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 Longtime members of Alcoholics Anonymous (AA) often report little or no craving for alcohol, but why this happens remains poorly understood. Now, in what is believed to be the first study to explore brain physiology in AA members, researchers from NYU Langone Medical Center found that members who recited AA prayers after viewing drinking-related images reported less craving for alcohol after praying than after just reading a newspaper. The reduced cravings in those that prayed corresponded to increased activity in brain regions responsible for attention and emotion as measured by MRI, according to study results published recently in the American Journal of Drug and Alcohol Abuse. 
 
 “Our findings suggest that the experience of AA over the years had left these members with an innate ability to use the AA experience—prayer in this case―to minimize the effect of alcohol triggers in producing craving,” says senior author Marc Galanter, MD, professor of psychiatry and director of the Division of Alcoholism and Drug Abuse at NYU Langone. “Craving is diminished in long-term AA members compared to patients who have stopped drinking for some period of time but are more vulnerable to relapse.” 
 
 The study results revolve around craving, one of the criteria physicians use to diagnose addiction. Such strong desires can persist even in addicted people who no longer use alcohol or drugs, and AA members recite abstinence-promoting prayers to reduce cravings. 
 
 “We wanted to determine what is going on in the brain in response to alcohol-craving triggers, such as passing by a bar or experiencing something upsetting, when long-term AA members are exposed to them,” Dr. Galanter says. 
 
 To investigate, Dr. Galanter and his colleagues recruited 20 long-term AA members who reported no cravings for alcohol during the week preceding testing. The participants were placed in an MRI scanner and then shown either pictures of alcoholic drinks or people drinking to simulate drinking behavior in a laboratory setting. The pictures were presented twice: first after asking the participant to read neutral material from a newspaper, and again after the participant recited an AA prayer promoting abstinence from alcohol to represent the impact of AA. 
 
 According to the study authors, all research subjects reported some degree of craving for alcohol after viewing the images, and less craving after reciting an AA prayer. MRI data revealed that there were changes in parts of the prefrontal cortex, the region of the brain that controls attention, and in brain sites responsible for control of emotion and the semantic reappraisal of emotion, which represents the different ways a people understand situations based on their perspectives. 
 
 “This finding suggests that there appears to be an emotional response to alcohol triggers, but that it’s experienced and understood differently when someone has the protection of the AA experience,” Galanter says. 
 
 In Galanter’s decade-long research into the role of spirituality in long-term AA members, he and his colleagues have found that members undergo a transition from initially craving alcohol to a new status where they reported little or no craving. This reduction in craving, according to Dr. Galanter, is associated with the amount of time that passed following a “spiritual awakening” in AA, which marks a transition to a different attitude toward drinking. 
 
 Previous investigations by other researchers of the role of prayer on drinking behavior found that alcohol abusers who reported a spiritual awakening drank less after treatment for alcoholism. Research participants assigned to engage in prayer—unrelated to drinking—every day for four weeks drank about half as much as those who were not. 
 
 “Our current findings open up a new field of inquiry into physiologic changes that may accompany spiritual awakening and perspective changes in AA members and others,” says Galanter. He says the study results also support the validity of a long-term AA experience in terms of physiologic changes in the brain. 
 
 In early 2016, Oxford University Press published Dr. Galanter’s book, What Is Alcoholics Anonymous?, which provides context for his group’s studies of the psychological effects of AA. 
 
 Dr. Galanter’s co-authors were Zoran Josipovic, PhD, and Helen Dermatis, PhD, of NYU Langone, Jochen Weber of Columbia University, and Mary Alice Millard, formerly of NYU Langone. The research was supported by a grant from the John Templeton Foundation. 
 
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 gregory.williams@nyumc.org ||||| Scientists have pinpointed a population of neurons in the brain that influences whether one drink leads to two, which could ultimately lead to a cure for alcoholism and other addictions. 
 
 A study, published in the Journal of Neuroscience by researchers at the Texas A&M Health Science Center College of Medicine, finds that alcohol consumption alters the structure and function of neurons in the dorsomedial striatum, a part of the brain known to be important in goal-driven behaviors. The findings could be an important step toward creation of a drug to combat alcoholism. 
 
 "Alcoholism is a very common disease," said Jun Wang, M.D., Ph.D., the lead author on the paper and an assistant professor in the Department of Neuroscience and Experimental Therapeutics at the Texas A&M College of Medicine, "but the mechanism is not understood very well." 
 
