Tracing volitional recovery in post-stroke akinetic mutism using longitudinal microstructure imaging: Insights from a single case study.

Lesions in the frontal-subcortical circuitry can lead to akinetic mutism (AM) characterized by diminished volition. However, the microstructural changes in the damaged network underlying its recovery remain unknown. Clinical examination and neuropsychological assessment were performed on a patient with post-stroke AM. Multimodal MRI scans were performed at baseline and follow-ups. We used diffusion MRI and biophysical models, specifically utilizing neurite orientation dispersion and density imaging for assessing gray matter microstructure, and fixel-based analysis for the evaluation of white matter. Longitudinal comparisons were performed between the patient and healthy controls. Pronounced recovery of volition was observed after dopamine agonist therapy combined with physical therapy. In addition to infarcts in the bilateral medial cortex, microstructure imaging detected reduced neurite density in extensive areas, specifically in temporal areas and subcortical nuclei, and decreased fiber density of white matter tracts (TFCE-corrected p < .05). Microstructural degeneration in the anterior cingulate cortex and cingulum was relatively persistent (Bonferroni-corrected p < .05). However, most tracts within the frontal-subcortical circuitry showed increased fiber density during the recovery stage. Microstructure of an extensive network may contribute to the disruption and recovery of volition. Fiber density within the frontal-subcortical circuitry could be a promising biomarker indicating volitional recovery.

The association of senior nursing students' economic resources, work volition and career adaptability with their future decent work securement: A psychology of working perspective.

AIM: To determine the relationship between economic resources (household income), work volition and career adaptability and the perception of future decent work securement of senior nursing students based on the Psychology of Working Theory. BACKGROUND: Future decent work securement is essential for young people to successfully enter to working life after graduation. Therefore, identifying factors that affect future decent work can help make nursing a desirable career option. DESIGN: Cross-sectional and correlational design. METHODS: This study was performed between May and June 2022 in three public universities in Turkey. The sample consisted of the senior students in the nursing undergraduate programs (n = 255). The data were collected using the Student Information Form, the Work Volition Scale-Student Version, the Career Adapt-Abilities Scale-Short Form and the Perceived Future Decent Work Securement Scale. Descriptive tests and Pearson's correlation analysis were used to analyze the data. The hypothesis model was tested using path analysis. RESULTS: This study found significant positive correlations between household income, work volition, career adaptability and future decent work securement. The direct effects of household income on work volition, work volition on career adaptability and future decent work securement were also significant. However, there was no significant effect of career adaptability on future decent work securement. In addition, work volition was found to have an indirect effect on the relationship between household income and career adaptability and future decent work securement. CONCLUSIONS: This study, where the Psychology of Working Theory was tested on a sample of nursing students, drew attention to the importance of work volition in developing the perception of future decent work securement. Career adaptability and decent work perception can be improved through work volition of the students.

Volition and control in law and in brain science: neurolegal translation of a foundational concept.

The law assumes that healthy adults are generally responsible for their actions and have the ability to control their behavior based on rational and moral principles. This contrasts with some recent neuroscientific accounts of action control. Nevertheless, both law and neuroscience acknowledge that strong emotions including fear and anger may "trigger" loss of normal voluntary control over action. Thus, "Loss of Control" is a partial defense for murder under English law, paralleling similar defenses in other legal systems. Here we consider the neuroscientific evidence for such legal classifications of responsibility, particularly focussing on how emotional states modulate voluntary motor control and sense of agency. First, we investigate whether neuroscience could contribute an evidence-base for law in this area. Second, we consider the societal impact of some areas where legal thinking regarding responsibility for action diverges from neuroscientific evidence: should we be guided by normative legal traditions, or by modern understanding of brain functions? In addressing these objectives, we propose a translation exercise between neuroscientific and legal terms, which may assist future interdisciplinary research.

Trouble with the curve: the 90-9-1 rule to measure volitional participation inequalities among Royal Canadian Mounted Police cadets during training.

