Abstract
BACKGROUND: Children of alcoholics (COAs) are at elevated risk for alcohol use disorders (AUD), yet not all COAs will develop AUD. The 2 primary aims of this study were to identify neural activation mechanisms that may mark protection or vulnerability to AUD in COAs and to map the same activation patterns in relation to risk behavior (externalizing or internalizing behavior). METHODS: Twenty-two adolescent COAs were recruited from an ongoing community longitudinal study of alcoholic and matched control families. They were categorized as either vulnerable (n = 11) or resilient (n = 11) based on the level of problem drinking over the course of adolescence. Six other adolescents with no parental history of alcoholism, and no evidence of their own problem drinking were recruited from the same study and labeled as low-risk controls. Valenced words were presented to the participants in a passive viewing task during functional magnetic resonance imaging. Activation to negative versus neutral words and positive versus neutral words were compared between groups. Behavior problems were assessed with the Youth Self-Report (YSR). RESULTS: The resilient COA group had more activation of the orbital frontal gyrus (OFG), bilaterally, and left insula/putamen than the control and vulnerable groups, in response to emotional stimuli. In contrast, the vulnerable group had more activation of the dorsomedial prefrontal cortex and less activation of the ventral striatum and extended amygdala, bilaterally, to emotional stimuli than the control and resilient groups. The vulnerable group had more externalizing behaviors which correlated with increased dorsomedial prefrontal activation and decreased ventral striatal and extended amygdala activation. CONCLUSIONS: These results are consistent with dissociable patterns of neural activation underlying risk and resiliency in COAs. We propose that the pattern observed in the resilient COAs represents an active emotional monitoring function, which may be a protective factor in this group. On the other hand, the vulnerable group displayed a pattern consistent with active suppression of affective responses, perhaps resulting in the inability to engage adaptively with emotional stimuli.