How distinct functional insular subdivisions mediate interacting neurocognitive systems.

Recent neurocognitive models propose that the insula serves as a hub of interoceptive awareness system, modulating 2 interplaying neurocognitive systems: The posterior insula (PI) receives and integrates various interoceptive signals; these signals are then transmitted to the anterior insula for processing higher-order representations into awareness, where the dorsal anterior insula (dAI) modulates the prefrontal self-control system and the ventral anterior insula (vAI) modulates the amygdala (AMG)-striatal reward-seeking circuit. We sought to test this view using a multimodal approach. We first used a resting-state functional magnetic resonance imaging (fMRI) approach with a sample of 120 undergraduate students. Then, we unpacked the neuro-cognitive association between insular connectivity and cognitive performance during an Iowa gambling fMRI task. Lastly, an independent Open Southwest University Longitudinal Imaging Multimodal dataset was used to validate the results. Findings suggested that the dAI was predominantly connected to the prefrontal regions; the vAI was primarily connected to the AMG-ventral-striatum system; and the PI was mainly connected to the visceral-sensorimotor system. Moreover, cognitive scores were positively correlated with FC between dAI and the self-control process of ventrolateral prefrontal cortex and were negatively correlated with FC between vAI and the reward-seeking process of orbitofrontal cortex and subgenual anterior cingulate cortex. The findings highlight the roles of our theorized subinsular functionality in the overall operation of the neural cognitive systems.

Increased ventral anterior insular connectivity to sports betting availability indexes problem gambling.

With the advent of digital technologies, online sports betting is spurring a fast-growing expansion. In this study, we examined how sports betting availability modulates the brain connectivity of frequent sports bettors with [problem bettors (PB)] or without [non-problem bettors (NPB)] problematic sports betting. We conducted functional connectivity analyses centred on the ventral anterior insular cortex (vAI), a brain region playing a key role in the dynamic interplay between reward-based processes. We re-analysed a dataset on sports betting availability undertaken in PB (n = 30) and NPB (n = 35). Across all participants, we observed that sports betting availability elicited positive vAI coupling with extended clusters of brain activation (encompassing the putamen, cerebellum, occipital, temporal, precentral and central operculum regions) and negative vAI coupling with the orbitofrontal cortex. Between-group analyses showed increased positive vAI coupling in the PB group, as compared with the NPB group, in the left lateral occipital cortex, extending to the left inferior frontal gyrus, the anterior cingulate gyrus and the right frontal pole. Taken together, these results are in line with the central assumptions of triadic models of addictions, which posit that the insular cortex plays a pivotal role in promoting the drive and motivation to get a reward by 'hijacking' goal-oriented processes toward addiction-related cues. Taken together, these findings showed that vAI functional connectivity is sensitive not only to gambling availability but also to the status of problematic sport betting.

Maladaptive changes in delay discounting in males during the COVID-19 pandemic: the predictive role of functional connectome.

The Coronavirus disease of 2019 (COVID-19) and measures to curb it created population-level changes in male-dominant impulsive and risky behaviors such as violent crimes and gambling. One possible explanation for this is that the pandemic has been stressful, and males, more so than females, tend to respond to stress by altering their focus on immediate versus delayed rewards, as reflected in their delay discounting rates. Delay discounting rates from healthy undergraduate students were collected twice during the pandemic. Discounting rates of males (n=190) but not of females (n=493) increased during the pandemic. Using machine learning, we show that prepandemic functional connectome predict increased discounting rates in males (n=88). Moreover, considering that delay discounting is associated with multiple psychiatric disorders, we found the same neural pattern that predicted increased discounting rates in this study, in secondary datasets of patients with major depression and schizophrenia. The findings point to sex-based differences in maladaptive delay discounting under real-world stress events, and to connectome-based neuromarkers of such effects. They can explain why there was a population-level increase in several impulsive and risky behaviors during the pandemic and point to intriguing questions about the shared underlying mechanisms of stress responses, psychiatric disorders and delay discounting.

Brain modular connectivity interactions can predict proactive inhibition in smokers when facing smoking cues.

