Brain scans reveal which alcoholics at greatest risk of relapse

Even the most experienced counselors have difficultly spotting a recovering alcoholic in danger of relapse. Brain imaging scans might do a better job, new Yale research suggests.

Alcoholics with abnormal activity in areas of the brain that control emotions and desires are eight times more likely to relapse and drink heavily than alcoholics with more normal patterns of activity or healthy individuals, according to the study published May 1 in the journal JAMA Psychiatry.

“These areas in the prefrontal cortex are involved in regulating emotion and in controlling responses to reward,” said Rajita Sinha, the Foundations Fund Professor of Psychiatry and professor in the Child Study Center and of Department of Neurobiology. “They are damaged by high levels of alcohol and stress and just do not function well.”

Ironically, the damage shows up on fMRI scans when alcoholics imagine being in their own most relaxing scenarios, like sitting at the beach listening to the waves, or taking a bubble bath. In non-alcoholics, these brain regions regulating emotion show markedly reduced activity during relaxing imagery, as anticipated. However, in alcoholics most likely to relapse, those brain regions remain hyperactive. On the other hand, when recovering alcoholics imagine their own recent stressful events, these control regions of the brain show little change, while in non-alcoholics, they show marked activation in response to stress. Such disrupted responses in areas of the brain governing emotions and reward lead to high cravings in the recovering alcoholic and an increased likelihood of subsequent relapse.

These brain scans in the future might serve as a diagnostic test to help professionals identify those most at risk of relapsing and suggest specific interventions to normalize brain function and prevent high rates of alcohol relapse, Sinha said.

“The findings show the prefrontal region is important for maintaining recovery for alcoholism,” Sinha said. “The brain physiology and function has changed due to chronic alcohol use and such changes jeopardize recovery even after initiating standard treatment.”

The research is funded by the National Institute of Alcohol Abuse and Alcoholism at the National Institutes of Health.

Dongju Seo of Yale is first author of the study. Other Yale authors include Cheryl M. Lacadie, Keri Tuit, Adam K. Hong and R. Todd Constable.