Objective: The Royal Canadian Mounted Police (RCMP) Study includes longitudinal multimodal assessments of RCMP cadets from pre-training (i.e., starting the Cadet Training Program [CTP]) to post-deployment and for five years thereafter. The data allow for investigating the multidimensionality of volitional participation in digital health data collection frameworks within serial data collection platforms and the impact of participation inequalities by classifying cadets using the 90-9-1 rule. By classifying cadets as Lurkers, Contributors, and Superusers formally described by the 90-9-1 rule, where 90% of actors do not participate, 9% seldom contribute, and 1% contribute substantially allows for the assessing of relationships between participation inequalities in self-monitoring behaviors as well as whether mental health disorder symptoms at pre-training (i.e., starting the CTP) were associated with subsequent participation. Methods: Participants were asked to complete a Full Assessment prior to their training at CTP, as well as short daily surveys throughout their training. Participation frequency was described using a process where participants were rank ordered by the number of daily surveys completed and classified into one of three categories. Full assessment surveys completed prior to their training at CTP included screening tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), and panic disorder (PD). The Kruskal-Wallis H test was used to assess differences in participation rates between mental health disorder symptom screening groups for each measure at pre-training, and Spearman's Rho was used to test for associations amongst self-reported Full Assessment screening tool responses and the number of daily surveys completed during CTP. Results: There were 18557 daily survey records collected from 772 participants. The rank-ordering of cadets by the number of daily surveys completed produced three categories in line with the 90-9-1 rule: Superusers who were the top 1% of cadets (n=8) and produced 6.4% of all recordings; Contributors who were the next 9% of cadets (n=68) and produced 49.2% of the recordings; and Lurkers who were the next 90% of cadets (n=695) and produced 44.4% of daily survey recordings. Lurkers had the largest proportion of positive screens for self-reported mental health disorders at pre-training. Conclusion: The creation of highly individualized, population-based mental health injury programs has been limited by an incomplete understanding of the causal relationships between protective factors and mental health. Disproportionate rates of disengagement from persons who screen positive for mental health disorders further compounds the difficulty in understanding the relationships between training programs and mental health. The current results suggest persons with mental health challenges may be less likely to engage in some forms of proactive mental health training. The current results also provide useful information about participation, adherence, and engagement that can be used to inform evidence-based paradigm shifts in health-related data collection in occupational populations.

Slowing gait during turning: how volition of modifying walking speed affects the gait pattern in healthy adults.

Background: Turning during walking and volitionally modulating walking speed introduces complexity to gait and has been minimally explored. Research question: How do the spatiotemporal parameters vary between young adults walking at a normal speed and a slower speed while making 90°, 180°, and 360° turns? Methods: In a laboratory setting, the spatiotemporal parameters of 10 young adults were documented as they made turns at 90°, 180°, and 360°. A generalized linear model was utilized to determine the effect of both walking speed and turning amplitude. Results: Young adults volitionally reducing their walking speed while turning at different turning amplitudes significantly decreased their cadence and spatial parameters while increasing their temporal parameters. In conditions of slower movement, the variability of certain spatial parameters decreased, while the variability of some temporal parameters increased. Significance: This research broadens the understanding of turning biomechanics in relation to volitionally reducing walking speed. Cadence might be a pace gait constant synchronizing the rhythmic integration of several inputs to coordinate an ordered gait pattern output. Volition might up-regulate or down-regulate this pace gait constant (i.e., cadence) which creates the feeling of modulating walking speed.

Volition motivates cognitive performance at the response-execution level by attenuating task-irrelevant motor activations.

Humans express volition by making voluntary choices which, relative to forced choices, can motivate cognitive performance in a variety of tasks. However, a task that requires the generation of motor responses on the basis of external sensory stimulation involves complex underlying cognitive processes, e.g., pre-response processing, response selection, and response execution. The present study investigated how these underlying processes are facilitated by voluntary choice-making. In five experiments, participants were free or forced to choose a task-irrelevant picture from two alternatives, and then completed a conflict task, i.e., Flanker, Stroop, Simon, Stroop-Simon, or Flanker-Simon task, where the conflict effect could occur at different processing levels. Results consistently showed that responses in all tasks were generally faster after voluntary (vs. forced) choices. Importantly, the conflict effect at the response-execution level (i.e., the Simon effect), but not the conflict effect at the pre-response and response-selection levels (i.e., the Flanker and Stroop effects), was reduced by the voluntary choice-making. Model fitting revealed that the peak amplitude of automatic motor activations in the response-execution conflict was smaller after voluntary (vs. forced) choices. These findings suggest that volition motivates subsequent cognitive performance at the response-execution level by attenuating task-irrelevant motor activations.

Determinants of physical activity in newly diagnosed obstructive sleep apnea patients: testing the health action process approach.

