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Childhood trauma (CT) is frequent in patients with alcohol use disorder (AUD) and may impact on adult drinking behaviour and treatment outcome. This study aimed to investigate the structural correlates of CT in AUD, focusing on the amygdala, which plays a crucial role in the neurobiology of trauma. We hypothesized reduced amygdala volume and reduced structural connectivity as quantified by fractional anisotropy (FA) and by number of streamlines in those AUD patients with a history of moderate to severe CT (AUD-CT). T1-weighted MP2RAGE and diffusion-weighted imaging (DWI) 3-Tesla MRI-scans were acquired in 41 recently abstinent patients with AUD. We compared bilateral amygdala volume and structural connectivity (FA and number of streamlines) of pathways emanating from the amygdala between AUD-CT (n = 20) and AUD without CT (AUD-NT, n = 21) using a mixed model multivariate analysis of variance (MANCOVA) controlling for age and gender. AUD-CT displayed reduced FA and reduced number of streamlines of amygdalar tracts. There were no differences regarding amygdala volume. The severity of physical abuse, a subscale of the childhood trauma questionnaire, was negatively correlated with FA and with number of streamlines. AUD-CT and AUD-NT differ regarding structural connectivity of pathways projecting to and from the amygdala, but not regarding amygdala volume. Those alterations of structural connectivity in AUD-CT may represent a distinguishable neurobiological subtype of AUD, which might be associated with the complex clinical picture and poorer outcome that patients with CT and AUD often present.

AIMS For the first time in a clinical sample with alcohol use disorder (AUD), this study compared the effects of two versions of alcohol-specific inhibition training (Alc-IT) on drinking outcomes and on experimental parameters assessing two possible working mechanisms: stimulus devaluation and inhibitory enhancement. DESIGN Multicentre, double-blind, three-arm, clinical RCT with 3-, 6- and 12-month follow-up comparing standard Alc-IT, improved Alc-IT, and an active control condition. SETTING Three specialized AUD treatment centres in Switzerland. PARTICIPANTS N = 242 detoxified, recently abstinent patients with severe AUD (18-60 years; 29.8% female). Intervention and Comparator Both interventions (standard Alc-IT (n=84), improved Alc-IT (n=79)) and the comparator (unspecific inhibition training (n=79)) consisted of six sessions of a modified inhibitory task (Go-NoGo-task) with alcohol-related and neutral stimuli. Both versions of Alc-IT required response inhibition in alcohol-related trials but differed in Go/NoGo-ratios (standard: 50/50; improved: 75/25), with improved Alc-IT posing higher inhibitory demands. The control condition, an unspecific inhibition training, featured alcohol-related pictures in Go- as well as NoGo-trials. MEASUREMENTS The primary outcome, percentage of days abstinent, was assessed at 3-month follow-up with a timeline follow-back interview. FINDINGS The group receiving improved Alc-IT showed a significantly higher percentage of days abstinent at 3-month follow-up compared with the control group (γcontrol = 74.30 ; γimproved = 85.78 ; β = 11.48, 95% confidence interval (CI) [2.57, 20.40] p = .012, adjusted r2 = .062), while for standard Alc-IT no effect significantly different from zero was detected (γstandard = 70.95 ; β = -3.35 , 95%-CI [-12.20, 5.50], p = .457, adjusted r2 = -.04). CONCLUSIONS Alcohol-specific inhibition training with high inhibitory demands increased days abstinent at 3-month follow-up in patients with severe alcohol use disorder. Such an improved, inhibitory-demanding, alcohol-specific inhibition training outperformed the standard version of alcohol-specific inhibition training, suggesting an inhibitory working mechanism.