Neurostructural correlates of real-life social drinking risk in alcohol use disorder

Abstract

The social context of alcohol consumption is increasingly recognized as an important factor in the development of alcohol use disorder (AUD). However, individuals with AUD may differ in how strongly alcohol use by people around them is associated with their own drinking, and the neurostructural basis of this variation remains unclear. Here we studied 83 individuals with AUD (53 men, 30 women; mean [SD] age, 37.20 [12.42] years; median DSM-5 AUD criteria, 4) using six weeks of ecological momentary assessment and structural magnetic resonance imaging (n = 80). Across 5,221 non-solitary observations, greater exposure to surrounding drinkers was associated with increased odds of momentary drinking (odds ratio, 4.23; 95% CI, 3.60-4.97), with significant between-person variation that we quantified as social drinking risk (SDR). Higher SDR was associated with lower gray matter volume in the pregenual anterior cingulate cortex (T = 5.40; P < .001) and weaker pregenual anterior cingulate cortex-ventral striatum structural covariance (T = 3.15; P = .032). These findings support SDR as an ecologically grounded phenotype linking daily-life social-context sensitivity to cingulostriatal structure, with potential relevance for mechanistic and interventional research in AUD.