# Alcohol, Approach-Avoidance, and Neurocircuitry Interactions in PTSD

> **NIH NIH R01** · UNIVERSITY OF TEXAS AT AUSTIN · 2024 · $670,804

## Abstract

Individuals with posttraumatic stress disorder (PTSD) have greater prevalence of alcohol use disorders (AUDs),
with this comorbidity associated with worse illness outcomes, yet there remains limited mechanistic
understanding of how PTSD confers risk for AUD. Understanding risk factors that associate with and predict the
development of AUDs in PTSD could inform interventions and prevention efforts to reduce the rate of this
comorbidity and improve outcomes of both disorders. Identifying predictors of risk requires longitudinal studies
in PTSD aimed at capturing the mechanisms leading to the emergence of AUDs. There is growing evidence
PTSD is related to biased decision-making during approach-avoidance conflict. Alcohol is also suggested to alter
approach-avoidance decision-making. AUDs and acute alcohol intoxication is associated with a bias to seek out
reward despite the possibility of threat (e.g., contributing to relapse following alcohol cue exposure and risky
behavior during intoxication respectively). Alcohol-induced changes in approach-avoidance decision-making
have not been investigated in the context of PTSD, but emerging data support our hypothesis that an interaction
between alcohol and approach-avoidance conflict in PTSD may occur and contribute to risk for alcohol misuse
and development of alcohol problems. No current data, cross-sectional or longitudinal, have tested the role of
alcohol-induced changes in approach-avoidance conflict as a mechanism of risk for AUD among individuals with
PTSD. To address this gap, we propose to leverage our group's expertise in placebo-controlled alcohol
administration procedures, longitudinal modeling, functional neuroimaging, and computational neuroscience
approaches to investigate the effects of acute alcohol on approach-avoidance decision-making and mediating
changes in multivariate neurocircuitry patterns in limbic, striatal, and salience networks. The proposed study will
test our conceptual model positing that acute alcohol alters the relative bias in computational mechanisms for
threat vs reward, thereby decreasing avoidance to threat and increasing approach to reward in adults with PTSD,
and through this mechanism increases risk for heavier alcohol use over time. Research aims are to identify
alcohol-induced changes in approach-avoidance decision-making and mediating neural networks that predict
alcohol use and symptoms of AUDs over a one-year follow-up period in adults with PTSD, compared to adults
with interpersonal violence exposure but no PTSD and healthy comparison adults. Essential to successfully
improving clinical prognosis in PTSD are research results that enable better prediction, diagnosis, and treatment
based on the individual. There is a paucity of human clinical research investigating interactions between acute
alcohol exposure and PTSD that may drive risk for development of AUDs following trauma. Data could identify
brain and behavioral mechanisms explaining how alcohol alters an...

## Key facts

- **NIH application ID:** 10849860
- **Project number:** 5R01AA030740-02
- **Recipient organization:** UNIVERSITY OF TEXAS AT AUSTIN
- **Principal Investigator:** Joshua M Cisler
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $670,804
- **Award type:** 5
- **Project period:** 2023-06-01 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10849860

## Citation

> US National Institutes of Health, RePORTER application 10849860, Alcohol, Approach-Avoidance, and Neurocircuitry Interactions in PTSD (5R01AA030740-02). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10849860. Licensed CC0.

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