This study aims to identify the determinants associated with physical activity (PA) behavior in newly diagnosed obstructive sleep apnea (OSA) patients by applying the Health Action Process Approach (HAPA) with a longitudinal design. Anthropometric and clinical (OSA severity, subjective somnolence, use of continuous positive airway pressure (CPAP)) variables, the determinants of physical activity specified in the HAPA (motivational self-efficacy, outcome expectancies, risk perception, intention, maintenance self-efficacy, action planning, coping planning, social support), as well as physical activity behavior were assessed using a longitudinal (T1 and T2) design in a sample of 57 OSA patients in routine care. Applying regression analyses, regarding the motivation phase, the amount of explained variance in intention was 77% and 39% of the variance in physical activity. In the motivational phase, motivational self-efficacy, risk perception and outcome expectancies were associated with intention. In the volitional phase, physical activity at T1 and social support (family) were related with physical activity at T2. In conclusion, the assumptions of HAPA were partially found in the context of newly diagnosed OSA patients. This study provided additional evidence regarding the role of motivational self-efficacy, outcome expectancies and risk perception during motivational phase, and highlighted the important role of social support from the family in the PA in this population.

Occupational adaptation for adults living with advanced cancer: A phenomenological longitudinal study.

INTRODUCTION: People living with advanced cancer want to continue participating in their valued occupations amid cancer progression. However, increasing dependence and bodily deterioration challenge a person's ability to do so, thus requiring adaptation to how they engage in their occupations. Theoretical frameworks on the process of occupational adaptation often do not address the implications of progressive functional decline. METHODS: A longitudinal phenomenological design was used to understand the lived experience of occupational engagement for working-aged adults living with advanced cancer. A semi-structured interview series explored participants' experience of occupational engagement and how this changed over time. Data were analysed thematically and mapped against the Model of Human Occupation (MOHO). FINDINGS: Eight adults (40-64 years old) participated in 33 interviews over 19 months. Three themes were constructed from the data: ongoing adaptation through doing, the significance of volition in adaptation, and everyday life is contingent on my environment. Study findings demonstrate that the process of adaptation occurs through occupational engagement, is motivated by volition, and is affected by the environment. Volition and the environment play a more central role in occupational adaptation than occupational competency for the advanced cancer cohort. CONCLUSION: Study findings further MOHO's theoretical conceptualisation of occupational adaptation by identifying the centrality of volition and the environment in the process of adaptation. For people living with advanced cancer, disease progression results in unremitting functional decline, thus rendering competency an unstable and untenable construct. Rather, this paper argues that occupational adaptation is facilitated by volition (i.e., the motivation behind the doing) and the environment, thus fostering a sense of identity and meaning at the end of life. Occupational therapists' awareness of the significance of volition and the environment can thus foster continued occupational engagement and meaning at the end of life for people living with advanced cancer.

The place of Free Will: the freedom of the prisoner.

Debates about the concept of Free Will date back to ancient times. About 40 years ago, Benjamin Libet designed an experiment showing that the conscious intention to move is preceded by a specific pattern of brain activation. His finding suggested that unconscious processes determine our decisions. Libet-style experiments have continued to dominate the debate about Free Will, pushing some authors to argue that the existence of Free Will is a mere illusion. We believe that this dispute is because we often measure Free Will using arbitrary human decisions rather than deliberate actions. After reviewing the definition of Free Will and the related literature, we conclude that the scientific evidence does not disprove the existence of Free Will. However, our will encounters several constraints and limitations that should be considered when evaluating our deeds' personal responsibility.

The benefit of making voluntary choices generalizes across multiple effectors.

It has been shown that cognitive performance could be improved by expressing volition (e.g., making voluntary choices), which necessarily involves the execution of action through a certain effector. However, it is unclear if the benefit of expressing volition can generalize across different effectors. In the present study, participants made a choice between two pictures either voluntarily or forcibly, and subsequently completed a visual search task with the chosen picture as a task-irrelevant background. The effector for choosing a picture could be the hand (pressing a key), foot (pedaling), mouth (commanding), or eye (gazing), whereas the effector for responding to the search target was always the hand. Results showed that participants responded faster and had a more liberal response criterion in the search task after a voluntary choice (vs. a forced choice). Importantly, the improved performance was observed regardless of which effector was used in making the choice, and regardless of whether the effector for making choices was the same as or different from the effector for responding to the search target. Eye-movement data for oculomotor choice showed that the main contributor to the facilitatory effect of voluntary choice was the post-search time in the visual search task (i.e., the time spent on processes after the target was found, such as response selection and execution). These results suggest that the expression of volition may involve the motor control system in which the effector-general, high-level processing of the goal of the voluntary action plays a key role.

