From childhood adversity to daily craving: Sex-specific neural alcohol cue reactivity

What is it about?

Childhood adversity, such as abuse or neglect, play a major role in the development of alcohol use disorder (AUD), and their impact appears to differ between females and males. One possible pathway is the brain's response to alcohol cues: in people with AUD, seeing alcohol activates brain regions involved in reward, attention, and self-control, and these responses are linked to craving and drinking. We therefore asked whether childhood adversity is linked to these brain responses differently in females and males, and whether these responses relate to AUD-related outcomes in everyday life. We studied 231 adults (94 female, 137 male) with mostly mild to moderate AUD who were not in treatment. Participants reported their childhood experiences in a questionnaire. In an MRI scanner, they viewed pictures of alcoholic and non-alcoholic drinks. Afterwards, they reported their craving and drinking in a smartphone diary every other day for 12 months. We analyzed average craving and alcohol use over the first 90 days. The link between childhood adversity and brain responses differed by sex. In female participants, more childhood adversity went along with stronger responses to alcohol cues in a frontal brain region (left superior frontal gyrus and anterior cingulate cortex), and stronger responses were linked to more craving in daily life. In male participants, more childhood adversity went along with weaker responses in this region. Neither childhood adversity nor brain responses were related to how much participants drank.

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Photo by Akhil Pawar on Unsplash

Photo by Akhil Pawar on Unsplash

Why is it important?

Most people with alcohol use disorder never seek treatment, and reliable biological markers of risk are still lacking. Our findings suggest that childhood adversity is linked to the brain's response to alcohol cues differently in females and males, and that in females, these responses relate to craving in everyday life. Because craving is a core symptom of AUD and predicts relapse, this brain pathway may help identify people at risk early, before drinking escalates. This supports sex-sensitive, trauma-informed prevention and treatment, especially for people with milder AUD who rarely reach care. The effects were modest and need to be confirmed in future studies.

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