MRI Evidence Provides Profound Insights into Alcoholism: Identification & Precision Treatment

Last December, I met with a team of superheroes. These superheroes don’t wear masks, nor do they wear intense super-latex costumes, but they are trying to save the world! These superheroes are academics – a super team of healthcare experts —- looking for definitive identification, diagnosis, and treatment options for Alcohol Use Disorder (AUD). Not housed in a secret cave or lair, their headquarters is tucked away from the bustle of the main campus at Virginia Commonwealth University, and as I headed into the typical boxy mid-20th century office building, I was met by their intrepid leader – the chief researcher, Dr. Albert Arias. While this edifice most certainly lacks the grandeur of a high-tech lair, or even of their famed Egyptian Building, the modest appearance of Virginia Commonwealth University’s Center for Neurological Imaging and Research belies the profound and cutting-edge nature of the work that goes on therein.

Albert Arias, M.D., M.S., heads up this impressive team of dedicated researchers, clinicians, and professors, including: James Bjork Ph.D., Chris Hammond M.D., Ph.D., Liangsuo Ma Ph.D., F. Gerard Mueller M.D., and Tiffany Pignatello, F.N.P. The team recently completed a research study funded by the Foundation for Alcoholism Research (FAR), a public charity of which I am Chair of the Board of Directors, entitled, “Toward Improved Diagnosis and Precision Treatment of Alcohol Use Disorder (AUD): Identifying the Neural Correlates of Key AUD Related Neurobehavioral Phenotypes.” What they have found is astounding and translational. These findings can and must profoundly change the way healthcare professionals diagnose and treat patients presenting with Alcohol Use Disorder (AUD).

Dr. Arias and his team performed MRIs on 78 patients diagnosed with AUD and 78 control subjects without the disease. Each subject participated in a detailed phenotyping battery before undergoing sessions of Magnetic Resonance Imaging (MRI). The team’s findings confirmed their hypotheses and previous researchers’ findings — that the neuroplasticity brain changes with prolonged excessive use of alcohol are profound.

Specifically, the chronic excessive use of alcoholic beverages hastens the neural activity in the Pre-Frontal Cortex – the area of the brain that controls Executive Functions: planning, prediction, caution, and impulse control and other key areas of the brain. Not to be facetious, but essentially this means that the individual with AUD, acts on a hijacked natural reward system. The research reveals that the neural pathways are severely disrupted – the neural transmissions are accelerated and as a result, severe organic damage to the neurons in these areas is sustained.

To simplify: what happens in our brains essentially is this: Dopamine, a neurotransmitter, is created and released by the Hippocampus when we experience a stimulus. If the stimulus one experiences was pleasurable, the dopamine speeds along the Mesolimbic Pathway to the Amygdala, which controls emotions. It hastens to the Nucleus Accumbens, which serves as an interface between motivation and action and so plays a key role in the reward sensation. Then the dopamine hits up the Frontal Cortex, the area controlling impulses, and the Hippocampus, where the dopamine release originated, creates a memory surrounding the circumstances of the experience. The Amygdala could be characterized as staging a takeover and begins usurping the Frontal Cortex to basically forego the planning or thinking about consequences. If that memory is pleasurable, the hippocampus creates and sustains the notion: “I want to do that again.”

In practical terms, in every day activity, the alcohol-addicted person may see a trigger or even simply idly think about doing the target behavior, and because his/her/their neural pathway has been compromised and accelerated by the chronic abuse of alcohol, this affected individual feels an irresistible compulsion to repeat the activity of over-imbibing alcohol to experience the pleasurable feeling again and again and again.

Conversely, the continued activation of this dopamine release, causes the Serotonin – the neurotransmitter that mediates satiation, happiness, focus, calmness and optimism, levels to go down. This explains why oftentimes, the person with AUD displays comorbid symptoms of anxiety, depression, and moreover, is very easily irritated. Perceived criticisms may be taken as major aggressions, inspiring an aggressive response. Persons suffering from AUD can be extremely emotionally reactive. The diminished levels of Serotonin result in the addicted brain being almost completely unaffected by negative consequences: loss of job, loss of loved one’s emotional and/or financial support, declining overall health —- all —- is compulsively sacrificed, perhaps with some reluctance, to the all-consuming desire to keep the Dopamine pathways buzzing with alcohol intake. I have heard it said, that to tell an alcoholic to use willpower and just stop, is akin to telling him to stop breathing. Those reading this article who have someone close to them suffering with AUD may readily recognize these features. And, it often becomes a “Chicken or egg?” question. Is a person who experiences anxiety and depression more prone to AUD, or does the AUD prompt the development anxiety and depression?

