title: Association between alcohol-cue modulated startle reactions and drinking behaviour in alcohol dependent patients - results of the PREDICT study.
abstract: Previous research on alcohol dependent patients has shown that variations in eyeblink startle response can be used as an indicator of their emotional responses to alcohol-related stimuli. Postulating that reactions on substance associated stimuli are controlled by either a negative or a positive affective processing system, we expect that abstinent alcoholics react differently (within-group) in the emotional evaluation of alcohol cues. Furthermore, we assumed the startle response to covary with medication response to acamprosate and naltrexone. We measured 74 detoxified inpatients' acoustic startle responses while they were being presented with alcohol-related images as well as affectively negative, neutral, and positive pictures before they were randomized to pharmacotherapy. Group-mean startle peak amplitudes were lowest for alcohol-related cues. The relative startle response (alcohol cues set in relation to the other stimulus categories) did not correlate with craving for alcohol (OCDS) or alcohol cue induced self-ratings of arousal, valence and craving. Patients with a lower percentage of abstinent days in the 90 days prior to the last drinking day showed a lower ("more appetitive") startle response to alcohol cues. A survival analysis using the time to first heavy drinking day as the survival criterion revealed a significant interaction between alcohol-cue startle responses and medication type. The results indicate that the psycho-physiological measure of emotional evaluation of alcohol cues includes unconscious processing not reflected by conscious self-ratings. Furthermore, our result of a differential medication effect may encourage further studies to use biological characteristics to stratify patients as a step towards individualized treatment for alcohol dependence.
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, D-68159 Mannheim, Germany. Electronic address: Tagrid.Lemenager@zi-mannheim.de.
authors.forename: Tagrid
authors.initials: T
authors.lastname: Leménager
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, D-68159 Mannheim, Germany; Institute for Sports and Sports Science, Karlsruhe Institute of Technology, Hertzstraße 16, Geb. 06.31, D-76187 Karlsruhe, Germany. Electronic address: Holger.Hill@kit.edu.
authors.forename: Holger
authors.initials: H
authors.lastname: Hill
authors.affiliation: Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, D-68159 Mannheim, Germany. Electronic address: Iris.Reinhard@zi-mannheim.de.
authors.forename: Iris
authors.initials: I
authors.lastname: Reinhard
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, D-68159 Mannheim, Germany. Electronic address: Sabine.Hoffmann@zi-mannheim.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Hoffmann
authors.affiliation: Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, D-01307 Dresden, Germany. Electronic address: Ulrich.Zimmermann@uniklinikum-dresden.de.
authors.forename: Ulrich S
authors.initials: US
authors.lastname: Zimmermann
authors.affiliation: Clinic for Addiction Medicine and Addictive Behaviour, Klinikum Stuttgart, Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374 Stuttgart, Germany. Electronic address: d.hermann@klinikum-stuttgart.de.
authors.forename: Derik
authors.initials: D
authors.lastname: Hermann
authors.affiliation: Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, D-01307 Dresden, Germany; Section of Systems Neuroscience, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, D-01187 Dresden, Germany. Electronic address: michael.smolka@tu-dresden.de.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Smolka
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, D-68159 Mannheim, Germany. Electronic address: Falk.Kiefer@zi-mannheim.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Kiefer
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, D-68159 Mannheim, Germany. Electronic address: Sabine.Vollstaedt-Klein@zi-mannheim.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Vollstädt-Klein
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, D-10117 Berlin, Germany. Electronic address: Andreas.Heinz@charite.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heinz
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, D-68159 Mannheim, Germany. Electronic address: Karl.Mann@zi-mannheim.de.
authors.forename: Karl
authors.initials: K
authors.lastname: Mann
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology*; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D001767:Blinking / Q000502:physiology; D003463:Cues; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods*; D013216:Reflex, Startle / Q000502:physiology
keywords: Alcohol dependence; Alcohol-cue modulated startle response; Individualized treatment