Success rates, near-response patterns, and learning trends with free-fusion stereograms.

Free-fusion stereograms are routinely used for demonstrating various stereoscopic effects. Yet, untrained observers find it challenging to perform this task. This study showed that only less than 1/3rd of sixty-one pre-presbyopic adults with normal binocular vision could successfully free-fuse random-dot image pairs and identify the stereoscopic shapes embedded in these patterns. Another one-third of participants performed the task with poor success rates, while the remaining could not perform the task. There was a clear dissociation of vergence and accommodative responses in participants who were successful with free-fusion, as recorded using a dynamic infrared eye tracker and photorefractor. Those in the unsuccessful cluster either showed strong vergence and accommodation or weak vergence and strong accommodation during the task. These response patterns, however, were specific to the free-fusion task because all these participants generated good convergence/accommodation to real-world targets and to conflicting vergence and accommodative demands stimulated with prisms or lenses. Task performance of the unsuccessful cluster also improved significantly following pharmacological paralysis of accommodation and reached the performance levels of the successful cluster. A minority of participants also appeared to progressively learn to dissociate one of the two directions of their vergence and accommodation crosslinks with repeated free-fusion trials. These results suggest that successful free-fusion might depend upon how well participants generate a combination of volitional and reflex vergence responses to large differences in disparity with conflicting static accommodative demands. Such responses would require that only one direction of the vergence-accommodation crosslinks be active at any given time. The sequence of near-responses could also be learnt through repeated trials to optimize task performance.

Libet's legacy: A primer to the neuroscience of volition.

The neuroscience of volition is an emerging subfield of the brain sciences, with hundreds of papers on the role of consciousness in action formation published each year. This makes the state-of-the-art in the discipline poorly accessible to newcomers and difficult to follow even for experts in the field. Here we provide a comprehensive summary of research in this field since its inception that will be useful to both groups. We also discuss important ideas that have received little coverage in the literature so far. We systematically reviewed a set of 2220 publications, with detailed consideration of almost 500 of the most relevant papers. We provide a thorough introduction to the seminal work of Benjamin Libet from the 1960s to 1980s. We also discuss common criticisms of Libet's method, including temporal introspection, the interpretation of the assumed physiological correlates of volition, and various conceptual issues. We conclude with recent advances and potential future directions in the field, highlighting modern methodological approaches to volition, as well as important recent findings.

Within-person association of volitional factors and physical activity: Insights from an ecological momentary assessment study.

OBJECTIVE: Current health behavior models of physical activity (PA) suggest that not all PA intentions are translated into actual PA behavior, resulting in a significant intention-behavior gap (IBG) of almost 50%. These models further suggest that higher self-efficacy and specific planning can aid in decreasing this gap. However, as most evidence stems from between-person (trait level), questionnaire-based research, it is unclear how large short-term IBGs are, how self-efficacy and planning covary within-persons across time and whether they similarly predict smaller IBGs. It is likely that day-to-day changes in circumstances and barriers affect these variables thus the applicability of theoretical models is uncertain. Here, within-person prospective analyses of ecological momentary assessment (EMA) data can provide insights. METHODS: 35 healthy participants (aged 23-67) completed four EMA-based questionnaires every day for three weeks. Each prompt assessed PA (retrospectively, "since the last EMA prompt"); PA intentions, planning specificity, self-efficacy, and intrinsic motivation (prospectively, "until the next EMA prompt") and momentary affect. Generalized logistic mixed-effect modeling was used to test predictors of PA. RESULTS: Across the 2341 answered EMA prompts, PA intentions were not enacted in 25% of the episodes (IBG). In episodes with given intentions, PA likelihood increased with higher levels of self-efficacy, planning specificity, and intrinsic motivation. The latter two also positively predicted PA duration and intensity. CONCLUSIONS: Short-term intention behavior gaps seem to be smaller than what is known from more long-term studies, most likely as individuals can anticipate the actual circumstances of PA. Further, current health behavior models show validity in explaining within-person dynamics in IBGs across time. Knowing the relevance of planning specificity, self-efficacy and intrinsic motivation for day-to-day variations in PA enactment can inform respective real-time mHealth interventions for facilitating PA.

Temporal Dynamics of Brain Activity Predicting Sense of Agency over Muscle Movements.

