Two of the most striking features in alcoholism are the irresistible craving for alcohol and the proceeding neglect of other activities and pleasures that were formerly relevant. Craving has been investigated extensively and is commonly due to a dysfunctional reward system. The neural basis of the neglect of self-relevant interests, which can be described as altered personal reference, and its association to the reward system, however, remains unclear. Using fMRI, we investigated neural activity during a paradigm that tested for both reward and personal reference with regard to the same stimuli, i.e., alcoholic and nonalcoholic pictures, in healthy subjects and abstinent alcoholic patients. Alcoholic patients showed slightly reduced signal changes in the brain stem adjacent to ventral tegmental area (VTA) and in the ventromedial prefrontal cortex (VMPFC) during the reward task, while we found no alterations in the right and left ventral striatum (VS). The same regions (VS, VTA, and VMPFC), however, showed reduced signal changes during personal reference with lack of neural differentiation between high and low referenced stimuli in alcoholic patients. In summary, we demonstrate for the first time neurophysiological alterations in reward circuitry during personal reference in alcoholic patients. Our results underline the important role of the reward circuitry during personal reference in the pathophysiology of alcohol addiction. Hum Brain Mapp 30:1691-1704, 2009. VVC 2008 Wiley-Liss, Inc.
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