Abstract
The influence of Pavlovian conditioned stimuli on ongoing behavior may contribute to explaining how alcohol cues stimulate drug seeking and intake. Using a Pavlovian-instrumental transfer task, we investigated the effects of alcohol-related cues on approach behavior (i.e., instrumental response behavior) and its neural correlates, and related both to the relapse after detoxification in alcohol-dependent patients. Thirty-one recently detoxified alcohol-dependent patients and 24 healthy controls underwent instrumental training, where approach or non-approach towards initially neutral stimuli was reinforced by monetary incentives. Approach behavior was tested during extinction with either alcohol-related or neutral stimuli (as Pavlovian cues) presented in the background during functional magnetic resonance imaging (fMRI). Patients were subsequently followed up for 6 months. We observed that alcohol-related background stimuli inhibited the approach behavior in detoxified alcohol-dependent patients (t = − 3.86, p < .001), but not in healthy controls (t = − 0.92, p = .36). This behavioral inhibition was associated with neural activation in the nucleus accumbens (NAcc) (t(30) = 2.06, p < .05). Interestingly, both the effects were only present in subsequent abstainers, but not relapsers and in those with mild but not severe dependence. Our data show that alcohol-related cues can acquire inhibitory behavioral features typical of aversive stimuli despite being accompanied by a stronger NAcc activation, suggesting salience attribution. The fact that these findings are restricted to abstinence and milder illness suggests that they may be potential resilience factors.
Clinical trial: LeAD study, http://www.lead-studie.de, NCT01679145.
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References
Heinz A, Löber S, Georgi A, Wrase J, Hermann D, Rey ER, Wellek S, Mann K (2003) Reward craving and withdrawal relief craving: assessment of different motivational pathways to alcohol intake. Alcohol Alcohol 38:35–39
Robbins TW, Everitt BJ (1999) Drug addiction: bad habits add up. Nature 398:567–570
Sanchis-Segura C, Spanagel R (2006) REVIEW: behavioural assessment of drug reinforcement and addictive features in rodents: an overview. Addict Biol 11:2–38
Corbit LH, Janak PH (2007) Ethanol-associated cues produce general pavlovian-instrumental transfer. Alcohol Clin Exp Res 31:766–774
Hogarth L, Dickinson A, Wright A, Kouvaraki M, Duka T (2007) The role of drug expectancy in the control of human drug seeking. J Exp Psychol Anim Behav Process 33:484–496
Barker JM, Torregrossa MM, Taylor JR (2012) Low prefrontal PSA-NCAM confers risk for alcoholism-related behavior. Nat Neurosci 15:1356–1358
Everitt BJ, Robbins TW (2005) Neural systems of reinforcement for drug addiction: from actions to habits to compulsion. Nat Neurosci 8:1481–1489
Glasner SV, Overmier JB, Balleine BW (2005) The role of Pavlovian cues in alcohol seeking in dependent and nondependent rats. J Stud Alcohol 66:53–61
Garbusow M, Schad DJ, Sebold M, Friedel E, Bernhardt N, Koch SP, Steinacher B, Kathmann N, Geurts DE, Sommer C, Muller DK, Nebe S, Paul S, Wittchen HU, Zimmermann US, Walter H, Smolka MN, Sterzer P, Rapp MA, Huys QJ, Schlagenhauf F, Heinz A (2016) Pavlovian-to-instrumental transfer effects in the nucleus accumbens relate to relapse in alcohol dependence. Addict Biol 21:719–731
Haber SN, Behrens TE (2014) The neural network underlying incentive-based learning: implications for interpreting circuit disruptions in psychiatric disorders. Neuron 83:1019–1039
Huys QJ, Tobler PN, Hasler G, Flagel SB (2014) The role of learning-related dopamine signals in addiction vulnerability. Prog Brain Res 211:31–77
Corbit LH, Balleine BW (2005) Double dissociation of basolateral and central amygdala lesions on the general and outcome-specific forms of pavlovian-instrumental transfer. J Neurosci 25:962–970
Corbit LH, Fischbach SC, Janak PH (2016) Nucleus accumbens core and shell are differentially involved in general and outcome-specific forms of Pavlovian-instrumental transfer with alcohol and sucrose rewards. Eur J Neurosci 43:1229–1236
Corbit LH, Balleine BW (2011) The general and outcome-specific forms of Pavlovian-instrumental transfer are differentially mediated by the nucleus accumbens core and shell. J Neurosci 31:11786–11794
