Alcohol use disorder (AUD) is an important global public health problem with complex aetiology and relapsing remitting course. Clinical measures of alcohol dependence severity and alcohol-craving, are largely unreliable in identifying individuals at high-risk for relapse. Functional human neuroimaging methods that employ symptom provocation paradigms have shown promise in identifying critical brain regions with cue-elicited alcohol-craving response.

The present study aimed at examining the utility of fMRI cue-reactivity (CR) in predicting relapse risk.

The study was conducted on inpatients of a tertiary care neuropsychiatric hospital. Thirty-two treatment-seeking right-handed men were recruited for the study after informed consent. Following detoxification and 3-day drug-washout period, they underwent a task-based fMRI while viewing images of alcohol-related and control cues presented to them using a previously validated fMRI paradigm. All patients received anti-craving medications (baclofen: 60–80 mg/d, n = 16; naltrexone: 50–100 mg/d, n = 16) and were prospectively followed-up till their first alcohol lapse.

Random-effect analysis using one-sample test revealed significant CR to alcohol-related cues (relative to implicit baseline) with activation in salience-reward related regions [insula, cingulate, dorsal striatum (DS)], visual-attention regions [occipito-temporal] and deactivation of default-mode regions [posterior cingulate (PCC)] (all significant at PFWE < 0.05, whole-brain corrected). Cox-proportional hazard regressions revealed that greater CR in Insula (Chi2 = 10.33; P = 0.001; HR = 3.1; 95% CI = 1.5–6.3) and DS (Chi2 = 10.87; P = 0.001; HR = 2.8; 95% CI = 1.5–5.2) predicts faster subsequent time to first drink after accounting for the role of clinical measures.

These findings indicate that CR can serve as potential marker to identify individuals at high-risk for relapse. Further examination of intervention-related CR change may aid in personalizing treatment of AUD.

The authors have not supplied their declaration of competing interest.