Proactive inhibition is a critical ability for smokers who seek to moderate or quit smoking. It allows them to pre-emptively refrain from seeking and using nicotine products, especially when facing salient smoking cues in daily life. Nevertheless, there is limited knowledge on the impact of salient cues on behavioural and neural aspects of proactive inhibition, especially in smokers with nicotine withdrawal. Here, we seek to bridge this gap. To this end, we recruited 26 smokers to complete a stop-signal anticipant task (SSAT) in two separate sessions: once in the neutral cue condition and once in the smoking cue condition. We used graph-based modularity analysis to identify the modular structures of proactive inhibition-related network during the SSAT and further investigated how the interactions within and between these modules could be modulated by different proactive inhibition demands and salient smoking cues. Findings pointed to three stable brain modules involved in the dynamical processes of proactive inhibition: the sensorimotor network (SMN), cognitive control network (CCN) and default-mode network (DMN). With the increase in demands, functional connectivity increased within the SMN, CCN and between SMN-CCN and decreased within the DMN and between SMN-DMN and CCN-DMN. Salient smoking cues disturbed the effective dynamic interactions of brain modules. The profiles for those functional interactions successfully predicted the behavioural performance of proactive inhibition in abstinent smokers. These findings advance our understanding of the neural mechanisms of proactive inhibition from a large-scale network perspective. They can shed light on developing specific interventions for abstinent smokers.

The role of the insula in internet gaming disorder.

Internet gaming disorder (IGD) is a concerning issue that requires further research. Here, we seek to examine its neural etiology with an emphasis on the role of the insula. To do so, we relied on the tripartite neurocognitive model of addictive behaviors as applied to IGD. We hypothesized that (a) video game cues will elicit stronger reward system activation and weaker prefrontal activation in gamers vs controls, (b) the IGD scores of gamers will be positively associated with activation of the reward system and negatively with activation of prefrontal regions, (c) deprivation from video gaming will result in increased activation of the insula, when gamers are exposed to video game cues vs to neutral cues, and (d) in deprivation conditions, there will be positive and negative coupling, respectively, between activation of the insula and the reward and prefrontal regions in gamers. We tested these hypotheses with a design with one between-subjects factor (gamers vs controls) and two within-subjects factors: stimuli (gaming vs neutral; for all participants) and session (deprivation vs satiety; only for gamers). Findings based on functional magnetic resonance imaging (fMRI; applied to all 52 subjects, 26 gamers, and 26 controls) and psychophysiological interaction (PPI; applied to the 26 gamers) engaged in a video reactivity task supported our assertions. The IGD score positively correlated with activity in the right ventral striatum and negatively with activity in the right dorsolateral prefrontal cortex (DLPFC). Left insular cortex activity was the highest when observing video gaming cues under deprivation. Lastly, there was an increased coupling between the left insula and left ventral striatum and a decreased coupling with left DLPFC when observing video gaming cues compared with when watching control videos in the deprivation condition.

Increased brain reactivity to gambling unavailability as a marker of problem gambling.

The unprecedented development and ubiquity of sports betting constitute an emerging public health concern. It is crucial to provide markers that could help to better identify people experiencing sports betting-related harms. The current study investigated whether problem gambling status, sports betting passion, and trait-self-control modulate brain reactivity to sports betting cues. Sixty-five frequent sports bettors (35 "nonproblem bettors" and 30 "problem bettors") were exposed to cues representing real upcoming sport events (with varying levels of winning confidence) that were made available or blocked for betting, during functional magnetic resonance imaging (fMRI) recording. Sports betting passion and trait-self-control were assessed using self-report scales. Sport events nonavailable for betting elicited higher insular and striatal activation in problem bettors, as compared with nonproblem bettors. Within a large cluster encompassing the ventral striatum, hippocampus, and amygdala, lower trait-self-control was associated with increased brain reactivity to sport events with high levels of winning confidence that were nonavailable for betting. No significant effect of sports betting passion was observed. These findings suggest that sports bettors' brain reactivity to gambling unavailability might be a relevant marker of sports betting-related harms, as well as of blunted trait-self-control.

Little video-gaming in adolescents can be protective, but too much is associated with increased substance use.

BACKGROUND: Studies have demonstrated inconsistent results regarding the association between video gaming time and substance use in teenagers. Understating intricacies of this association can help with substance use reduction in teenagers. OBJECTIVES: This study aimed to untangle this complex relationship by theorizing and examining a U-shaped association. METHODS: We analyzed two large samples (n1 = 7313 [52.5% female] and n2 = 8079 [51.6% female]) of 8th and 10th graders in the United States. Substance use was operationalized as the sum of self-reported number of lifetime use instances of 14 unprescribed substances. Video game use time (hours per week) was self-reported on a 1 (none) to 9 (40+) scale. Common covariates/risk factors were included. RESULTS: Consistently across datasets, partial-correlation between squared video gaming time and substance use (r = .10, p < .001 in 2014 and r = .08, p < .001 in 2015) supported the hypothesized u-shaped association. Analysis of covariance revealed that teenagers playing video games for 1-5 h a week report on significantly fewer instances of substance use compared with non-gamers (p < .001-.007). Post hoc analyses revealed that those who play at least 30 h per week report on significantly (p < .001) more instances of substance use (3.92 in 2014 and 3.38 in 2015) compared with teenagers playing video games for 1-5 h a week (2.17 in 2015 and 1.96 in 2015). CONCLUSIONS: Video gaming time and substance use follow a u-shaped association; light video gaming can be protective in terms of substance use, while too much video gaming is associated with increased substance use.