Bray S, Rangel A, Shimojo S, Balleine B, O’Doherty JP (2008) The neural mechanisms underlying the influence of pavlovian cues on human decision making. J Neurosci 28:5861–5866
Geurts DE, Huys QJ, den Ouden HE, Cools R (2013) Aversive pavlovian control of instrumental behavior in humans. J Cogn Neurosci 25:1428–1441
Talmi D, Seymour B, Dayan P, Dolan RJ (2008) Human pavlovian-instrumental transfer. J Neurosci 28:360–368
Dayan P (2009) Dopamine, reinforcement learning, and addiction. Pharmacopsychiatry 42(Suppl 1):S56–S65
Beck A, Schlagenhauf F, Wustenberg T, Hein J, Kienast T, Kahnt T, Schmack K, Hagele C, Knutson B, Heinz A, Wrase J (2009) Ventral striatal activation during reward anticipation correlates with impulsivity in alcoholics. Biol Psychiat 66:734–742
Heinz A, Siessmeier T, Wrase J, Buchholz HG, Grunder G, Kumakura Y, Cumming P, Schreckenberger M, Smolka MN, Rosch F, Mann K, Bartenstein P (2005) Correlation of alcohol craving with striatal dopamine synthesis capacity and D2/3 receptor availability: a combined [18F]DOPA and [18F]DMFP PET study in detoxified alcoholic patients. Am J Psychiatry 162:1515–1520
Park SQ, Kahnt T, Beck A, Cohen MX, Dolan RJ, Wrase J, Heinz A (2010) Prefrontal cortex fails to learn from reward prediction errors in alcohol dependence. J Neurosci 30:7749–7753
Wrase J, Schlagenhauf F, Kienast T, Wustenberg T, Bermpohl F, Kahnt T, Beck A, Strohle A, Juckel G, Knutson B, Heinz A (2007) Dysfunction of reward processing correlates with alcohol craving in detoxified alcoholics. NeuroImage 35:787–794
Heinz A, Schlagenhauf F (2010) Dopaminergic dysfunction in schizophrenia: salience attribution revisited. Schizophrena Bull 36:472–485
Zink CF, Pagnoni G, Martin-Skurski ME, Chappelow JC, Berns GS (2004) Human striatal responses to monetary reward depend on saliency. Neuron 42:509–517
Beck A, Wüstenberg T, Genauck A, Wrase J, Schlagenhauf F, Smolka MN, Mann K, Heinz A (2012) Effect of brain structure, brain function, and brain connectivity on relapse in alcohol-dependent patients. Arch Gen Psychiatry 69:842–852
Vollstädt-Klein S, Kobiella A, Buhler M, Graf C, Fehr C, Mann K, Smolka MN (2011) Severity of dependence modulates smokers’ neuronal cue reactivity and cigarette craving elicited by tobacco advertisement. Addict Biol 16:166–175
Ostlund SB, Maidment NT, Balleine BW (2010) Alcohol-paired contextual cues produce an immediate and selective loss of goal-directed action in rats. Front Integr Neurosci 4:19
Jacobi F, Mack S, Gerschler A, Scholl L, Hofler M, Siegert J, Burkner A, Preiss S, Spitzer K, Busch M, Hapke U, Gaebel W, Maier W, Wagner M, Zielasek J, Wittchen HU (2013) The design and methods of the mental health module in the German Health Interview and Examination Survey for Adults (DEGS1-MH). Int J Methods Psychiatr Res 22:83–99
Wittchen H-U, Pfister H (1997) DIA-X-Interviews: manual Für Screening-Verfahren Und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime). In: Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12 Monate); PC-Programm Zur Durchführung Des Interviews (Längs- Und Querschnittuntersuchung); Auswertungsprogramm. Swets & Zeitlinger, Frankfurt
Garbusow M, Schad DJ, Sommer C, Jünger E, Sebold M, Friedel E, Wendt J, Kathmann N, Schlagenhauf F, Zimmermann US, Heinz A, Huys QJ, Rapp MA (2014) Pavlovian-to-instrumental transfer in alcohol dependence: a pilot study. Neuropsychobiology 70:111–121
Huys QJ, Cools R, Golzer M, Friedel E, Heinz A, Dolan RJ, Dayan P (2011) Disentangling the roles of approach, activation and valence in instrumental and pavlovian responding. PLoS Comput Biol 7:e1002028
Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM (1989) Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 84:1353–1357
Sobell LC, Sobell MB (1992) Timeline Follow-back: a technique for assessing self-reported ethanol consumption. In: Allen J, Litten RZ (eds) Measuring alcohol consumption: psychosocial and biological methods. Humana, Totowa, pp 41–72
Skinner HA, Horn JL (1984) Alcohol dependence scale (ADS): users guide. Addiction Research Foundation, Toronto
Anton RF, Moak DH, Latham P (1995) The Obsessive Compulsive Drinking Scale: a self-rated instrument for the quantification of thoughts about alcohol and drinking behavior. Alcohol Clin Exp Res 19:92–99
Mann K, Ackermann K (2000) Die OCDS-G: psychometrische kennwerte der deutschen version der obsessive compulsive drinking scale. Sucht 46:90–100
