Posttraumatic Reexperiencing and Alcohol Use: Mediofrontal Theta as a Neural Mechanism for Negative Reinforcement

Over half of U.S.military veterans with posttraumatic stress disorder (PTSD) use alcohol heavily, potentially to cope with their symptoms. This study investigated the neural underpinnings of PTSD symptoms and heavy drinking in veterans. We focused on brain responses to salient outcomes within predictive coding theory. This framework suggests the brain generates prediction errors (PEs) when outcomes deviate from expectations. Alcohol use might provide negative reinforcement by reducing the salience of negatively valenced PEs and dampening experiences like loss. We analyzed electroencephalography responses to unpredictable gain/loss feedback in n=82 veterans ofOperations Enduring and Iraqi Freedom.We used time-frequency principal components analysis of event-related potentials to isolate neural responses indicative of PEs, identifying mediofrontal theta linked to losses (feedback-related negativity) and central delta associatedwith gains (reward positivity). Intrusive reexperiencing symptoms of PTSD were associated with intensified mediofrontal theta signaling during losses, suggesting heightened negative PE sensitivity. Conversely, increased hazardous alcohol use was associated with reduced theta responses, implying a dampening of these negative PEs. The separate deltareward positivity component showed associations with alcohol use but not PTSD symptoms. The findings suggest a common neural component of PTSD and hazardous alcohol use involving altered PE processing. We suggest that reexperiencing enhances the intensity of salient negative PEs,while chronic alcohol usemay reduce their intensity, thereby providing negative reinforcement by muting posttraumatic distress and associated brain responses. Modifying the mediofrontal theta response could address the intertwined nature of PTSD symptoms and alcohol use, providing new avenues for treatment.