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Brain Imaging Reveals Why ‘One Day at a Time’ Works

Female hand rejecting glass with alcoholic beverage
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Individuals struggling with alcoholism often use the phrase “one day at a time” to help them on their paths to recovery. Now, by imaging the brains of people diagnosed with alcohol use disorder (AUD), researchers at Yale have figured out just why that strategy is so effective.

Short Circuit

The brain scans revealed that there was a disruption between two areas of the brain in individuals exhibiting AUD: the ventromedial prefrontal cortex and striatum. These two brain areas form what is known as the “reward circuit”  and are involved in decision making— a critical skill needed by someone looking to avoid succumbing to additional drinking.

In conducting the study, researchers used a functional MRI to observe the brains of study participants in both a control group and a group experiencing AUD. They showed the participants a series of images in three categories: neutral, stressful, those containing alcohol cues. They found that in people with AUD, the ventromedial prefrontal cortex showed significant activity when shown the neutral images. Still, with both the stressful images and those linked to alcohol, there was a significant lack of activity between that region and the striatum.

Timing Matters

They further noted when participants had their last drink—anywhere from one day to two weeks before the scan—and found that the brain disruption was more severe closer to the time of the last drink, which likely explains why it’s particularly challenging for alcoholics to take the initial step of quitting and sticking with it. The severity of the disruption was found to be a good predictor of future heavy drinking behavior.

As time wore on, however, the disruption began to repair, which offers hope for therapeutics that might act on the affected brain region. This could help those starting in recovery have a greater chance of success. The researchers are currently examining whether or not certain high blood pressure drugs might accomplish this goal.

“For people with AUD, the brain takes a long time to normalize, and each day is going to be a struggle,” said Rajita Sinha, the Foundations Fund Professor of Psychiatry and professor in the Child Study Center, professor of neuroscience, and senior author of the study. “For these people, it really is ‘one day at a time.'”

The research has been reported in the peer-reviewed American Journal of Psychiatry.