For the first time, our results reveal alterations in causal connectivity in individuals with AUD. We demonstrate that it is possible to distinguish AUD individuals from HCs at an individual level using MVPA. Notably, brain regions with high weight include the left pre-SMA, right dACC, right LOFC, right putamen, and right NACC. The results of spectral DCM revealed altered EC in AUD individuals, specifically from the left pre-SMA to right putamen, from the right dACC to right putamen, and from the right NACC to left pre-SMA. In addition, the EC strength from the right NACC to left pre-SMA and from the right dACC to right putamen mediated the association between addiction severity (MAST scores) and behavioral measures. These results suggest that the reciprocal causal connections among the most informative brain regions for the classification may be particularly targeted by AUD, explaining deteriorated self-control, and impulsive and compulsive alcohol consumption in AUD. Additionally, impulsivity may represent a crucial personality trait that renders individuals susceptible to alcohol use and the development of AUD. These findings provide novel causal insights into the diagnosis and management of AUD.