The role of the dorsal anterior insula in sexual risk: Evidence from an erotic Go/NoGo task and real-world risk-taking.

The insula plays an important role in response inhibition. Most relevant here, it has been proposed that the dorsal anterior insular cortex (dAIC) plays a central role in a salience network that is responsible for switching between the default mode network and the executive control network. However, the insula's role in sexually motivated response inhibition has not yet been studied. In this study, eighty-five 18- to 30-year-old sexually active men who have sex with men (MSM) performed an erotic Go/NoGo task while in an MRI scanner. Participants' real-world sexual risk-taking (frequency of condomless anal intercourse over the past 90 days) was then correlated with their neural activity during the task. We found greater activity in bilateral anterior insular cortex (both dorsal and ventral) on contrasts with stronger motivational information (attractive naked male pictures versus pictures of clothed, middle-aged females) and on contrasts requiring greater response inhibition (NoGo versus Go). We also found that activity in the right dAIC was negatively correlated with participants' real-world sexual risk-taking. Our results confirmed the involvement of the insular cortex in motivated response inhibition. Especially, the decreased right dAIC activity may reduce the likelihood that the executive control network will come online when individuals are faced with situations requiring inhibitory control and thus lead them to make more risky choices.

Delay discounting mediates the association between posterior insular cortex volume and social media addiction symptoms.

Addiction-like symptoms in relation to excessive and compulsive social media use are common in the general population. Because they can lead to various adverse effects, there is a growing need to understand the brain systems and processes that are involved in potential social media addiction. We focus on the morphology of the posterior subdivision of the insular cortex (i.e., the insula), because it has been shown to be instrumental to supporting the maintenance of substance addictions and problematic behaviors. Assuming that social media addiction shares neural similarities with more established ones and consistent with evidence from the neuroeconomics domain, we further examine one possible reason for this association-namely that insular morphology influences one's delay discounting and that this delay discounting contributes to exaggerated preference for immediate social media rewards and consequent addiction-like symptoms. Based on voxel-based morphometry techniques applied to MRI scans of 32 social media users, we show that the gray matter volumes of the bilateral posterior insula are negatively associated with social media addiction symptoms. We further show that this association is mediated by delay discounting. This provides initial evidence that insular morphology can be associated with potential social media addiction, in part, through its contribution to poor foresight and impulsivity as captured by delay discounting.

Facing temptation: The neural correlates of gambling availability during sports picture exposure.

Nowadays, sports betting has become increasingly available and easy to engage in. Here we examined the neural responses to stimuli that represent sporting events available for betting as compared to sporting events without a gambling opportunity. We used a cue exposure task in which football (soccer) fans (N = 42) viewed cues depicting scheduled football games that would occur shortly after the scanning session. In the "betting" condition, participants were instructed to choose, at the end of each block, the game (and the team) they wanted to bet on. In the "watching" condition, participants chose the game they would prefer to watch. After the scanning session, participants completed posttask rating questionnaires assessing, for each cue, their level of confidence about the team they believed would win and how much they would enjoy watching the game. We found that stimuli representing sport events available for betting elicited higher fronto-striatal activation, as well as higher insular cortex activity and functional connectivity, than sport events without a gambling opportunity. Moreover, games rated with more confidence towards the winning team resulted in greater brain activations within regions involved in affective decision-making (ventromedial prefrontal cortex), cognitive inhibitory control (medial and superior frontal gyri) and reward processing (ventral and dorsal striatum). Altogether, these novel findings offer a sensible simulation of how the high availability of sports betting in today's environment impacts on the reward and cognitive control systems. Future studies are needed to extend the present findings to a sample of football fans that includes a samilar proportion of female and male participants.

Prefrontal Cortical Activity During the Stroop Task: New Insights into the Why and the Who of Real-World Risky Sexual Behavior.