Stuppäck C, Barnas C, Falk M, Günther V, Hummer M, Oberbauer H, Pycha R, Whitworth A, Fleischhacker WW (1995) Eine modifizierte und ins deutsche über-setzte Form der Clinical Institut Withdrawal Assessment for Alcohol Scale (CIWA-A). Wiener Zeitschrift für Suchtforschung 18:39–48
Bleich S, Havemann-Reinecke U, Kornhuber J (2002) Der Fagerström-Test für Nikotinabhängigkeit (FTNA). Göttingen, Hogrefe
Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO (1991) The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict 86:1119–1127
Lehrl S, Triebig G, Fischer B (1995) Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence. Acta Neurol Scand 91:335–345
Daw ND, Gershman S, Seymour B, Dayan P, Dolan R (2011) Modelbased influences on humans’ choices and striatal prediction errors. Neuron 69:1204–1215
MATLAB version 7.12.0 (2011). The MathWorks Inc, Massachusetts
Brainard DH (1997) The psychophysics toolbox. Spat Vis 10:433–436
Pelli DG (1997) The VideoToolbox software for visual psychophysics: transforming numbers into movies. Spat Vis 10:437–442
R Development Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
Bates D, Maechler M, Bolker B, Walker S (2014) lme4: linear mixed-effects models using Eigen and S4. R package version 1.1–7, http://CRAN.R-project.org/package=lme4. Accessed 15 Dec 2017
Kuznetsova A, Brockhoff PB, Christensen RB (2014) lmerTest Package: tests in linear mixed effects models. J Stat Softw 82:672
Welch BL (1947) The generalisation of student’s problems when several different population variances are involved. Biometrika 34:28–35
Iglesias S, Mathys C, Brodersen KH, Kasper L, Piccirelli M, den Ouden HE, Stephan KE (2013) Hierarchical prediction errors in midbrain and basal forebrain during sensory learning. Neuron 80:519–530
Spruyt A, De Houwer J, Tibboel H, Verschuere B, Crombez G, Verbanck P, Hanak C, Brevers D, Noel X (2013) On the predictive validity of automatically activated approach/avoidance tendencies in abstaining alcohol-dependent patients. Drug Alcohol Depend 127:81–86
Townshend JM, Duka T (2007) Avoidance of alcohol-related stimuli in alcohol-dependent inpatients. Alcohol Clin Exp Res 31:1349–1357
Vollstädt-Klein S, Loeber S, von der Goltz C, Mann K, Kiefer F (2009) Avoidance of alcohol-related stimuli increases during the early stage of abstinence in alcohol-dependent patients. Alcohol Alcohol 44:458–463
Wiers RW, Eberl C, Rinck M, Becker ES, Lindenmeyer J (2011) Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome. Psychol Sci 22:490–497
Houben K, Havermans RC, Wiers RW (2010) Learning to dislike alcohol: conditioning negative implicit attitudes toward alcohol and its effect on drinking behavior. Psychopharmacology 211:79–86
Grüsser SM, Heinz A, Raabe A, Wessa M, Podschus J, Flor H (2002) Stimulus-induced craving and startle potentiation in abstinent alcoholics and controls. Eur Psychiatry 17:188–193
Eder AB, Dignath D (2016) Asymmetrical effects of posttraining outcome revaluation on outcome-selective Pavlovian-to-instrumental transfer of control in human adults. Learn Motiv 54:12–21
Huys QJ, Golzer M, Friedel E, Heinz A, Cools R, Dayan P, Dolan RJ (2016) The specificity of Pavlovian regulation is associated with recovery from depression. Psychol Med 46:1027–1035
Baxter BW, Hinson RE (2001) Is smoking automatic? Demands of smoking behavior on attentional resources. J Abnorm Psychol 110:59–66
Cox WM, Hogan LM, Kristian MR, Race JH (2002) Alcohol attentional bias as a predictor of alcohol abusers’ treatment outcome. Drug Alcohol Depend 68:237–243
Hogarth LC, Mogg K, Bradley BP, Duka T, Dickinson A (2003) Attentional orienting towards smoking-related stimuli. Behav Pharmacol 14:153–160
Mogg K, Field M, Bradley BP (2005) Attentional and approach biases for smoking cues in smokers: an investigation of competing theoretical views of addiction. Psychopharmacology 180:333–341
Bühringer G, Wittchen HU, Gottlebe K, Kufeld C, Goschke T (2008) Why people change? The role of cognitive-control processes in the onset and cessation of substance abuse disorders. Int J Methods Psychiatr Res 17(Suppl 1):S4-S15
Lewis AH, Niznikiewicz MA, Delamater AR, Delgado MR (2013) Avoidance-based human Pavlovian-to-instrumental transfer. Eur J Neurosci 38:3740–3748
