Development of a real-world simulated instrument for evaluating visuospatial working memory: a preliminary psychometric study on older adults.

BACKGROUND: A prevalent challenge in neuropsychological assessment, particularly when utilizing instruments designed for controlled laboratory environments, is that the outcomes may not correspond to an individual's real-life status. Accordingly, assessments of visuospatial working memory (VSWM) conducted in such settings might fail to capture certain facets of this function, as it operates in real life. On the other hand, entirely ecological assessments may risk compromising internal validity. This study aimed to develop an intermediate mode of assessment that measures VSWM in older adults by employing a setting, a task, and a response format that aligns closely with both laboratory and ecological assessments. Furthermore, a preliminary investigation was carried out to study the variations in spatial cognition among different demographic groups. METHODS: In a two-session study, 77 healthy older adults, eight patients with mild cognitive impairment (MCI), and seven patients with Alzheimer's disease (AD) were recruited to complete the wayfinding questionnaire (WQ), the Corsi block-tapping task (CBTT), and the Spatial Memory Table (SMT). The SMT is a novel instrument developed specifically for this study, aiming to provide a more accurate measure of VSWM performance in older adults' everyday life. Test-retest and split-half reliabilities, as well as the face, content, concurrent, convergent, and known-groups validities, were analyzed to investigate the psychometric properties of the SMT. RESULTS: The analyses were mainly centered on studying the psychometric properties of the SMT. Test-retest reliability (r = .753, p < .001) and split-half reliability (ρSC = 0.747) were found to be acceptable. Concurrent validity using CBTT (r = .264, p = .021), convergent validity using WQ subscales (navigation and orientation: r = .282, p = .014; distance estimation: r = .261, p = .024), and known-groups validity using the SMT scores among people with MCI and AD (χ2 = 35.194, df = 2, p < .001) were also indicative of the instrument's good validity. Data analysis also revealed acceptable levels of face validity (U = 4.50; p = .095) and content validity (CVR ≥ 0.60). As a result of comparing VSWM and wayfinding variables across genders and education levels, a significant difference was observed for navigation and orientation and spatial anxiety between women and men (p < .05). None of the variables were different among education levels. CONCLUSION: The SMT was found to be a reliable and valid tool for measuring VSWM performance in older adults. Given these findings, the SMT can be regarded as a measure that sufficiently approximates both laboratory and real-life demands for VSWM. Additionally, the instrument demonstrated a preliminary acceptable capacity to differentiate between healthy individuals and those with MCI and AD.

Disgust-reduction evaluative conditioning (DREC) and brain stimulation in patients with contamination-based obsessive-compulsive disorder: a protocol for a randomized control trial.

BACKGROUND: The negative emotional valence of a stimulus can be altered if paired with a pleasant stimulus, a phenomenon referred to as evaluative conditioning. Disgust, as a central emotion in obsessive-compulsive disorder (OCD), particularly in the contamination subtype, may be an appropriate target for such a method. We know that disgust processing and OCD pathophysiology share in some brain areas, including the orbitofrontal cortex, as the neuromodulation techniques targeted in this area have been able to decrease OCD symptoms. We aim to conduct a randomized clinical trial to investigate the evaluative conditioning effect on disgust reduction in patients with contamination-based OCD when administered with or without neuromodulation targeted orbitofrontal cortex. METHOD: In a single-blind randomized control trial (RCT), 55 patients with contamination-based OCD will be randomly assigned to four arms. In a factorial design, they will receive 10 sessions of evaluative conditioning training (either sham or real) plus cathodal transcranial direct current stimulation (tDCS) over the orbitofrontal cortex (either sham or real). The intensity of disgust experience and clinical symptoms will be investigated as primary outcomes and quantitative electroencephalogram and cognitive functions as secondary outcomes. The data will be collected at three assessment levels: baseline, after completing intervention sessions, and 2-month follow-up. DISCUSSION: The present RCT is the first study that applies evaluative conditioning training in the OCD clinical sample. It will clarify the effect of the evaluative conditioning method alone and with tDCS on disgust reduction in patients with contamination-based OCD. It will provide initial evidence for such an emotion modulation method in the OCD population. The effect of this emotion-focused protocol on cognitive functions and electroencephalogram components is also of interest. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05907369. Registered on 16 June 2023. Retrospectively registered.

