We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Brain Imaging Biomarkers to Predict Relapse in Alcohol Addiction

Nora D. Volkow, MD1; Ruben D. Baler, PhD1
[+] Author Affiliations
1National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland.
JAMA Psychiatry. 2013;70(7):661-663. doi:10.1001/jamapsychiatry.2013.1141.
Text Size: A A A
Published online


Nearly 15 million Americans 12 years of age and older were dependent on or abused alcohol in 2010.1 The high prevalence of problem alcohol use worldwide has been estimated to cause 2.5 million deaths each year,2 not to mention the exorbitant costs associated with excess morbidity3 and loss of productivity.4 The chronic and relapsing nature of alcoholism, just like that of every other substance use disorder, is one of the major obstacles to its successful treatment. This is why the search for predictive biomarkers to help clinicians select and monitor a therapeutic course of action and to help researchers evaluate new therapeutic interventions is so urgent.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Schematic Diagram of the Neural Network Necessary for Self-Control and Its Overlap With the Default Mode Network (DMN)

A, The ventromedial prefrontal cortex (vmPFC)/anterior cingulate cortex (ACC), identified by Seo et al as a robust biomarker of alcohol relapse risk, modulates and, in turn, is modulated by the activity of multiple other cortical and subcortical regions whose combined output is used to orchestrate adaptive and flexible goal-directed behaviors. Current evidence suggests that information from cortical and subcortical structures converges toward a single common value representation before passing on to the choice-related motor control circuitry. Modulatory inputs play a critical role in establishing this final common representation with those inputs carrying signals related to interoception, salience attribution, conditioning, executive control, reward, habituation, and stress and mood reactivity. B, In addition, each region has been numbered and its general location tagged onto maps of the human brain (internal and external views) overlaid with orange and yellow pseudocolors that represent the resting state connectivity of the DMN. Regions (vmPFC/ACC and precuneus) that were hyperactive during the neutral conditions and that predicted relapse show significant overlap with the DMN. DLPFC indicates dorsolateral prefrontal cortex; iPFC, inferior prefrontal cortex; lOFC, lateral orbitofrontal cortex; mOFC, medial orbitofrontal cortex; Nac, nucleus accumbens; VTA, ventral tegmental area.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

14 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Alcohol Abuse

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: A Primer on the Precision and Accuracy of the Clinical Examination