Testing neurobiological models of reward/incentive sensitization in the continuation of alcohol use disorder (AUD) symptoms in young adults with AUD: A four-year longitudinal study

Abstract

Abstract Alcohol use disorder (AUD) remains an urgent public health problem. Alcohol response phenotype may be an important factor underlying vulnerability to and progression of AUD. This study examined the prospective association between acute alcohol responses and continued or remitted AUD over time in young adults with AUD. This sample was N = 101 AUD participants (M age =27.1 ± 4.0 SD yrs) comprising the third cohort of the Chicago Social Drinking Project. They completed two beverage challenge laboratory sessions (0.8 g/kg fixed-dose alcohol vs . placebo) and four years of follow-up to ascertain future AUD symptoms, drinking behaviors, and consequences. Retention was high with an overall 99.2% follow-up rate. Analyses identified three AUD trajectory subgroups over follow-up including a high AUD trajectory subgroup ( n = 37), a medium AUD trajectory subgroup ( n = 48), and a low AUD trajectory subgroup ( n = 16). Generalized estimating equations showed that greater sensitivity to alcohol’s pleasurable effects, including stimulation and hedonic and motivational reward (liking and wanting, respectively) predicted more AUD symptoms over follow-up ( p s<0.001) and were positively associated with AUD trajectory subgroups. However, sedation, heart rate, and cortisol response to alcohol were not significantly associated with AUD trajectory subgroups. In sum, greater alcohol stimulation, liking, and wanting prospectively predicted the continuation and increasing severity of AUD over a four-year period. The findings challenge theoretical models emphasizing reward deficit and global tolerance in addiction and support the role of positive reinforcement, indexed by sensitivity to alcohol’s pleasurable effects, as an important factor in AUD persistence. Clinical Trial Name: Chicago Social Drinking Project Registration #: NCT00961792 URL: http://clinicaltrials.gov/ct2/show/NCT00961792