Validity and Reliability of a Revised S-UPPS-P Impulsive Behavior Scale: The Interplay between Impulsivity and Working Memory.

Impulsivity is a multidimensional construct. The UPPS-P model of impulsivity differentiates five distinct dimensions: negative urgency, positive urgency, lack of premeditation, lack of perseverance, and sensation seeking. The present study, reports the first translation and validation of the recently revised short form of the UPPS-P scale (S-UPPS-P) on a Persian-speaking sample, examining the relationship between impulsivity and working memory. who also completed the Positive and Negative Affect Scale (PANAS), the Buss and Perry Aggression Questionnaire, the Behavioral Inhibition and Activation Scales (BIS/BAS), and the Wechsler Digit Span Task (WDST). A series of confirmatory factor analyses, and Cronbach's alpha results supported the factor structure of the scale. The findings supported the S-UPPS-P model's hypothesized correlations with PANAS, aggressiveness, and the construct validity of the model. The results of hierarchical regression analysis showed that backward and forward digit span scores of the WDST predicted the S-UPPS-P impulsivity scores over the portion explained by BIS/BAS, PANAS, and aggression scores. To conclude, the revised S-UPPS-P Impulsive Behavior Scale was well supported even in a very different population than usually sampled, adding to growing evidence that it assesses distinct but interrelated aspects of the impulsivity construct. Our findings also suggest that attentional capacities and working memory play important roles in the prediction of impulsivity.

Effectiveness of eye movement exercise and diaphragmatic breathing with jogging in reducing migraine symptoms: A preliminary, randomized comparison trial.

BACKGROUND: Migraine is a multifactorial headache disorder. Maladaptive functional networks or altered circuit-related connectivity in the brain with migraine appear to perturb the effects of usual treatments. OBJECTIVES: In the present preliminary trial, we aim to study the effectiveness of performing pieces of body-mind, cognitive, or network reconstruction-based training (i.e., eye movement exercise plus jogging; EME+J and diaphragmatic breathing plus jogging; DB+J) in decreasing migraine symptoms. METHODS: We used a three-arm, triple-blind, non-inferiority randomized comparison design with pre-test, post-test, and follow-up measurements to assess the effectiveness of EME+J and DB+J in the brain with migraine. Participants were randomly assigned to one of the study groups to perform either 12 consecutive weeks of EME+J (n = 22), DB+J (n = 19), or receiving, treatment as usual, TAU (n = 22). RESULTS: The primary outcome statistical analysis through a linear mixed model showed a significant decrease in the frequency (p = .0001), duration (p = .003), and intensity (p = .007) of migraine attacks among the interventions and measurement times. The pairwise comparisons of simple effects showed that EME+J and DB+J effectively reduced migraine symptoms at the post-test and follow-up (p < .05). Cochran's tests showed that interventions decreased the number of menses-related migraine attacks. EME+J and DB+J effectively decreased over-the-counter (OTC) drug use, refreshed wake-up mode, and improved sleep and water drinking patterns. These are the secondary outcomes that Cochran's tests showed in the interventional groups after the interventions and at 12 months of follow-up. CONCLUSION: EME+J or DB+J can be an effective and safe method with no adverse effects to decrease the symptoms of migraine attacks. Moreover, a reduction in the frequency of menstrual cycle-related attacks, OTC drug use, and improved quality of sleep and drinking water were the secondary outcomes of the post-test and a 12-month follow-up.

Individualized Web-Based Attention Training With Evidence-Based Counseling to Address HIV Treatment Adherence and Psychological Distress: Exploratory Cohort Study.

BACKGROUND: The prevalence of mood, trauma, and stressor-related disorders is disproportionately higher among people living with HIV than among individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders. OBJECTIVE: The objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress among people living with HIV. The study targeted African American and Latino young men who have sex with men, two population groups in the US that continue to experience disparities in HIV treatment outcomes. METHODS: Study participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the 4-week intervention received weekly counseling for adherence and daily access to web-based attention training via their personal mobile devices or computers. RESULTS: Of the 14 participants who began the intervention, 12 (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to antiretroviral therapy declined from 42% at baseline to 25% at intervention completion (P=.02, phi=0.68). Mean depressive symptoms measured by the 9 item Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, Cohen d=1.2). In addition, participants' attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (P=.01 and P=.02) and were accompanied by large effect sizes ranging from 0.78 to 1.0. CONCLUSIONS: Our findings support the feasibility of web-based attention training combined with counseling to improve antiretroviral therapy adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up.