Seymour B, O’Doherty JP, Koltzenburg M, Wiech K, Frackowiak R, Friston K, Dolan R (2005) Opponent appetitive-aversive neural processes underlie predictive learning of pain relief. Nat Neurosci 8:1234–1240
Grüsser SM, Mörsen CP, Wolfling K, Flor H (2007) The relationship of stress, coping, effect expectancies and craving. Eur Addict Res 13:31–38
Heinz A, Siessmeier T, Wrase J, Hermann D, Klein S, Grusser SM, Flor H, Braus DF, Buchholz HG, Grunder G, Schreckenberger M, Smolka MN, Rosch F, Mann K, Bartenstein P (2004) Correlation between dopamine D(2) receptors in the ventral striatum and central processing of alcohol cues and craving. Am J Psychiatry 161:1783–1789
Boileau I, Payer D, Houle S, Behzadi A, Rusjan PM, Tong J, Wilkins D, Selby P, George TP, Zack M, Furukawa Y, McCluskey T, Wilson AA, Kish SJ (2012) Higher binding of the dopamine D3 receptor-preferring ligand [11C]-(+)-propyl-hexahydro-naphtho-oxazin in methamphetamine polydrug users: a positron emission tomography study. J Neurosci 32:1353–1359
Volkow ND, Wang GJ, Telang F, Fowler JS, Alexoff D, Logan J, Jayne M, Wong C, Tomasi D (2014) Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity. Proc Natl Acad Sci USA 111:E3149–E3156
Sullivan EV, Pfefferbaum A (2014) The neurobiology of alcohol craving and relapse. Alcohol Nerv Syst Handb Clin Neurol 125:355–368
Charlet K, Beck A, Jorde A, Wimmer L, Vollstädt-Klein S, Gallinat J, Walter H, Kiefer F, Heinz A (2014) Increased neural activity during high working memory load predicts low relapse risk in alcohol dependence. Addict Biol 19:402–414
Prom-Wormley EC, Ebejer J, Dick DM, Bowers MS (2017) The genetic epidemiology of substance use disorder: a review. Drug Alcohol Depend 180:241–259
Hogarth L (2012) Goal-directed and transfer-cue-elicited drug-seeking are dissociated by pharmacotherapy: evidence for independent additive controllers. J Exp Psychol Anim Behav Process 38:266–278
Hogarth L, Chase HW (2011) Parallel goal-directed and habitual control of human drug-seeking: implications for dependence vulnerability. J Exp Psychol Anim Behav Process 37:261–276
Acknowledgements
This work was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG, FOR 1617: Grants HE 2597/13-1 and 13-2, HE 2597/14-1 and 14-2, HE 2597/15-1 and 15-2, RA 1047/2-1 and 2-2, SCHA 1971/1-2, SCHL 1969/2-1 and 2-2, SM 80/7-1 and 7-2, WI 709/10-1 and 10-2, and ZI 1119/3-1 and 3-2). Eva Friedel is a participant in the BIH Charité Clinician Scientist Program funded by the Charité-Universitätsmedizin and the Berlin Institute of Health. Moreover, we thank the LeAD study teams in Berlin and Dresden for all the work and help regarding data collection! We would also like to gratefully thank Carolin Wackerhagen for producing the alcohol- and water-related background stimuli! Finally, we are grateful to Lee Hogarth for discussing the nature of our PIT effects, and for interference account predictions. MR-imaging for this study was performed at the Berlin Center for Advanced Neuroimaging (BCAN) and Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden.
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AB, AH, MAR, MNS, QJMH, USZ were responsible for the study concept and design. CS, DJS, HW, MG, MS, NB, PS and QJMH implemented and piloted the PIT (behavioral and fMRI) paradigm. AH, CH, CS, EF, MG, MS, UE, and USZ recruited alcohol-dependent patients and assessed the follow-up data. HUW and SKP were responsible for the assessment of questionnaires. SN set up a preprocessing pipeline for the imaging data. DJS, EF, FS and MG performed the first- and second-level analyses on fMRI data. DJS and MG performed further statistical analyses with support of AH, MAR and QJMH. AH, DJS, EF, FS, MG and MS drafted the manuscript. CS, HUW, HW, MAR, MNS, NB, PS, QJMH, SKP, SL, SN and USZ provided critical revision of the manuscript for important intellectual content. All the authors critically reviewed content and approved the final version for publication.
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Schad, D.J., Garbusow, M., Friedel, E. et al. Neural correlates of instrumental responding in the context of alcohol-related cues index disorder severity and relapse risk. Eur Arch Psychiatry Clin Neurosci 269, 295–308 (2019). https://doi.org/10.1007/s00406-017-0860-4
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DOI: https://doi.org/10.1007/s00406-017-0860-4