral response bias and event-related brain potentials implicate elevated incentive salience attribution to alcohol cues in emerging adults with lower sensitivity to alcohol

AIMS

This study used a behavioral approach-avoidance task including images of alcoholic beverages to test whether low sensitivity to alcohol (LS) is a phenotypical marker of a dispositional propensity to attribute bottom-up incentive value to naturally conditioned alcohol cues.

DESIGN, SETTING AND PARTICIPANTS

Experimental study with a measured individual difference variable at a university psychology laboratory in Missouri, MO, USA. Participants were 178 emerging adults (aged 18-20 years) varying in self-reported sensitivity to alcohol's acute effects.

MEASUREMENTS

Participants completed the alcohol approach-avoidance task while behavior (response time; RT) and the electroencephalogram (EEG) were recorded. Stimulus-locked event-related potentials (ERPs) provided indices of integrated (top-down and bottom-up) stimulus incentive value (P3 amplitude) and conflict between top-down task demands and bottom-up response propensities (N450 amplitude).

FINDINGS

Linear mixed models showed faster RT for 'alcohol-approach' relative to 'alcohol-avoid' trials for lower-sensitivity (LS) [mean_D  ± standard error_D (M_D  ± SE_D ) = 29.51 ± 9.74 ms, t₍₃₂₈₎  = 3.03, P = 0.003] but not higher-sensitivity (HS) individuals (M_D  ± SE_D  = 2.27 ± 9.33 ms, t₍₃₂₈₎  = 0.243, P = 0.808). There was enhanced N450 amplitude (response conflict) for alcohol-avoid relative to alcohol-approach trials for LS participants (M_D  ± SE_D  = 0.811 ± 0.198 μV, Z = 4.108, P < 0.001) and enhanced N450 amplitude for alcohol-approach relative to alcohol-avoid for HS participants (M_D  ± SE_D  = 0.419 ± 0.188 μV, Z = 2.235, P = 0.025). There was also enhanced P3 amplitude for alcohol-approach relative to alcohol-avoid for LS (M_D  ± SE_D  = 0.825 ± 0.204 μV, Z = 4.045, P < 0.001) but not HS (M_D  ± SE_D  = 0.013 ± 0.194 μV, Z = 0.068, P = 0.946).

CONCLUSIONS

Findings from a human laboratory study appear to support the notion that low sensitivity to alcohol indexes a propensity to attribute bottom-up incentive value to naturally conditioned alcohol cues.

Internal consistency and test-retest reliability of the P3 event-related potential (ERP) elicited by alcoholic and non-alcoholic beverage pictures

Addiction researchers are interested in the ability of neural signals, like the P3 component of the ERP, to index individual differences in liability factors like motivational reactivity to alcohol/drug cues. The reliability of these measures directly impacts their ability to index individual differences, yet little attention has been paid to their psychometric properties. The present study fills this gap by examining within-session internal consistency reliability (ICR) and between-session test-retest reliability (TRR) of the P3 amplitude elicited by images of alcoholic beverages (Alcohol Cue P3) and non-alcoholic drinks (NADrink Cue P3) as well as the difference between them, which isolates alcohol cue-specific reactivity in the P3 (ACR-P3). Analyses drew on data from a large sample of alcohol-experienced emerging adults (session 1 N = 211, 55% female, aged 18-20 yr; session 2 N = 98, 66% female, aged 19-21 yr). Evaluated against domain-general thresholds, ICR was excellent (M ± SD; r= 0.902 ± 0.030) and TRR was fair (r = 0.706 ± 0.020) for Alcohol Cue P3 and NADrink Cue P3, whereas for ACR-P3, ICR and TRR were poor (r = 0.370 ± 0.071; r = 0.201 ± 0.042). These findings indicate that individual differences in the P3 elicited by cues for ingested liquid rewards are highly reliable and substantially stable over 8-10 months. Individual differences in alcohol cue-specific P3 reactivity were less reliable and less stable. The conditions under which alcohol/drug cue-specific reactivity in neural signals is adequately reliable and stable remain to be discovered.

Enhanced conditioned "liking" of novel visual cues paired with alcohol or non-alcohol beverage container images among individuals at higher risk for alcohol use disorder

RATIONALE/OBJECTIVE

This study used an evaluative conditioning (EC) procedure to assess the affective properties of a CS for ingested drug reward in humans. Specifically, the study tested whether the evaluative response ("liking"/"disliking") to an arbitrary visual stimulus ("CS₂," e.g., a purple hexagon) could be changed through pairings with an alcohol or non-alcohol beverage cue ("CS₁," e.g., a full wine glass, a juice box), which is ostensibly a conditioned visual predictive stimulus for alcohol or non-alcohol liquid reward, respectively.

METHODS

Participants (N = 369, 18-23 years, 66% female, 79% white, 21% reporting no alcohol use ever or in the past year) received 24 CS₁ pairings with each CS₂. CS₂ and CS₁ evaluations were assessed pre- and post-conditioning.

RESULTS

Alcohol and non-alcohol CS₂ "liking" correlated with alcohol use. "Liking" of the alcohol but not non-alcohol CS₁ also correlated with alcohol use. Alcohol CS₁ "liking" also correlated with alcohol and non-alcohol CS₂ 'liking," whereas non-alcohol CS₁ 'liking" correlated with non-alcohol but not alcohol CS₂ "liking."

CONCLUSIONS

Taken together, findings support the idea that drug-related visual stimuli acquire appetitive (hedonic and/or incentive) properties as a function of individual differences in drug use, which entail individual differences in exposure to the conditioning effects of addictive substances like alcohol. Findings also suggest a link between drug use and the propensity to attribute affective/motivational significance to reward-predictive cues in general.