The prospective association between illicit drug use and nonprescription opioid use among vulnerable adolescents.

In recent years, more than half of all drug overdose deaths in United States involved an opioid. To address this epidemic, antecedents to opioid misuse must be identified and empirically validated. The objective of the current investigation was to examine whether illicit drug use was prospectively associated with nonprescription opioid use among adolescents from a vulnerable population with a greater prevalence of substance abuse. A population-based cohort study of 1060 adolescents from 29 alternative high schools in southern California was conducted over a two-year period. A total of 929 adolescents (mean age 17.5 years, 49.9% female, 76.4% Hispanic) who had not experimented with nonprescription opioids at the baseline assessment were included in the analytic sample. The outcome was self-reported use of nonprescription opioids within two years. The predictors tested were illicit drug use, illicit drug use excluding marijuana, and the use of nonmedical marijuana. Covariates included age, sex, ethnicity, socioeconomic status, parental education, weekly income, sensation seeking, stress, anxiety, depression, and the use of alcohol and nicotine products. Multilevel, covariate-adjusted logistic regression models indicated that the odds of experimentation with nonprescription opioids was greater among adolescents who had used illicit drugs or illicit drugs excluding marijuana. Nonmedical marijuana use alone was a statistically significant predictor in unadjusted but not covariate-adjusted models. While prior studies have examined the progression from nicotine, alcohol, and marijuana use to nonprescription opioid use, the present findings emphasize the importance of illicit drug use as a detectable and empirically supported risk factor for future opioid misuse.

The Investigation of Simultaneous EEG and Eye Tracking Characteristics During Fixation Task in Mild Alzheimer's Disease.

Alzheimer's disease (AD) is a neurodegenerative disorder that occurs many years before the first clinical symptoms. Finding more exact, significant, and valuable criteria or indices for the diagnosis of the mild form of Alzheimer's disease is very important for clinical and research purposes. Electroencephalography (EEG) and eye tracking biomarkers would provide noninvasive tools for the early detection of AD. Due to the advantages of EEG and eye tracking, in this study, we employed them simultaneously to conduct research on the mild AD. For this purpose, 19 patients with mild AD were compared with 19 gender- and age-matched normal subjects who did not have any history of cognitive or neurological disorders. EEG and eye-tracking data were concurrently collected in both groups in a fixation task. Our results revealed that the total fixation duration was significantly shorter for the AD patients, but their fixation frequency was more than that of the controls. In addition, increased theta power and decreased alpha power were observed in the AD group. Interestingly, there was a statistically significant correlation between fixation frequency and alpha power in the parietal area in the control group. However, this connection was not statistically significant in the AD group. The findings also indicated an elevated coherence in the AD patients in the parieto-occipital area. It is assumed that the AD patients might use the neural compensational processes for the fixation state. This study provides evidence for the simultaneously EEG and eye-tracking changes in the areas, which are involved in the control of the fixational eye movements.

Differential effects of stimulant versus opiate drugs on driving performance.

BACKGROUND AND AIMS: Pharmacological differences among different drug classes influence human cognition, visual, and motor behavior in different ways. These differences impact driving safety, and therefore individuals who use stimulant and opioid drugs might experience different patterns in driving safety and impairment in driving performance. This study examined the effect of long-term use of stimulant drugs and of opiate drugs on driving performance, hazard perception, visual search skills and psychomotor skills related to driving. METHODS: A total of 75 individuals, including 28 predominantly stimulant users, 22 predominantly opiate users and 25 healthy non-drug users, participated. Driving performance and psychomotor skills were assessed via a 15-minute drive in a simulator; hazard perception was assessed via a computerized task; and visual search skill was assessed by eye tracking. RESULTS: ANOVA analyses indicate both stimulant and opiate users drove at higher speeds and experienced more crashes than the healthy non-drug users. Stimulant but not opiate users violated red light regulations more often than the healthy non-drug users. In the hazard perception task, stimulant drug users performed more poorly than both opioid drug users and healthy non-drug users. Specifically, they had lower saccade movement scores and higher average fixation times. CONCLUSIONS: Results confirm that both stimulant drug users and opiate drug users show impaired driving performance compared to healthy non-drug users. Stimulant drug users possessed poorer hazard perception skills compared to the opiate users and the control group, perhaps as a result of cognitive deficits created by the drug use.

