title: Unique brain areas associated with abstinence control are damaged in multiply detoxified alcoholics.
abstract: BACKGROUND
  The ability to abstain from drinking, despite incentives to imbibe, is essential to recovery from alcoholism.
  
  
  METHODS
  We used an incentive conflict task to investigate ability to abstain from responding during presentations of incentive cues. Both alcoholic (n = 23) and healthy subjects (n = 22) were required to withhold responding during the simultaneous presentation of two visual stimuli in which the individual presentation allowed responding for monetary reward. Brain structures activated during performance of the task were studied using functional magnetic resonance imaging in healthy volunteers (n = 8), and changes in gray matter volume were studied in a separate group of patients (n = 29) compared with control subjects (n = 31) in regions of interest identified on functional magnetic resonance imaging.
  
  
  RESULTS
  Abstinent alcoholic patients were severely impaired on the incentive conflict task. The impairment was greater in patients with experience of several versus a single detoxification. Healthy volunteers, during the same incentive conflict task, showed distinct patterns of brain activation (including gyrus rectus, ventromedial prefrontal cortex, and superior frontal gyrus). Reduction of gray matter volume in ventromedial prefrontal cortex and superior frontal gyrus of patients was more extensive in those with multiple detoxifications.
  
  
  CONCLUSIONS
  Performance deficits in alcoholics are associated with withdrawal-induced impairments in prefrontal subfields, which are exacerbated following repeated episodes of detoxification. Detoxification thus compromises functional and structural integrity of prefrontal cortex and may thus impair the ability to control future drinking. Performance in the incentive conflict task is a sensitive biomarker for such deficits.
authors: School of Psychology, University of Sussex, Brighton, United Kingdom. t.duka@sussex.ac.uk
authors: Theodora
authors: T
authors: Duka
authors: Leanne
authors: L
authors: Trick
authors: Kyriaki
authors: K
authors: Nikolaou
authors: Marcus A
authors: MA
authors: Gray
authors: Matthew J
authors: MJ
authors: Kempton
authors: Hugh
authors: H
authors: Williams
authors: Steven C R
authors: SC
authors: Williams
authors: Hugo D
authors: HD
authors: Critchley
authors: David N
authors: DN
authors: Stephens
references: Cereb Cortex. 2007 Apr;17(4):826-38
references: 16699079
references: Nat Neurosci. 2004 Jun;7(6):664-72
references: 15156146
references: Science. 2004 Apr 16;304(5669):452-4
references: 15087550
references: Alcohol Alcohol. 2001 Sep-Oct;36(5):357-68
references: 11524299
references: Alcohol Alcohol. 2002 Mar-Apr;37(2):187-92
references: 11912076
references: Neuron. 2002 Feb 28;33(5):815-26
references: 11879657
references: Neuroimage. 2003 Jul;19(3):1233-9
references: 12880848
references: Brain. 2000 Nov;123 ( Pt 11):2189-202
references: 11050020
references: Nat Rev Neurosci. 2005 Sep;6(9):691-702
references: 16136173
references: J Cogn Neurosci. 2005 Jul;17(7):1058-73
references: 16102237
references: Psychopharmacology (Berl). 1997 Jun;131(3):207-15
references: 9203230
references: J Neurophysiol. 2006 Jan;95(1):301-10
references: 16192329
references: Nat Neurosci. 2005 Sep;8(9):1255-62
references: 16116457
references: Nat Rev Neurosci. 2002 Mar;3(3):243-9
references: 11994756
references: Eur Psychiatry. 2002 Mar;17(1):17-23
references: 11918988
references: J Clin Invest. 2003 May;111(10):1444-51
references: 12750391
references: Neuropsychol Rev. 2007 Sep;17(3):239-57
references: 17874302
references: Curr Opin Neurobiol. 2004 Dec;14(6):769-76
references: 15582382
references: Neuroimage. 2009 Jan 1;44(1):243-51
references: 18834944
references: Psychol Rev. 1984 Apr;91(2):251-68
references: 6571424
references: Semin Clin Neuropsychiatry. 2001 Jul;6(3):205-16
references: 11447572
references: Alcohol Clin Exp Res. 2004 Feb;28(2):233-46
references: 15112931
references: Eur J Neurosci. 2006 Jul;24(1):205-16
references: 16882017
references: J Comp Physiol Psychol. 1972 May;79(2):307-17
references: 5025999
references: Biol Psychiatry. 2008 Aug 1;64(3):192-202
references: 18374900
references: Alcohol Clin Exp Res. 2000 Nov;24(11):1712-23
references: 11104119
references: Philos Trans R Soc Lond B Biol Sci. 2008 Oct 12;363(1507):3169-79
references: 18640918
references: Eur J Neurosci. 2008 May;27(9):2213-8
references: 18445214
references: Science. 2004 May 21;304(5674):1167-70
references: 15155951
references: Alcohol Clin Exp Res. 1993 Feb;17(1):94-8
references: 8452212
references: Biol Psychiatry. 2005 Oct 15;58(8):597-604
references: 16095567
references: Psychol Rep. 1978 Dec;43(3 Pt 1):803-6
references: 740823
references: Alcohol Clin Exp Res. 2003 Oct;27(10):1563-72
references: 14574226
references: Neuroimage. 2002 Nov;17(3):1415-28
references: 12414281
references: Hum Brain Mapp. 2009 Oct;30(10):3309-24
references: 19350562
references: J Cogn Neurosci. 2006 Nov;18(11):1843-9
references: 17069475
references: Neuroscientist. 2004 Jun;10(3):260-8
references: 15155064
references: Cortex. 1978 Jun;14(2):234-44
references: 679704
references: Neuroimage. 1998 Jan;7(1):30-40
references: 9500830
references: J Neurosci. 2001 Apr 15;21(8):2793-8
references: 11306631
references: J Cogn Neurosci. 2008 Mar;20(3):432-46
references: 18004952
references: Am J Psychiatry. 2005 Aug;162(8):1403-13
references: 16055761
references: Biol Psychiatry. 2005 Sep 1;58(5):392-400
references: 16018978