Our muscles are the primary means through which we affect the external world, and the sense of agency (SoA) over the action through those muscles is fundamental to our self-awareness. However, SoA research to date has focused almost exclusively on agency over action outcomes rather than over the musculature itself, as it was believed that SoA over the musculature could not be manipulated directly. Drawing on methods from human-computer interaction and adaptive experimentation, we use human-in-the-loop Bayesian optimization to tune the timing of electrical muscle stimulation so as to robustly elicit a SoA over electrically actuated muscle movements in male and female human subjects. We use time-resolved decoding of subjects' EEG to estimate the time course of neural activity which predicts reported agency on a trial-by-trial basis. Like paradigms which assess SoA over action consequences, we found that the late (post-conscious) neural activity predicts SoA. Unlike typical paradigms, however, we also find patterns of early (sensorimotor) activity with distinct temporal dynamics predicts agency over muscle movements, suggesting that the "neural correlates of agency" may depend on the level of abstraction (i.e., direct sensorimotor feedback versus downstream consequences) most relevant to a given agency judgment. Moreover, fractal analysis of the EEG suggests that SoA-contingent dynamics of neural activity may modulate the sensitivity of the motor system to external input.SIGNIFICANCE STATEMENT The sense of agency, the feeling of "I did that," when directing one's own musculature is a core feature of human experience. We show that we can robustly manipulate the sense of agency over electrically actuated muscle movements, and we investigate the time course of neural activity that predicts the sense of agency over these actuated movements. We find evidence of two distinct neural processes: a transient sequence of patterns that begins in the early sensorineural response to muscle stimulation and a later, sustained signature of agency. These results shed light on the neural mechanisms by which we experience our movements as volitional.

Costs and benefits of voluntary attention in crows.

Behavioural signatures of voluntary, endogenous selective attention have been found in both mammals and birds, but the relationship between performance benefits at attended and costs at unattended locations remains unclear. We trained two carrion crows (Corvus corone) on a Posner-like spatial cueing task with dissociated cue and target locations, using both highly predictive and neutral central cues to compare reaction time (RT) and detection accuracy for validly, invalidly and neutrally cued targets. We found robust RT effects of predictive cueing at varying stimulus-onset asynchronies (SOA) that resulted from both advantages at cued locations and costs at un-cued locations. Both crows showed cueing effects around 15-25 ms with an early onset at 100 ms SOA, comparable to macaques. Our results provide a direct assessment of costs and benefits of voluntary attention in a bird species. They show that crows are able to guide spatial attention using associative cues, and that the processing advantage at attended locations impairs performance at unattended locations.

Consciousness: a neurosurgical perspective.

Neurosurgeons are in a unique position to shed light on the neural basis for consciousness, not only by their clinical care of patients with compromised states of consciousness, but also by employing neurostimulation and neuronal recordings through intracranial electrodes in awake surgical patients, as well as during stages of sleep and anethesia. In this review, we discuss several aspects of consciousness, i.e., perception, memory, and willed actions, studied by electrical stimulation and single neuron recordings in the human brain. We demonstrate how specific neuronal activity underlie the emergence of concepts, memories, and intentions in human consciousness. We discuss the representation of specific conscious content by temporal lobe neurons and present the discovery of "concept cells" and the encoding and retrieval of memories by neurons in the medial temporal lobe. We review prefrontal and parietal neuronal activation that precedes conscious intentions to act. Taken together with other studies in the field, these findings suggest that specific conscious experience may arise from stochastic fluctuations of neuronal activity, reaching a dynamic threshold. Advances in brain recording and stimulation technology coupled with the rapid rise in artificial intelligence are likely to increase the amount and analysis capabilities of data obtained from the human brain, thereby improving the decoding of conscious and preconscious states and open new horizons for modulation of human cognitive functions such as memory and volition.

Exploring the internal forward model: action-effect prediction and attention in sensorimotor processing.

Action-effect predictions are believed to facilitate movement based on its association with sensory objectives and suppress the neurophysiological response to self- versus externally generated stimuli (i.e. sensory attenuation). However, research is needed to explore theorized differences in the use of action-effect prediction based on whether movement is uncued (i.e. volitional) or in response to external cues (i.e. stimulus-driven). While much of the sensory attenuation literature has examined effects involving the auditory N1, evidence is also conflicted regarding this component's sensitivity to action-effect prediction. In this study (n = 64), we explored the influence of action-effect contingency on event-related potentials associated with visually cued and uncued movement, as well as resultant stimuli. Our findings replicate recent evidence demonstrating reduced N1 amplitude for tones produced by stimulus-driven movement. Despite influencing motor preparation, action-effect contingency was not found to affect N1 amplitudes. Instead, we explore electrophysiological markers suggesting that attentional mechanisms may suppress the neurophysiological response to sound produced by stimulus-driven movement. Our findings demonstrate lateralized parieto-occipital activity that coincides with the auditory N1, corresponds to a reduction in its amplitude, and is topographically consistent with documented effects of attentional suppression. These results provide new insights into sensorimotor coordination and potential mechanisms underlying sensory attenuation.

