Neural Correlates of Trauma and Binge Drinking: Exploring the Impact of Trauma, Moral Injury, and PTSD Symptoms on Brain Activity and Drinking Behavior in Trauma Exposed Individuals

Abstract

Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) often co-occur, yet their neural mechanisms remain unclear. This pilot study examined whether PTSD symptoms and moral injury (MI) influence neural responses to stress cues. Twenty-seven trauma-exposed adults (nine binge drinkers, 18 social drinkers) completed clinical assessments and two fMRI sessions involving stress and neutral images followed by an alcohol taste test. Whole-brain analyses showed increased cerebellar activation in those with PTSD symptoms during stress exposure, with additional clusters in the premotor cortex and supplementary motor area. ROI analyses were largely non-significant; however, combined models revealed differences in the bilateral amygdala and left insula. Adding age and sex identified additional regions, including the anterior cingulate cortex. Although not significant, binge drinkers without PTSD/MI consumed more alcohol. Overall, findings suggest neural activation and drinking during stress cues may reflect the combined influence of MI, PTSD, and alcohol use.