Discussion
here-included, Droutman
DISORDER
The main finding of our study is a decrease in insula activation following baclofen versus placebo medication in a slot machine paradigm among patients with alcohol use disorder.Prior to study inclusion, all patients showed high ADS and OCDS scores, high chronic alcohol consumption (LDH), and a high number of detoxifications, representing a severely affected sample of AUD patients. The BAC group showed even higher lifetime alcohol consumption (LDH) than the PLA group. In this context, it is important to note that Pierce and colleagues (On a clinical level, we observed significantly higher abstinence rates in the BAC compared to the PLA group, i.e., higher percentage of abstinent patients as well as longer abstinence durations during the 12-week high-dose phase, which has also been observed in our larger sample from our pharmacological trial (Müller et al. On the As an In the Although, our results extend the knowledge about the effects of baclofen in the treatment of AUD, some limitations of the present study need to be considered.First, the small sample size limits the statistical power of our analyses, and the robustness of our results needs to be proven in replication studies. Although we observed statistically relevant differences between baclofen and placebo treatment and their respective neurobiological correlates in a longitudinal design, this observation requires replication in a larger sample. Since the here-included sample is a sub-sample of Müller et al. (being a preregistered clinical trial), we were not able to further increase the sample size (Müller et al. Lastly, due to the individual titration of the study medication, not all BAC patients reached the maximum dosage of 270 mg/d. Nevertheless, in flexible dosage studies like ours, it is common that the placebo group reaches the maximum dosage more likely (e.g., Reynaud et al. Taken together, the present neuroimaging results contribute to the understanding of underlying neurobiological mechanisms of (individually titrated) baclofen treatment, in particular within the domain of AUD-related altered reward anticipation processing.Our results indicated that baclofen might desensitize right insula activation during recurrent reward processing in AUD patients after 2 weeks of individual high-dose baclofen treatment as well as increase the abstinence rate. Baclofen might thus enable a more flexible adaptation of neuronal activation in terms of repetition effects similar to HC, in accordance with the key role attributed to insula function in addiction (Droutman et al. 