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Neural mechanisms of sexual decision-making in women with alcohol use disorder

Abstract

Rationale

The co-occurrence of alcohol consumption and sexual activity is associated with increased risk for sexual assault, sexually transmitted disease, and unplanned pregnancy among young adult women with alcohol use disorder (AUD). There is considerable previous work demonstrating neural reactivity to alcohol cues in AUD. Because alcohol consumption and sexual behavior are both rewarding and tend to co-occur, sexual cues may produce similar neural reactivity in women with AUD, possibly indicating a shared mechanism underlying reactivity to both types of cues. Alternatively, reactivity to alcohol versus sexual cues may be distinct, suggesting domain-specific mechanisms.

Objectives

We investigated whether the decision vulnerabilities in AUD women regarding sexual activity were related to differences in brain activation compared to control women.

Methods

Women with (n = 15) and without (n = 16) AUD completed a hypothetical decision-making task during fMRI that presented low- or high-risk scenarios involving visual sexual, appetitive, and neutral cues.

Results

Results showed that sexual cues were more often endorsed by women with AUD compared to controls and elicited differential brain activation patterns in frontal, visual, and reward regions. During high-risk decisions, women with AUD failed to downregulate activation, causing hyperactivation compared to controls.

Conclusions

Visual sexual cues produced reactivity like that previously demonstrated for alcohol cues, suggesting a shared or domain-general mechanism for alcohol and sexual cue reactivity in women with AUD. Riskier sexual decisions in women with AUD may be a consequence of repeatedly pairing alcohol use and sexual activity, a characteristic behavior of this population.

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Acknowledgements

This work was supported in part by R21 AA017638 to T.W. James.

Funding

Data collection was sponsored by the National Institute on Alcohol Abuse and Alcoholism, National Institute of Health.

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Authors

Contributions

K.L. Folco wrote the manuscript and contributed to portions of data analysis, L.R. Arcurio and T.W. James designed experiments, collected and analyzed data, and contributed to portions of the manuscript text. D.J. Fridberg contributed to preliminary analyses and manuscript preparation. P.R. Finn managed recruiting, screening, and testing of participants. J.R. Heiman provided guidance, expertise, and insight regarding sexual behavior to experimental design, analysis, and manuscript revisions.

Corresponding author

Correspondence to Thomas W. James.

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Folco, K.L., Fridberg, D.J., Arcurio, L.R. et al. Neural mechanisms of sexual decision-making in women with alcohol use disorder. Psychopharmacology 238, 1867–1883 (2021). https://doi.org/10.1007/s00213-021-05815-w

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Keywords

  • Female sexual risk
  • fMRI
  • Alcohol use disorder reward networks
  • Incentive sensitization
  • Decision-making
  • Alcohol use disorder
  • Cue reactivity
  • Co-sensitization