Research Helps Explain Why Long-Term AA Members Are Less Likely to Relapse

Alcoholics Anonymous (AA) is the modality most often used in America to help people with substance use disorder achieve recovery. There is little evidence, however, of the brain mechanisms that are associated with AA-based abstinence. During the annual meeting symposium “Recent Advances in Substance Abuse Treatment” by Marc Galanter, M.D., a professor of psychiatry and director of the Division of Alcoholism and Drug Abuse at New York University School of Medicine, described how he and his colleagues used imaging techniques to study neural correlates of the way AA members respond to alcohol-related triggers.

When the team began surveying long-term AA members, the respondents typically reported little or no craving for alcohol in their daily lives. They designed their study to clarify the neural correlates of this diminished alcohol craving in a controlled setting. To do this, the research team employed AA-related prayer as a proxy for the fellowship’s approach to suppression of craving. Photographs related to drinking were shown to subjects while they were in a functional magnetic resonance imaging (fMRI) scanner. This was done after passive viewing, after they read neutral material, and also after reading AA prayers. Subjective reports of craving were lower following the AA prayer, and this decrease was correlated with the degree subjects had been involved in AA. This prayer effect was found to be associated with prefrontal and parietal areas related to endogenous attention and control of emotions, and with posterior temporal areas related to semantic reappraisal of emotion.

Craving during early abstinence from alcohol has been found to be associated with activation of the ventral striatum, said Galanter. In this study, however, there was no significant difference in activation in the ventral striatum across the three conditions tested. After a long period of abstinence, it may be that the subjective experience of craving is the product of a conditioned emotional response to alcohol triggers that is experienced as alcohol craving and is independent of striatal activation.

A reduction in the subjective experience of craving among AA members may therefore reflect their experience in the fellowship and its impact on neural mechanisms for management of attention and emotion. The findings are significant because they help to clarify why long-term AA members have diminished vulnerability to relapse. They may also shed light more generally on the nature of successful long-term abstinence in alcohol-dependent people. Techniques of modifying a conditioned response to alcohol triggers, as in AA, may represent an option for treating alcohol use disorders, said Galanter.

Galanter is the coeditor of the American Psychiatric Publishing Textbook of Substance Abuse Treatment, Fifth Edition from American Psychiatric Publishing. APA members can purchase the book at a discount here.

Watch a video interview of Galanter as he explains his research.