Neural, Motivational, and Psychological Measures of Pain Avoidance Predict Future Alcohol Use in Adult Drinkers

Drinking as a coping method in response to pain is a complex behaviour, involving multiple neural, motivational, and psychological factors. Among these factors, pain sensitivity and pain-related drinking motive can significantly promote alcohol use. In contrast, proactive avoidance - a beneficial strategy of initiating overt actions to avoid negative outcomes - reduces harmful consumption. Yet, these factors have not been assessed as potential predictors of future drinking behaviour. Here, in a longitudinal study we collected fMRI data in 50 drinkers who, at baseline, performed a probabilistic learning go/nogo task that involved proactive avoidance of painful electric shocks. Pain-related psychological measures and the neural correlates of proactive avoidance were examined in relation to participants' alcohol use and craving in the following 12 months. We found that deficits in proactive avoidance were associated with future drinking severity. Importantly, diminished activation of the dorsal anterior cingulate cortex (dACC) during proactive avoidance also predicted subsequent percentage of heavy drinking days. Using Bayesian network modelling, we established a potential pathway in which drinkers' heightened pain sensitivity led to greater pain-avoidance drinking motive and alcohol craving. Both craving and weakened dACC activation to proactive avoidance predicted higher levels of drinking during the follow-up period. Taken together, our study identified pain sensitivity, pain-avoidance drinking motive, and impaired proactive avoidance as predictors of future alcohol use severity. These findings highlight the roles of pain response, thus potentially informing interventions for individuals at risk of alcohol use disorders.