Feasibility of using a computer-assisted working memory training program for healthy older women.

Interventions for age-associated cognitive impairment are of increasing significance as populations age. Using N-back and memory strategy enhancement, the present study aimed to explore the feasibility of using, and outcomes of a working memory (WM) training program on visuospatial and verbal WM in older female adults. Older women from two comparable local health centers who scored 26 and higher on Mini-Mental State Examination were invited to participate. Women at one center (experimental group) received three sessions on memory enhancement techniques and a computerized training program with N-back. Women at the other center (control group) received three sessions on memory and aging and training on using various features of cellphones. All participants completed the Corsi Block Task and Digit Span Task at pre- and post-training. The experimental group showed significant improvements in their visuospatial and verbal WM compared to the control group. These findings support the brain's plasticity in the elderly. WM training for improving cognitive performance in older adults has potential and should be further investigated.

Effectiveness of cathodal tDCS of the primary motor or sensory cortex in migraine: A randomized controlled trial.

OBJECTIVES: Transcranial Direct Current Stimulation (tDCS) is a new technology that is extensively used for migraine treatment. The present study aims to examine the effectiveness of cathodal-tDCS (c-tDCS) in decreasing migraine pain frequency, duration, and intensity at the right primary motor cortex (M1) or sensory cortex (S1) in individuals with episodic or chronic migraine. METHODS: The present study has a randomized, single-blind, and sham-controlled design. It tests the effectiveness of 22 sessions of c-tDCS (20min/1000 µA) in 45 migraine patients (episodic = 35; chronic = 10/with aura = 28; without aura = 17). Spread over 10 consecutive weeks, the sessions started with three sessions per week and ended with one session per week. Participants were tested at the baseline, at the end of intervention, and at 12-month follow-up. The migraine diagnosis was based on criteria set by International Headache Society (IHS) and patients were allocated to two experimental (nm1 = 15; ns1 = 15) and a sham intervention group (nc = 15). RESULTS: The results of a series of MANCOVAs showed a significant reduction (p < 0.05) in all hypothesized symptoms of migraine pain in both experimental groups compared to the sham intervention group at the posttest and follow-up. CONCLUSION: The application of c-tDCS to M1 or S1 can be used as a technological intervention for the prophylactic and therapeutic treatment of episodic or chronic migraine. ETHICAL COMMITTEE REGISTRATION NUMBER: Ir.mums.fm.rec.1396.362.

Aggression, emotional self-regulation, attentional bias, and cognitive inhibition predict risky driving behavior.

The present study explored whether aggression, emotional regulation, cognitive inhibition, and attentional bias towards emotional stimuli were related to risky driving behavior (driving errors, and driving violations). A total of 117 applicants for taxi driver positions (89% male, M age=36.59years, SD=9.39, age range 24-62years) participated in the study. Measures included the Ahwaz Aggression Inventory, the Difficulties in emotion regulation Questionnaire, the emotional Stroop task, the Go/No-go task, and the Driving Behavior Questionnaire. Correlation and regression analyses showed that aggression and emotional regulation predicted risky driving behavior. Difficulties in emotion regulation, the obstinacy and revengeful component of aggression, attentional bias toward emotional stimuli, and cognitive inhibition predicted driving errors. Aggression was the only significant predictive factor for driving violations. In conclusion, aggression and difficulties in regulating emotions may exacerbate risky driving behaviors. Deficits in cognitive inhibition and attentional bias toward negative emotional stimuli can increase driving errors. Predisposition to aggression has strong effect on making one vulnerable to violation of traffic rules and crashes.

Free will in addictive behaviors: A matter of definition.