Background: Research suggests that deficits in both executive functioning and trait impulsivity may play a role in risky sexual behavior. At the neural level, differences in regulation of the prefrontal cortex have been linked to impulsivity, measured neurocognitively and through self-report. The relationship between neurocognitive measures of executive control and trait impulsivity in predicting risky sexual behavior has not been investigated. Purpose: To investigate the relationship between neural functioning during the Stroop task and risky sexual behavior, as well as the effect of individual differences in urgent (positive and negative) impulsivity on this relationship. Methods: A total of 105 sexually active men who have sex with men completed the Stroop task during functional magnetic resonance imaging scanning. They also completed impulsivity inventories and self-reported their risky sexual behavior (events of condomless anal sex in the last 90 days). Results: Risky participants had greater activation than safe participants during the color congruent condition of the Stroop task in anterior cingulate cortex/dorsomedial prefrontal cortex, dorsolateral prefrontal cortex, left frontal pole, and right insula. Across these regions, this neural activation mediated the link between (positive and/or negative) urgent impulsivity and risky sexual behavior. Conclusions: Findings suggest that the brains of men who engage in risky sexual behavior may employ a different distribution of cognitive resources during tasks of executive functioning than men who practice safe sex, and that this may relate to differences in the prefrontal cortical/fronto-insular system responsible for impulse control.

On the Processes Underlying the Relationship Between Alexithymia and Gambling Severity.

A great number of individuals with persistent problematic gambling behavior exhibit alexithymic tendencies, greater impulsivity, impaired working memory and poor mood. However, the relationship between these cognitive, affective and personality factors in problem gambling remains poorly understood. Our aim was to investigate multiple pathways of the alexithymia and problem gambling relationship. One hundred and six male subjects with different levels of gambling problem severity were recruited. Alexithymia, impulsivity and verbal working memory were evaluated, and their relationships to disordered gambling was examined by means of a path analysis. Results indicate that alexithymia is related to an increase in the severity of gambling indirectly, i.e., through distress severity. In addition, a rise of alexithymic tendencies was also associated with problem gambling severity through enhanced impulsivity that directly increased distress. Working memory capacity failed to significantly impact our path model. Overall, our findings contribute a new finding to the literature by highlighting the importance of alexithymia, in addition to impulsivity, in the understanding of gambling problem severity and its clinical course.

Damage to insula abolishes cognitive distortions during simulated gambling.

Gambling is a naturalistic example of risky decision-making. During gambling, players typically display an array of cognitive biases that create a distorted expectancy of winning. This study investigated brain regions underpinning gambling-related cognitive distortions, contrasting patients with focal brain lesions to the ventromedial prefrontal cortex (vmPFC), insula, or amygdala ("target patients") against healthy comparison participants and lesion comparison patients (i.e., with lesions that spare the target regions). A slot machine task was used to deliver near-miss outcomes (i.e., nonwins that fall spatially close to a jackpot), and a roulette game was used to examine the gambler's fallacy (color decisions following outcome runs). Comparison groups displayed a heightened motivation to play following near misses (compared with full misses), and manifested a classic gambler's fallacy effect. Both effects were also observed in patients with vmPFC and amygdala damage, but were absent in patients with insula damage. Our findings indicate that the distorted cognitive processing of near-miss outcomes and event sequences may be ordinarily supported by the recruitment of the insula. Interventions to reduce insula reactivity could show promise in the treatment of disordered gambling.

Increased ventral-striatal activity during monetary decision making is a marker of problem poker gambling severity.

The aim of this study was to examine the impact of different neural systems on monetary decision making in frequent poker gamblers, who vary in their degree of problem gambling. Fifteen frequent poker players, ranging from non-problem to high-problem gambling, and 15 non-gambler controls were scanned using functional magnetic resonance imaging (fMRI) while performing the Iowa Gambling Task (IGT). During IGT deck selection, between-group fMRI analyses showed that frequent poker gamblers exhibited higher ventral-striatal but lower dorsolateral prefrontal and orbitofrontal activations as compared with controls. Moreover, using functional connectivity analyses, we observed higher ventral-striatal connectivity in poker players, and in regions involved in attentional/motor control (posterior cingulate), visual (occipital gyrus) and auditory (temporal gyrus) processing. In poker gamblers, scores of problem gambling severity were positively associated with ventral-striatal activations and with the connectivity between the ventral-striatum seed and the occipital fusiform gyrus and the middle temporal gyrus. Present results are consistent with findings from recent brain imaging studies showing that gambling disorder is associated with heightened motivational-reward processes during monetary decision making, which may hamper one's ability to moderate his level of monetary risk taking.

