fMRI of the brain's response to stimuli experimentally paired with alcohol intoxication.

Rationale: Individuals learn associations between alcohol's sensory properties and intoxication, with such conditioned stimuli (CS) becoming involved in craving and relapse. However, these CS also carry idiosyncratic associations.

Objectives: This study aimed to test brain responses to novel CS conditioned with alcohol intoxication.

Methods: Fourteen heavy drinkers (age 24.9 ± 3.2) performed a reaction time task with embedded novel geometric CS and were told only that the task was to measure alcohol's effect on speed. Rapid intravenous alcohol infusion (the unconditioned stimulus; UCS) began with the appearance of a CS+, using pharmacokinetic modeling to increment breath alcohol by ~18 mg% in 200 s per each of six CS-UCS pairings. Placebo-saline infusion with CS- used the same infusion parameters in same-day randomized/counterbalanced sessions. The next morning subjects, connected to inactive intravenous pumps, underwent functional magnetic resonance imaging (fMRI) of the same task with mixed brief presentations of CS+, CS-, and irrelevant CS and were told that alcohol could be infused at any time during imaging.

Results: CS- responses were significantly greater than those of CS+ in medial frontal cortex. Notably, CS+ responses were negative, suggesting reduced neural activity. Negative activity was most pronounced in early scans, extinguishing with time. As subjects were told that alcohol could be administered in fMRI, a CS+ without alcohol is similar to a negative prediction error, with associated reduced frontal activity during withheld reward.

Conclusions: Novel stimuli relatively free of demand characteristics can be classically conditioned to intermittent brain exposure of even low alcohol concentrations, permitting imaging studies of conditioned alcohol expectancies.