Certain people are at risk for using alcohol or other drugs excessively and for developing problems with their use. Their susceptibility might arise from a variety of factors, including their genetic make-up, brain chemistry, family background, personality and other psychological variables, and environmental and sociocultural variables. Moreover, after substance use has become established, there are additional cognitive-motivational variables (e.g., substance-related attentional bias) that contribute to enacting behaviors consistent with the person's motivation to acquire and use the substance. People who are at such risk are likely to choose to use addictive substances even though doing so entails negative consequences. In the sense of complete freedom from being determined by causal factors, we believe that there is no such thing as free will, but defined as ability to make choices from among multiple options, even though the choices are ultimately governed by natural processes, addicted individuals are free to choose. Although they might appear unable to exercise this kind of free will in decisions about their substance use, addictive behaviors are ultimately always goal-directed and voluntary. Such goal pursuits manifest considerable flexibility. Even some severely addicted individuals can cease their use when the value of continuing the use abruptly declines or when the subjective cost of continuing the use is too great with respect to the incentives in other areas of their lives. Formal treatment strategies (e.g., contingency management, Systematic Motivational Counseling, cognitive training) can also be used to facilitate this reversal.

Efficacy of the attention control training program on reducing attentional bias in obese and overweight dieters.

Evidence indicates that attentional bias and dieter's eating styles (i.e., external, emotional, restraint) play important roles in the success or failure of dieters. First, we studied food-related attentional bias (FAB; based on interference scores on a modified Stroop test), eating styles (Dutch Eating Behavior Questionnaire), and increases in body mass index (BMI) in overweight or obese dieters (n = 34) and nondieters (n = 35). Compared with nondieters, dieters showed higher FAB, which was positively associated with BMI. In addition, the majority of overweight and obese participants had higher scores on emotional and restrained eating styles. Second, we investigated the effect of a Food Attention Control Training Program (Food-ACTP) on reducing FAB and dieting success. Dieters (n = 49) were divided into three groups: intervention (training), no-intervention (control), and sham-intervention, all of whom were measured at pretest, posttest, and follow up. Only the intervention group showed reductions in their FAB, diet failure rate, and BMI at follow up. For the intervention group, there was a significant interaction between changes in FAB and eating styles in predicting decreases in BMI. Overall, this work shows that attentional bias plays an important role in eating behavior, and dieters can benefit from practicing with Food-ACTP as a complimentary intervention. The exact mechanism through which Food-ACTP improves dieting success awaits further investigation.

Enhanced visual performance in obsessive compulsive personality disorder.

Visual performance is considered as commanding modality in human perception. We tested whether Obsessive-compulsive personality disorder (OCPD) people do differently in visual performance tasks than people without OCPD. One hundred ten students of Ferdowsi University of Mashhad and non-student participants were tested by Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), among whom 18 (mean age = 29.55; SD = 5.26; 84% female) met the criteria for OCPD classification; controls were 20 persons (mean age = 27.85; SD = 5.26; female = 84%), who did not met the OCPD criteria. Both groups were tested on a modified Flicker task for two dimensions of visual performance (i.e., visual acuity: detecting the location of change, complexity, and size; and visual contrast sensitivity). The OCPD group had responded more accurately on pairs related to size, complexity, and contrast, but spent more time to detect a change on pairs related to complexity and contrast. The OCPD individuals seem to have more accurate visual performance than non-OCPD controls. The findings support the relationship between personality characteristics and visual performance within the framework of top-down processing model.

Effects of attention control training on drug abusers' attentional bias and treatment outcome.

OBJECTIVE: Attentional bias for drug-related stimuli (Drug-AB) has been shown to play an important role in drug abuse, drug treatment, and relapse. This study sought to retrain Drug-AB using the Drug Attention Control Training Program (Drug-ACTP) on a sample of Iranian drug abusers. METHOD: The experimental group (n = 24) received 3 sessions of training with the Drug-ACTP in addition to treatment as usual; the control group (n = 24) received only treatment as usual. All participants completed a demographic questionnaire, the drug-Stroop test, measures of physiological cue reactivity, the Personal Concerns Inventory (a measure of motivational structure), Persian Temptation Scale, Perceived Stress Scale (PSS), Positive Affect and Negative Affect Schedule (PANAS), Situational Confidence Questionnaire (SCQ), and Readiness to Change Questionnaire (RTCQ). All participants were tested at baseline, posttraining, and a 2-month follow-up. A brief, 6-month telephone follow-up was also conducted to monitor their temptation, SCQ, RTCQ, PANAS, and PSS scores; doses of medicine taken; and number of lapses. RESULTS: The results showed that, compared to the control group, the experimental group showed (a) reductions in Drug-AB, temptations to use, doses of medicine, and number of lapses; and (b) increases on the RTCQ and 2 subscales of the SCQ. Regardless of group membership, adaptive motivation was positively correlated with success in achieving therapeutic goals, and negatively associated with doses of methadone taken and number of relapses. CONCLUSIONS: It seems that attentional training can be an important addition to methadone maintenance therapy. (PsycINFO Database Record

Neuroscience of attentional processes for addiction medicine: from brain mechanisms to practical considerations.