Why does all this matter? The statistics are staggering. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 29.5 million Americans suffer from AUD, that is almost 10 % of our population (June 2024). Alcohol Use Disorder and excessive drinking are responsible for approximately 178,000 deaths in the United States annually, making excessive alcohol use the 4th leading preventable cause of death in the U.S., only slightly behind tobacco, physical inactivity and drug overdose (NIAAA.NIH.gov). If nothing else causes actionable response to the disease of Alcohol Use Disorder, we might consider the cost to society in terms of dollars. Alcohol Abuse is a drain on the American economy, costing $250 billion yearly. The breakdown is as follows: Healthcare – $29 billion, Workplace Productivity – a whopping $179 billion, Collisions – $13 billion, and $25 billion in Criminal Justice costs. This is unacceptable and there is something that can be done about it.

Dr. Arias and his team have proven with MRI evidence, that AUD is a formidable physiological as well as psychological-behavioral disease. The evidence makes the journey to recovery seem impossible, as it sadly proved to be for my young adult son and so many others. But the team offers hope — especially because now that an MRI can pinpoint the location and extent of the pathophysiological damage, the team is confident that the future holds hope for patients and their families in terms of identification, diagnosis and hence the groundwork for a precision medicine approach to treatment. Much more research work is being contemplated, with the team taking the data from FAR’s seed grant and citing it in their applications for larger National Institute of Health grants to enlarge the sample size and extrapolate the results to healthcare practice protocols.

Possible precision treatment protocols include consistently pairing the traditional detox and extended rehabilitation with drug therapies, such as naltrexone, that promote abstinence or at the least, enact a significant reduction in alcohol consumption while measuring changes in MRI neuroactivity before and after such treatments. Then when those undeniable cravings are somewhat under control — follow-up with intense Cognitive Behavioral Therapies; yoga and meditation, and perhaps even more promising in the future —– adding innovative targeted deep brain stimulation or radiation therapies directed with precision to zap affected neurons and neural pathways.

Just as our extended lunch meeting was breaking up, Dr. Jim Bjork read my mind and remarked out loud about the synergy their team enjoys in their work. He observed, “Our individual unique skill sets complement each other really well.”

Yes – their superb team dynamics were evident: Dr. Arias is the fearless leader, dapper and steadfast master clinician. innovative and insightful chief investigator. Dr. Bjork is the behavioral analyst, the “Color Man” who provides background information, injects humor, and is a consummate professor, who enlightens by breaking complex concepts and processes into clear soundbites with examples.

Dr. Ma is the math genius, expert statistician, and data analyst, and master of brain connectivity research; with his interpretation, the research results become meaningful data, the data extrapolates into actionable forecasts of logical next steps. Dr. Hammond focuses on the youth population and keeps the group apprised of the ever-changing trends and it seems, exponentially increasing numbers of patients with AUD and is a futurist who looks forward to creating and implementing prevention protocols for youth. And Nurse Tiffany Pignatello is the glue who pulls the team into a cohesive unit, she is the facilitator and connector, who ensures resources are readily available, and takes on the role of First Welcomer – who makes initial contact and vets subjects.

Exciting next steps for the team are underway as they are preparing to publish the results of the study funded by FAR and the team has submitted a proposal to NIAAA to continue and expand the data from this project. In the meanwhile, they are embarking on a promising new line of research into psychedelic treatments for drug and alcohol addictions. All of this work is as yet too experimental to directly apply to daily healthcare practice, however, eventually the team is confident that this work will emerge to transform diagnosis and treatment for patients presenting with AUD! It was enlightening and energizing to spend time with this team of academic superheroes as they excitedly and precisely presented, explained and summarized their findings. The VCU team’s excitement was palpable as was the dedication to their quest for precise identification, diagnosis, prevention and treatment protocols for patients with Alcohol Use Disorder to amplify the impact of their research findings to everyday healthcare best practices.

By Kathleen Madden, President and Corresponding Secretary, Foundation for Alcohol Research (FAR)

About FAR, The Foundation for Alcoholism Research (FAR), is a 501(c)3 all-volunteer public charity, with its mission to raise and distribute funds to perform research into the causes, identification, prevention, treatment, and cure of Alcohol Use Disorder (AUD), observing over 15 years since its founding.