Dissociable brain signatures of choice conflict and immediate reward preferences in alcohol use disorders

<jats:title>Abstract</jats:title><jats:p>Impulsive delayed reward discounting (<jats:styled-content style="fixed-case">DRD</jats:styled-content>) is an important behavioral process in alcohol use disorders (<jats:styled-content style="fixed-case">AUDs</jats:styled-content>), reflecting incapacity to delay gratification. Recent work in neuroeconomics has begun to unravel the neural mechanisms supporting <jats:styled-content style="fixed-case">DRD</jats:styled-content>, but applications of neuroeconomics in relation to <jats:styled-content style="fixed-case">AUDs</jats:styled-content> have been limited. This study examined the neural mechanisms of <jats:styled-content style="fixed-case">DRD</jats:styled-content> preferences in <jats:styled-content style="fixed-case">AUDs</jats:styled-content>, with emphasis on dissociating activation patterns based on <jats:styled-content style="fixed-case">DRD</jats:styled-content> choice type and level of cognitive conflict. Heavy drinking adult men with (<jats:italic><jats:styled-content style="fixed-case">n</jats:styled-content></jats:italic> = 13) and without (<jats:italic><jats:styled-content style="fixed-case">n</jats:styled-content></jats:italic> = 12) a diagnosis of an <jats:styled-content style="fixed-case">AUD</jats:styled-content> completed a monetary <jats:styled-content style="fixed-case">DRD</jats:styled-content> task during a functional magnetic resonance imaging scan. Participant responses were coded based on choice type (impulsive versus restrained) and level of cognitive conflict (easy versus hard). <jats:styled-content style="fixed-case">AUD</jats:styled-content>+ participants exhibited significantly more impulsive <jats:styled-content style="fixed-case">DRD</jats:styled-content> decision‐making. Significant activation during <jats:styled-content style="fixed-case">DRD</jats:styled-content> was found in several decision‐making regions, including dorsolateral prefrontal cortex (<jats:styled-content style="fixed-case">DLPFC</jats:styled-content>), insula, posterior parietal cortex (<jats:styled-content style="fixed-case">PPC</jats:styled-content>), and posterior cingulate. An axis of cognitive conflict was also observed, with hard choices associated with anterior cingulate cortex and easy choices associated with activation in supplementary motor area. <jats:styled-content style="fixed-case">AUD</jats:styled-content>+ individuals exhibited significant hyperactivity in regions associated with cognitive control (<jats:styled-content style="fixed-case">DLPFC</jats:styled-content>) and prospective thought (<jats:styled-content style="fixed-case">PPC</jats:styled-content>) and exhibited less task‐related deactivation of areas associated with the brain's default network during <jats:styled-content style="fixed-case">DRD</jats:styled-content> decisions. This study provides further clarification of the brain systems supporting <jats:styled-content style="fixed-case">DRD</jats:styled-content> in general and in relation to <jats:styled-content style="fixed-case">AUDs</jats:styled-content>.</jats:p>