Brain, Behavioral, Affective, and Sex Correlates of Recovery From Alcohol Use Disorders
Abstract
Background
Recovery from alcohol use disorders (AUDs) consists of salutary changes in behavior and affect. While evidence suggests that recovery-related behavioral changes, such as abstinence, emerge in tandem with both neural and affective changes, the precise relationships among these changes are unknown. To understand these relationships, this study examined associations between the duration of abstinence (DOA), affective states, and neuroimaging-based structural measures of the brain reward system (BRS) in AUD men (AUDM) and AUD women (AUDW).
Methods
Participants were community respondents from the Boston area comprising right-handed abstinent individuals with AUD (n = 60; 30 men) and controls without AUD (NC; n = 60; 29 men). Multivariate linear regressions compared short-/mid-term abstainers (≤5 years), long-term abstainers (>5 years), and the NC group on measures of BRS volume (3T magnetic resonance imaging scans) and measures of affect (Profile of Mood States [POMS]; Multiple Affect Adjective Check List [MAACL]; Hamilton Rating Scale for Depression [HRSD]). Analyses contrasted sex differences and accounted for age, education, drinking severity, and verbal IQ.
Results
Compared to the NC group, short-/mid-term abstainers exhibited larger posterior insular volume (total (β = 0.019, 95% CI: 0.004, 0.034)), higher negative affect (POMS Mood Disturbance (β = 27.8, 95% CI: 11.56, 44.04), and lower positive affect (POMS Vigor (β = −4.89, 95% CI: −9.06, −0.72)). Compared to the NC group, Long-term abstainers exhibited significantly smaller volumes of aggregate anterior cingulate cortex (β = −0.06, 95% CI: −0.113, −0.008) and higher HRSD scores (β = 1.56, 95% CI: 0.14, 2.98). Relative to AUDM, AUDW exhibited significantly larger right anterior insular volumes (β = 0.03, 95% CI: 0.01, 0.06) and significantly greater MAACL Positive Affect scores (β = 7.56, 95% CI: 0.59, 11.55) in association with DOA.
Conclusions
This study found that differences in abstinence from alcohol were correlated with differences in both neural recovery and affective dimensions of recovery from AUDs. The observed sex differences extend evidence of dimorphic effects of AUDs and recovery on brain structure and function. Future longitudinal research will test inferences concerning the directionality of these relationships.
Research in context
This study found changes in alcohol use behavior, mood, and the brain among women and men during recovery from alcohol use disorder (AUD) are interlinked.
Empirical evidence show that AUD individuals in long-term abstinence (greater than five years) report higher levels of subjective happiness and emotional well-being, as well as a significantly lower risk of relapse.
To better understand this process, the study’s researchers examined the associations between the duration of abstinence, emotional states, and structural measures of brain regions involved in emotional processing, among abstinent men and women with AUD.
The researchers found that,
- Compared to the control group who did not have AUD, short- to mid-term abstainers exhibited lower positive mood and higher negative mood, both of which appeared to be related to structural differences of brain regions involved in pain processing and social emotions.
- However, long-term abstainers exhibited more normative mood profiles, with the exception of higher levels of depression, in conjunction with their own distinctive neural profile.
- Relative to men with AUD, women with AUD had significantly larger volumes of certain brain subregions, as well as greater positive mood scores for a given duration of abstinence.
The findings from this study suggest that, for individuals in recovery from AUD, abstinence itself is its own type of behavioral intervention for changing the brain and, ultimately, changing the negative moods and emotions that frequently lead to relapse.