Impaired Control Symptoms in Alcohol Use Disorder Show Convergent Associations Across Behavioral and Neural Markers of Inhibitory Control and Drinking Behavior
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Deficits in inhibitory control are considered a central feature of alcohol use disorder (AUD), yet behavioral and neuroimaging findings have been inconsistent. One potential explanation is the marked heterogeneity of AUD, which encompasses multiple symptom dimensions that may differ in their underlying neurocognitive mechanisms. In this study, we investigated whether behavioral and neural markers of inhibitory control are associated with specific DSM-5 AUD symptom domains. Methods A total of 589 participants (432 with non-treatment seeking AUD, 157 controls) completed a Stop-Signal Task (SST) during fMRI. Associations between DSM-5 symptom domains (impaired control over alcohol use, risky use, social problems, physical dependence) and SST performance, inhibition-related brain activation, and alcohol consumption were examined. Real-life drinking behavior was additionally assessed over 12 months using ecological momentary assessment (EMA). Results Greater impaired control symptom severity was associated with poorer performance on go trials and diminished post-error slowing during SST. At the neural level, higher impaired control symptom severity was associated with reduced activation across fronto-insular, parietal, cingulate, supplementary motor, and cerebellar regions. In contrast, other symptom domains showed little to no associations with inhibition-related behavioral or neural measures. Higher impaired control symptom severity was associated with greater alcohol consumption across questionnaire-based and EMA-based assessments. Conclusions In this large cohort, altered behavioral performance and recruitment of inhibition-related brain regions in the SST was selectively linked to impaired control symptoms. These findings highlight the importance of symptom-based approaches for understanding heterogeneity in addiction and may inform the development of more targeted interventions.
Authors: Justin Böhmer, Pablo Reinhardt, Marco Bottino, Christoph Bärtl, Fabian Arntz, Malin K. Hildebrandt, Hao Chen, Louis Thill, Johannes Petzold, Kerstin Ritter, Michael Rapp, Falk Kiefer, Patrick Bach, Bernd Lenz, Andreas Heinz, Gianna Spitta, Annika Rosenthal, Tanja Endrass, Michael N. Smolka, Rainer Spanagel, Gina-Isabelle Henze, Michael Marxen, Henrik Walter
Institutions: Humboldt-Universität zu Berlin, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Deutsches Zentrum für Psychische Gesundheit, Freie Universität Berlin, Charité – Universitätsmedizin Berlin, Technische Universität Dresden, University of Potsdam, University of Tübingen, Heidelberg University, Central Institute of Mental Health, Medizinische Fakultät Mannheim
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Deutsche Forschungsgemeinschaft
OpenAlex ID: W7221575533