Early event-related potential differentiation of alcohol cues associates with subjective craving levels in severe alcohol use disorder.

OBJECTIVE

Alcohol use disorder (AUD) contributes to 4.7% of deaths worldwide, yet assessment relies on subjective craving reports. Event-related potentials (ERPs) provide objective markers of cue reactivity linked to craving and motivational salience. However, emphasis on later components (P3) may overlook earlier, automatic processes reflecting the transition from controlled to habitual responding. This study examined whether early and late ERP components differentiate alcohol from non-alcohol stimuli in severe AUD and associate with craving.

METHODS

Seventy-eight inpatients with severe AUD completed cue-reactivity (CR) and go/no-go (GNG) EEG tasks using personalized alcohol and non-alcohol stimuli. ERPs were analyzed in early (100-200 ms, 200-350 ms) and late (350-650 ms) windows, and their relationship with craving examined.

RESULTS

Alcohol stimuli in the CR task generated significantly more positive ERP amplitudes than non-alcohol stimuli across all windows. Differences correlated positively with craving. The GNG task produced a robust GNG effect but minimal alcohol/non-alcohol differentiation.

CONCLUSION

Early neural responses to alcohol-related cues emerge before the P3, demonstrating rapid, automatic differentiation. These differences correlate strongly with craving.

SIGNIFICANCE: This is the first study showing early neural differentiation of alcohol cues in patients with severe AUD. Associations with craving may serve as objective markers of addiction severity.