Univariate and Multivariate fMRI Investigations of Delay Discounting and Episodic Future Thinking in Alcohol Use Disorder

Alcohol use disorder (AUD) remains a major public health concern globally with substantially increased mortality and a significant economic burden. The low rates of treatment and the high rates of relapse mean that excessive alcohol consumption detrimentally affects many aspects of the user's life and the lives of those around them. One reason for the low efficacy of treatments for AUD could be an unclear understanding of the neural correlates of the disease. As such, the studies in this dissertation aim at elucidating the neural mechanisms undergirding AUD, which could lead to more efficacious treatment and rehabilitation strategies. The propensity for impulsive decision making (choosing smaller, sooner rewards over larger, later ones) also known as delay discounting (DD), is an established risk-factor for a variety of substance abuse disorders, including AUD. Brain mapping of DD routinely uses modalities such as blood-oxygenation-level-dependent functional magnetic resonance imaging (BOLD fMRI). However, the extent to which these brain activation maps reflect the characteristics of impulsive behavior has not been directly studied. To examine this, we used multi-voxel pattern analysis (MVPA) methods such as multivariate classification using Support Vector Machine (SVM) algorithms and trained accurate classifiers of high vs. low impulsivity with individual fMRI brain maps. Our results demonstrate that brain regions in the prefrontal cortex encode neuroeconomic decision making characterizing DD behavior and help classify individuals with low impulsivity from individuals with high impulsivity. Individuals suffering from addictive afflictions such as AUD are often unable to plan for the future and are trapped in a narrow temporal window, resulting in short-term, impulsive decision making. Episodic future thinking (EFT) or the ability to project oneself into the future and pre-experience an event, is a rapidly growing area of addiction research and individuals suffering from addictive disorders are often poor at it. ...