Academic journal article Alcohol Research

Neuroplasticity and Predictors of Alcohol Recovery

Academic journal article Alcohol Research

Neuroplasticity and Predictors of Alcohol Recovery

Article excerpt

Recovery from alcoholism is a complex and long-term process with high relapse rates. Therefore, understanding why people relapse has been critically important to improving treatment outcomes. To that end, researchers are looking for clinical and biological markers that predict relapse after treatment and to use those risk factors to develop effective treatments to reduce relapse rates. One promising research area is examining how alcohol changes structure and function in the brain, affecting what neuroscience calls neuroplasticity and causing neuroadaptations that can affect the brain's reward and decision-making centers and, in turn, affect relapse and recovery.

During recovery, individuals with alcohol use disorder (AUD) psychologically and physiologically recuperate from the deleterious effects of alcohol exposure by achieving complete abstinence or low-level, nonhazardous alcohol intake. The National Epidemiologic Survey of Alcohol-Related Conditions (NESARC) conducted 43,093 in-person interviews with a national sample of adults and found that 4,422 subjects, at some point prior to the past year, met the criteria for alcohol dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). According to the survey, during the preceding year, of those 4,422 alcohol-dependent people, 35.9 percent achieved either low-risk drinking (17.7 percent) or abstinence (18.2 percent) (Dawson et al. 2005). The study also noted that recovery rates tend to be even lower in clinical samples of people with severe dependence and for people with lifetime dependence or at high risk of relapse (Dawson et al. 2005). Additionally, the risk of relapse after treatment for AUD increases if people have concurrent conditions, such as anxiety or stress sensitivity (Kushner et al. 2005; Sinha et al. 2011).

In an effort to identify clinical and biological markers that predict relapse risk, researchers have looked toward the brain and alcohol-related changes in the brain that might make it more difficult for people with AUD to recover successfully. In particular, recent research has capitalized on advances in neuroimaging techniques to examine neuroplastic changes that may increase vulnerability to alcoholism and alcohol relapse (Buhler and Mann 2011). In fact, evidence suggests that chronic, heavy alcohol consumption is related to neuronal changes that target critical central nervous system (CNS) functions governing homeostasis, emotion regulation, and decisionmaking. These changes, in turn, may make it significantly more challenging for people to stop drinking and may result in various comorbid, psychological, and physiological symptoms (Bechara 2005; Breese et al. 2011). For instance, when people with AUD are abstinent, altered neural circuits of stress and reward modulation make them highly sensitive to stress and increase alcohol craving and other withdrawal symptoms, including anxiety, negative emotion, autonomic nervous system (ANS) disruption, fatigue, and sleep problems (Breese et al. 2011; Seo and Sinha 2014).

These chronic alcohol-related neuronal changes and their co-occurring symptoms, such as stress, may serve as markers of alcohol relapse and longterm recovery but are not currently addressed in most AUD treatment programs. Already there is evidence that people who maintain long-term abstinence show functional differences in resting-state brain synchrony relative to those with short-term abstinence (Camchong et al. 2013).

This paper reviews the evidence for neuronal changes associated with alcoholism in humans, including those resulting from acute and chronic effects of alcohol, and how these changes contribute to alcohol relapse. To help understand alcohol recovery in a clinical research setting, the review will specifically focus on neuroplastic changes associated with alcohol relapse immediately following treatment. This paper also reviews the effects of stress on alcohol-related neuroplasticity and alcohol recovery, along with relevant clinical implications and future research directions. …

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