Context-Specific Inhibition is Related to Craving in Alcohol Use Disorders: A Dangerous Imbalance

BACKGROUND: Most contemporary neuroscientific models of alcohol use disorders (AUD) incorporate an imbalance between enhanced cue reactivity, which results in a strong urge to consume, and the impaired inhibitory control of that urge. While these phenomena have been frequently investigated separately, studies involving both aspects and thus precisely investigating the postulated imbalance are rare. In this study, inhibition was investigated in an addiction-specific context and individual craving levels were also examined. METHODS: This study compared inhibition in alcohol-related and neutral contexts in patients with AUD and healthy controls, while also taking into account the individual amount of craving. All subjects performed a Go/NoGo task involving neutral and alcohol-related NoGo trials, while their brain activity was recorded using multichannel electroencephalography. The map strength and topography of the N2 and P3 components of the NoGo event-related potentials were compared between groups and contexts using whole-scalp randomization-based methods. The effects of interest were further investigated with sLORETA source analysis. RESULTS: For the N2 component, the context by craving interaction was strong for map strength and map topography. The source analysis indicated that in subjects with high craving, alcohol-related context led to enhanced and prolonged activation in the posterior cingulate and premotor cortical areas. This interaction was specific for craving, but not for diagnostic classification. The amplitude of the P3 component was reduced in subjects with AUD, which replicated previous findings. CONCLUSIONS: In subjects with strong craving, the conflict reflected in the NoGo-N2 was enhanced in the alcohol-related context. Such enhanced conflict probably makes the successful inhibition of the urge to drink in high-risk situations even more difficult for this subgroup of patients and should therefore be addressed in individualized treatment planning.