Lesion mapping of cognitive control and value-based decision making in the prefrontal cortex.

A considerable body of previous research on the prefrontal cortex (PFC) has helped characterize the regional specificity of various cognitive functions, such as cognitive control and decision making. Here we provide definitive findings on this topic, using a neuropsychological approach that takes advantage of a unique dataset accrued over several decades. We applied voxel-based lesion-symptom mapping in 344 individuals with focal lesions (165 involving the PFC) who had been tested on a comprehensive battery of neuropsychological tasks. Two distinct functional-anatomical networks were revealed within the PFC: one associated with cognitive control (response inhibition, conflict monitoring, and switching), which included the dorsolateral prefrontal cortex and anterior cingulate cortex and a second associated with value-based decision-making, which included the orbitofrontal, ventromedial, and frontopolar cortex. Furthermore, cognitive control tasks shared a common performance factor related to set shifting that was linked to the rostral anterior cingulate cortex. By contrast, regions in the ventral PFC were required for decision-making. These findings provide detailed causal evidence for a remarkable functional-anatomical specificity in the human PFC.

Effect of casino-related sound, red light and pairs on decision-making during the Iowa gambling task.

Casino venues are often characterized by "warm" colors, reward-related sounds, and the presence of others. These factors have always been identified as a key factor in energizing gambling. However, few empirical studies have examined their impact on gambling behaviors. Here, we aimed to explore the impact of combined red light and casino-related sounds, with or without the presence of another participant, on gambling-related behaviors. Gambling behavior was estimated with the Iowa Gambling Task (IGT). Eighty non-gamblers participants took part in one of four experimental conditions (20 participants in each condition); (1) IGT without casino-related sound and under normal (white) light (control), (2) IGT with combined casino-related sound and red light (casino alone), (3) IGT with combined casino-related sound, red light and in front of another participant (casino competition-implicit), and (4) IGT with combined casino-related sound, red light and against another participant (casino competition-explicit). Results showed that, in contrast to the control condition, participants in the three "casino" conditions did not exhibit slower deck selection reaction time after losses than after rewards. Moreover, participants in the two "competition" conditions displayed lowered deck selection reaction time after losses and rewards, as compared with the control and the "casino alone" conditions. These findings suggest that casino environment may diminish the time used for reflecting and thinking before acting after losses. These findings are discussed along with the methodological limitations, potential directions for future studies, as well as implications to enhance prevention strategies of abnormal gambling.

Impaired decision-making under risk in individuals with alcohol dependence.

BACKGROUND: Alcohol dependence is associated with poor decision-making under ambiguity, that is, when decisions are to be made in the absence of known probabilities of reward and loss. However, little is known regarding decisions made by individuals with alcohol dependence in the context of known probabilities (decision under risk). In this study, we investigated the relative contribution of these distinct aspects of decision-making to alcohol dependence. METHODS: Thirty recently detoxified and sober asymptomatic alcohol-dependent individuals and 30 healthy control participants were tested for decision-making under ambiguity (using the Iowa Gambling Task[IGT]) and decision-making under risk (using the Cups Task and Coin Flipping Task). We also tested their capacities for working memory storage (digit span forward) and dual tasking (operation span task). RESULTS: Compared to healthy control participants, alcohol-dependent individuals made disadvantageous decisions on the IGT, reflecting poor decisions under ambiguity. They also made more risky choices on the Cups and Coin Flipping Tasks reflecting poor decision-making under risk. In addition, alcohol-dependent participants showed some working memory impairments, as measured by the dual tasking, and the degree of this impairment correlated with high-risk decision-making, thus suggesting a relationship between processes subserving working memory and risky decisions. CONCLUSIONS: These results suggest that alcohol-dependent individuals are impaired in their ability to decide optimally in multiple facets of uncertainty (i.e., both risk and ambiguity) and that at least some aspects of these deficits are linked to poor working memory processes.

Basal ganglia plus insula damage yields stronger disruption of smoking addiction than basal ganglia damage alone.

