Co‐occurring BD and AUD associated with increased craving

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Researchers studied reward circuitry dysfunction, which may be a mechanism of co‐occurring bipolar disorder (BD) and alcohol use disorder (AUD), using functional magnetic resonance imaging (fMRI). The objective was to find out how alcohol cue processing differs in people with co‐occurring BD and AUD compared with people who have either one of the disorders. They used a visual alcohol cue reactivity paradigm following one week or more of abstinence from alcohol and other drugs. They rated past‐week mood symptoms for depression and mania, as well as obsessive‐compulsive drinking and impulsiveness. Function MRI was analyzed focusing on the ventral striatum, dorsal striatum, and ventromedial prefrontal cortex. The researchers analyzed associations between cue reactivity and select behavioral correlates, namely, alcohol craving, impulsivity, maximum number of alcohol drinks on a single occasion and days since last alcohol drink). Of the 112 participants, 28 (25.0%) had BD and AUD, 26 (23.2%) had AUD alone, 31 (27.7%) had BD alone, and 27 (24.1%) were healthy controls. The mean age was 38.7 years, 50 (45.5%) were female, 33 (30%) were smokers, and 37 (34.9%) reported recent alcohol consumption. Individuals with BD and AUD exhibited reduced activation compared with all other groups. Other groups did not significantly differ from one another. The hypo‐activations were associated with increased impulsivity and obsessive‐compulsive alcohol craving exclusively among individuals with BD and AUD. The researchers concluded that the potential interaction between BD and AUD blunted the response to rewards and decreased inhibitory control. They added that reduced right inferior frontal gyrus and insula alcohol cue reactivity is a novel biomarker of comorbid BD and AUD that may respond to pharmacological interventions targeting impulsivity‐related neural mechanisms for improved executive control. The study, “Alcohol Cue Processing in Co‐Occurring Bipolar Disorder and Alcohol Use Disorder, is by William H. Mellick, Ph.D., and colleagues, and was conducted at the Medical University of South Carolina, Addiction Sciences Division and published Nov. 1 in JAMA Psychiatry.