Interaction between behavioral inhibition and neural alcohol cue-reactivity in ADHD and alcohol use disorder

S Vollstädt-Klein,F Kiefer,J Seidt,B Alm,E Sobanski,O Hennig,S Gerhardt,G Sharafi,A Lee,A Strosche,D Hermann,Wh Sommer,R Nuriyeva,M Luderer

doi:10.1007/s00213-020-05492-1

Abstract

RationaleCompared to the general population, adult Attention-Deficit / Hyperactivity Disorder (ADHD) is more prevalent in patients with Alcohol Use Disorder (AUD). Impaired behavioral inhibition is a common characteristic in both ADHD and AUD. Relapse risk is increased in patients with AUD and comorbid, untreated ADHD and in AUD patients with increased neural cue-reactivity.ObjectivesIn this study, we examined the interaction between neural correlates of behavioral inhibition and alcohol cue-reactivity with a hybrid imaging task.MethodsOut of 69 adult study participants, we included n = 49 in our final analyses: Individuals had a diagnosis of either AUD (n = 13), ADHD (n = 14) or both (n = 5), or were healthy controls (HC; n = 17). The functional magnetic resonance imaging paradigm aimed to examine the combined effects of both an interference-inhibition task (“Simon-task”) and an alcohol cue-reactivity task. Instead of segregating by diagnostic group, we pursued a dimensional approach in which we compared measures of AUD and ADHD severity, as well as the interaction of both, using multiple regression analyses.ResultsThe four groups did not differ on the behavioral level on either the inhibition task or the alcohol cue-reactivity task. However, brain activation in frontal control and reward-related regions during completion of the combined tasks were related to ADHD and AUD severity (symptom load). During presentation of both alcohol cues and the inhibition task, participants with higher AUD and ADHD symptom load exhibited greater BOLD (blood oxygen level dependent) responses in subcortical reward-related regions.ConclusionsOur findings support the hypothesis that ADHD additionally diminishes inhibition ability in individuals with AUD. This may increase relapse risk when confronted with alcohol cues. Further, it is crucial for patients with comorbid AUD and ADHD to take into account not only reduced cognitive control over behavioral inhibition but also simultaneously heightened alcohol cue-reactivity.

Highlights

Attention-Deficit/ Hyperactivity Disorder (ADHD) is a common childhood onset mental health disorder persisting in many cases until adulthood (Huntley et al, 2012)
We examined the interaction between response inhibition and cue-reactivity using a hybrid imaging task in which individuals were confronted with alcohol stimuli as distractors while performing a response inhibition task
From the overall sample of 69 participants, 49 subjects were included in the functional magnetic resonance imaging (fMRI) analysis: 13 alcohol use disorder (AUD), 14 ADHD, 17 healthy controls and five AUD + ADHD

Summary

Introduction

Attention-Deficit/ Hyperactivity Disorder (ADHD) is a common childhood onset mental health disorder persisting in many cases until adulthood (Huntley et al, 2012). The increased prevalence of ADHD in adults with AUD seems to be greatly attributable to ADHD individuals being more susceptible to early alcohol use, a persisting risky drinking behavior and is predictive of the maintenance of AUD in later life (Charach et al, 2011; Estévez-Lamorte et al, 2019; Estévez et al, 2015; Lee et al, 2011; Wilens & Morrison, 2011). The cooccurrence of these disorders might be due to shared genetics (Capusan, Bendtsen, Marteinsdottir, Kuja-Halkola, & Larsson, 2015; Edwards & Kendler, 2012) or neuropsychological factors such as increased impulsivity (Pedersen et al, 2016; Roberts, Peters, Adams, Lynam, & Milich, 2014) or decreased inhibitory control (Smith, Mattick, Jamadar, & Iredale, 2014)

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