INTRODUCTION: The main objective of this study was to elucidate the importance of the basal ganglia (BG) and insula (INS) for nicotine addiction and smoking behavior. METHODS: We used a lesion study examining the effects of BG and INS damage on changes in smoking behavior and nicotine dependence over time in a prospective manner. We studied whether combined BG and INS damage yields more substantial disruption of smoking and nicotine dependence than damage to the BG alone and compared with damage to other brain regions outside the BG and INS (brain-damaged comparison [BDC] group). We obtained neuroanatomical and behavioral data for 63 neurological patients with stroke at 1 month after onset and at 3-, 6-, and 12-month follow-ups. All patients were smokers at lesion onset. RESULTS: The BG and BG + INS groups had significantly higher and more sustained rates of smoking cessation than patients with damage elsewhere. By 12 months after onset, only 14.3% of the patients in the BDC group were classified as nonsmokers. In the BG group, 37% were not smoking by the 12-month follow-up, and in the BG + INS group, smoking cessation was even more pronounced, as 75% of this group was not smoking at the 12-month epoch. CONCLUSIONS: The findings show that damage to the BG alone can cause disruption of smoking addiction, and when BG damage is combined with INS damage, the disruption increases. The latter finding is consistent with the proposal that the INS has a key role in smoking addiction.

Poor ability to resist tempting calorie rich food is linked to altered balance between neural systems involved in urge and self-control.

BACKGROUND: The loss of self-control or inability to resist tempting/rewarding foods, and the development of less healthful eating habits may be explained by three key neural systems: (1) a hyper-functioning striatum system driven by external rewarding cues; (2) a hypo-functioning decision-making and impulse control system; and (3) an altered insula system involved in the translation of homeostatic and interoceptive signals into self-awareness and what may be subjectively experienced as a feeling. METHODS: The present study examined the activity within two of these neural systems when subjects were exposed to images of high-calorie versus low-calorie foods using functional magnetic resonance imaging (fMRI), and related this activity to dietary intake, assessed by 24-hour recall. Thirty youth (mean BMI = 23.1 kg/m2, range = 19.1 - 33.7; age =19.7 years, range = 14 - 22) were scanned using fMRI while performing food-specific go/nogo tasks. RESULTS: Behaviorally, participants more readily pressed a response button when go trials consisted of high-calorie food cues (HGo task) and less readily pressed the response button when go trials consisted of low-calorie food cues (LGo task). This habitual response to high-calorie food cues was greater for individuals with higher BMI and individuals who reportedly consume more high-calorie foods. Response inhibition to the high-calorie food cues was most difficult for individuals with a higher BMI and individuals who reportedly consume more high-calorie foods. fMRI results confirmed our hypotheses that (1) the "habitual" system (right striatum) was more activated in response to high-calorie food cues during the go trials than low-calorie food go trials, and its activity correlated with participants' BMI, as well as their consumption of high-calorie foods; (2) the prefrontal system was more active in nogo trials than go trials, and this activity was inversely correlated with BMI and high-calorie food consumption. CONCLUSIONS: Using a cross-sectional design, our findings help increase understanding of the neural basis of one's loss of ability to self-control when faced with tempting food cues. Though the design does not permit inferences regarding whether the inhibitory control deficits and hyper-responsivity of reward regions are individual vulnerability factors for overeating, or the results of habitual overeating.

Functional imaging of an alcohol-Implicit Association Test (IAT).

This research assessed activation in neural substrates involved in implicit associative processes through functional magnetic resonance imaging of an alcohol-Implicit Association Test (IAT) focused on positive outcomes of alcohol use. Comparisons involved 17 heavy and 19 light drinkers, ranging in age from 18 to 22, during compatible and incompatible association task trials. Behaviorally, a significant IAT effect was found with heavy drinkers showing stronger positive implicit associations toward alcohol use than light drinkers. Imaging data revealed heavy drinkers showed greater activity during compatible trials relative to incompatible trials in the left putamen and insula while no significant difference in activity between conditions was found in the light drinkers. Light drinkers showed significantly more activity in the left orbital frontal cortex during both compatible and incompatible trials than heavy drinkers, and the dorsolateral prefrontal cortex was engaged more in both light and heavy drinkers during incompatible trials relative to compatible trials. Further, within-group analyses showed significant amygdala activity along with the putamen and insula among heavy drinkers during compatible trials relative to incompatible trials. These results are consistent with a dual process framework of appetitive behaviors proposing that (1) implicit associations underlying habit are mediated through neural circuitry dependent on the striatum, and (2) controlled behaviors are mediated through neural circuitry more dependent on the prefrontal cortex. This is the first study to evaluate the neural mechanisms elicited by an alcohol-IAT, providing an additional step toward increasing understanding of associative habit processes and their regulatory influence over addictive behaviors.