The present chapter first argues how having a goal for procuring alcohol or other substances leads to the development of a time-binding, dynamic, and goal oriented motivational state termed current concern, as the origin of substance-related attentional bias. Next, it discusses the importance of attentional bias in the development, continuation of, and relapsing to substance abuse. It further proceeds with a review of selective evidence from cognitive psychology that helps account for making decisions about using an addictive substance or refraining from using it. A discussion on the various brain loci that are involved in attentional bias and other kinds of cue reactivity is followed by presenting findings from neurocognitive research. Finally, from an interdisciplinary perspective, the chapter presents new trends and ideas that can be applied to addiction-related cognitive measurement and training.

Executive Function: Comparing Bilingual and Monolingual Iranian University Students.

The study aimed to examine whether Kurdish-Persian early Bilingual university students (EBL) and Persian Monolingual university students (ML) differ on tasks of executive function (EF). Thirty male EBL and 30 male ML students from Ferdowsi University of Mashhad completed a Persian Stroop Color-Word task (SCWT), Backward Digit Span Test (BDST), Raven Standard Progressive Matrices, and a demographic questionnaire. The results of an analysis of variance showed EBL students responded faster on the SCWT compared with ML students, suggesting an inhibition advantage for EBL students. Moreover, mean scores of BDST showed better performance of EBL students in working memory than ML students. These results provided evidence of advantaged EF among EBL and were consistent with the possibility that individuals who began speaking a second language (L2) earlier in childhood have greater advantages, due either to effects of acquiring an L2 earlier or to a longer duration of bilingual experience.

A Combi-Stroop test for measuring food-related attentional bias.

There are methodological complexities with the supraliminal-lexical versions of the modified versions of the Stroop tests that could be responsible for inconsistencies across the literature (Field & Cox, 2008). We tested whether a combination of subliminal-pictorial and classic Stroop tests can differentiate between dieters' and nondieters' food attentional bias (FAB). Participants were dieters (n = 30) and nondieters (n = 32) who were tested 3 hr after having a meal. Each picture from among 24 high-calorie and 24 low-calorie food pictures was presented for 32 ms before the appearance of a congruent or an incongruent color word, in response to which participants were required to manually report, via a tagged keyboard, the correct color of the word as quickly and accurately as possible. Color-naming latencies and interference scores were calculated. Dieters showed the highest reaction times to incongruent color words following high-calorie food pictures; overall, dieters showed significantly higher FABs than nondieters. The Combi-Stroop test has differential validity. Moreover, findings suggest that FAB can result from early allocation of dieters' attention to food-related stimuli.

Differentiating heavy from light drinkers by neural responses to visual alcohol cues and other motivational stimuli.

The course to alcohol dependence often starts with a preclinical period of heavy drinking. The present article reports functional magnetic resonance imaging data showing that even this pattern of alcohol consumption is associated with maladaptive neural responses to alcohol and other stimuli. When participants were confronted with visual cues related to alcohol, heavy drinkers showed amplified blood oxygen level-dependent signal responses in specific emotional areas (insular cortex) and in parts of the brain's reward circuitry (ventral striatum). This neuronal amplification was not present in light drinkers. Crucially, at the same time heavy drinkers showed reduced responses in frontal areas to pictures related to higher order life goals and in the cingulate cortex to appetitive food stimuli, suggesting that they have difficulty finding alternative, socially desirable goals. Using discriminant function analysis, we demonstrate that the combination of alcohol-related overactivation and underactivation to alternative goals allows heavy and light drinkers to be differentiated with a high degree of precision. Our findings highlight the diagnostic value of functional brain mapping of cue reactivity. Imaging measures may help to identify addictive dispositions in preclinical stages and to clarify the mechanisms that underlie the development and maintenance of alcohol dependence.