 Now, Wang and his team have helped come a little closer to that understanding. Using an animal model, the researchers determined that alcohol actually changes the physical structure of medium spiny neurons, the main type of cell in the striatum. These neurons can be thought of like a tree, with many branches, and many small protrusions, or spines, coming off of them. They each have one of two types of dopamine receptors, D1 or D2, and so can be thought of as either D1 or D2 neurons. D1 neurons are informally called part of a "go" pathway in the brain, while D2 neurons are in the "no-go" pathway. In other words, when D2 neurons are activated, they discourage action -- telling you to wait, to stop, to do nothing. 
 
 Although it is well known that the neurotransmitter dopamine is involved in addiction, this study goes further, showing that the dopamine D1 receptor also plays an important role in addiction. The team found that periodic consumption of large amounts of alcohol acts on D1 neurons, making them much more excitable, which means that they activate with less stimulation. 
 
 "If these neurons are excited, you will want to drink alcohol," Wang said. "You'll have a craving." That is to say, when neurons with D1 receptors are activated, they compel you to perform an action -- reaching for another bottle of tequila, in this case. This then creates a cycle, where drinking causes easier activation, and activation causes more drinking. 
 
 These changes in activation of D1 neurons might be related to the physical changes happening at the sub-cellular level in brains that have been exposed to alcohol. They have longer branching and more of the mature, mushroom-shaped spines -- the type that stores long-term memories -- than their abstaining counterparts. 
 
 Conversely, the placebo group, the ones not exposed to alcohol, tended to have more of the immature versions of the mushroom-shaped spines in D1 neurons of their brains. The total number of spines didn't change in the two groups, but the ratio between mature and immature was dramatically different between the alcohol group and the placebo group. This has important implications for memory and learning in drug addiction. 
 
 "When you drink alcohol, long-term memory is enhanced, in a way," Wang said. "But this memory process is not useful -- in fact, it underlies addiction since it affects the 'go' neurons." Because there was no difference in the number of each type of spine in the D2 (no-go) neurons of alcohol-consuming and control models, the researchers realized there was a specific relationship between D1 neurons and alcohol consumption. 
 
 "We're now able to study the brain at the neuron-specific and even spine-specific level," Wang said. 
 
 How do you determine which neuron, which type of neurons or which group of neurons is responsible for a specific disease? That's what the next part of the study tried to answer. 
 
 The alcohol-consuming animal models with the increased mature spines in D1 neurons also showed an increased preference to drink large quantities of alcohol when given the choice. 
 
 "Even though they're small, D1 receptors are essential for alcohol consumption," Wang said. 
 
 Furthermore, and perhaps most excitingly, when those same animal models were given a drug to at least partially block the D1 receptor, they showed much-reduced desire to drink alcohol. However, a drug that inhibited the D2 dopamine receptors had no effect. "If we suppress this activity, we're able to suppress alcohol consumption," Wang said. "This is the major finding. Perhaps in the future, researchers can use these findings to develop a specific treatment targeting these neurons." 
 
 The study, which was co-authored with researchers from the University of California San Francisco, was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). 
 
 "My ultimate goal is to understand how the addicted brain works," Wang said, "and once we do, one day, we'll be able to suppress the craving for another round of drinks and ultimately, stop the cycle of alcoholism."
– Does prayer have the power to help recovering alcoholics squash temptation? A small new study out of the NYU Langone Medical Center finds that at least among 20 long-term Alcoholics Anonymous members who reported no cravings in the week leading up to the test, prayer reduced cravings that arose when shown images of alcoholic drinks or people drinking. To perform the tests, the researchers report in the American Journal of Drug and Alcohol Abuse, participants were asked to read the newspaper or pray after being shown the images. Participants reported some craving following seeing the images, but less so after having prayed, while MRI data showed changes in parts of the prefrontal cortex that controls attention as well as in regions thought to control emotion. "This finding suggests that there appears to be an emotional response to alcohol triggers, but that it’s experienced and understood differently when someone has the protection of the AA experience," says senior author Marc Galanter, who published a book on Alcoholics Anonymous earlier this year. He goes on to suggest that the reduction in cravings in AA members correlates to the amount of time that has elapsed since one's so-called "spiritual awakening," which AA describes as taking a different attitude toward drinking. In previous research, participants asked to pray every day for four weeks drank about half as much as those who were not. (See why some have been challenging the 75-year hegemony of AA.)