Can personal task choice shield against fear and anger prime effects on effort? A study on cardiac response.

This experiment tested whether personal task choice can shield against implicit affective influences on sympathetically mediated cardiovascular response, reflecting effort. Participants were N = 121 healthy university students who completed a moderately difficult memory task with integrated briefly flashed and masked fear vs. anger primes. Half of the participants believed they could choose between an attention and a memory task, while the other half was automatically assigned to the task. Replicating previous research, we expected an influence of the affect primes on effort when the task was externally assigned. By contrast, when participants were given a task choice, we predicted strong action shielding and thus a weak implicit affect effect on resource mobilization. As expected, participants in the assigned task condition showed stronger cardiac pre-ejection period reactivity when exposed to fear primes than when processing anger primes. Importantly, this affect prime effect disappeared when participants could ostensibly choose the task. These findings add to other recent evidence for action shielding by personal task choice and importantly extend this effect to implicit affective influences on cardiac reactivity during task performance.

Attention without Constraint: Alpha Lateralization in Uncued Willed Attention.

Studies of voluntary visual spatial attention have used attention-directing cues, such as arrows, to induce or instruct observers to focus selective attention on relevant locations in visual space to detect or discriminate subsequent target stimuli. In everyday vision, however, voluntary attention is influenced by a host of factors, most of which are quite different from the laboratory paradigms that use attention-directing cues. These factors include priming, experience, reward, meaning, motivations, and high-level behavioral goals. Attention that is endogenously directed in the absence of external attention-directing cues has been referred to as "self-initiated attention" or, as in our prior work, as "willed attention" where volunteers decide where to attend in response to a prompt to do so. Here, we used a novel paradigm that eliminated external influences (i.e., attention-directing cues and prompts) about where and/or when spatial attention should be directed. Using machine learning decoding methods, we showed that the well known lateralization of EEG alpha power during spatial attention was also present during purely self-generated attention. By eliminating explicit cues or prompts that affect the allocation of voluntary attention, this work advances our understanding of the neural correlates of attentional control and provides steps toward the development of EEG-based brain-computer interfaces that tap into human intentions.

The Role of Unawareness, Volition, and Neural Hyperconnectivity in Alcohol Use Disorder: A Functional Magnetic Resonance Imaging Study.

BACKGROUND: Automated alcohol craving and habitual alcohol consumption characterize the later stages of alcohol use disorder (AUD). This study reanalyzed previously collected functional neuroimaging data in combination with the Craving Automated Scale for Alcohol (CAS-A) questionnaire to investigate the neural correlates and brain networks underlying automated drinking characterized by unawareness and nonvolition. METHODS: We assessed 49 abstinent male patients with AUD and 36 male healthy control participants during a functional magnetic resonance imaging-based alcohol cue-reactivity task. We performed whole-brain analyses examining the associations between CAS-A scores and other clinical instruments and neural activation patterns in the alcohol versus neutral contrast. Furthermore, we performed psychophysiological interaction analyses to assess the functional connectivity between predefined seed regions and other brain areas. RESULTS: In patients with AUD, higher CAS-A scores correlated with greater activation in dorsal striatal, pallidal, and prefrontal regions, including frontal white matter, and with lower activation in visual and motor processing regions. Between-group psychophysiological interaction analyses showed extensive connectivity between the seed regions inferior frontal gyrus and angular gyrus and several frontal, parietal, and temporal brain regions in AUD versus healthy control participants. CONCLUSIONS: The present study applied a new lens to previously acquired alcohol cue-reactivity functional magnetic resonance imaging data by correlating neural activation patterns with clinical CAS-A scores to elucidate potential neural correlates of automated alcohol craving and habitual alcohol consumption. Our results support previous findings showing that alcohol addiction is associated with hyperactivation in habit-processing regions, with hypoactivation in areas mediating motor and attention processing, and with general hyperconnectivity.