Alcohol approach bias, a tendency to approach rather than to avoid alcohol and alcohol-related cues regardless of associated negative consequences, is an emerging key characteristic of alcohol use disorder (AUD). Reaction times from the Approach-Avoidance Task (AAT) can be used to quantify alcohol approach bias. However, only a handful of studies have investigated the neural correlates of implicit alcohol approach behavior. Graph Theory Analysis (GTA) metrics, specifically, weighted global efficiency (wGE), community detection, and inter-community information integration were used to analyze functional magnetic resonance imaging (fMRI) data of an in-scanner version of the AAT from 31 heavy drinking Veterans with AUD (HDV) engaged in out-patient treatment and 19 healthy Veterans as controls (HC). We found a functional imprint of alcohol approach bias in HDVs. HDVs showed significantly higher wGE values for approaching than for avoiding alcohol, indicating that their brain was more efficiently organized or functionally set to approach alcohol in the presence to alcohol-related external cues. In contrast, Brains of HCs did not show such a processing advantage for either the approach or avoid condition. Further post-hoc analyses revealed that HDVs and HCs differed in how they implemented top-down control when approaching/avoiding alcohol and in how the fronto-parietal control network interacted with subsystems of the default mode network. These findings contribute to understanding the complex neural underpinnings of alcohol approach bias and lay the foundation for developing more potent and targeted interventions to modify these neural patterns in AUD patients.

The authors have declared no competing interest.

Department of VA Clinical Science Research & Development: IK2CX001510 (Pennington); National Institutes of Health: DA039903 (Pennington

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