Neural reactivity to a racial trauma cue in an African American woman with alcohol use disorder and PTSD: Case report

• Study highlights racial trauma's impact on AUD+PTSD neural activation in Black women. • Personalized script-imagery reveals distinct brain response to racial trauma cues. • Novel fMRI methods with script imagery shows unique brain activation to racial trauma cues. • fMRI reactivity reveals racial trauma activation in sensorimotor-related brain regions. Alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are common co-occurring diagnoses that disproportionately affect racial minorities and women. Black/African American women are more likely to experience racial trauma, which compounds AUD+PTSD comorbidity. Limited research has investigated the effect of racial trauma on AUD+PTSD using functional magnetic resonance imaging (fMRI). We used a novel script-driven imagery procedure during MRI for racial trauma in a 26-year-old, self-identifying Black woman enrolled in a 12-week randomized clinical trial for individuals with AUD+PTSD. During a baseline fMRI scan, the participant listened to personalized audio scripts of an index traumatic event cue (i.e., “PTSD cue”), an alcohol-related cue, a racial trauma cue, and a neutral cue. This case report describes comparisons of brain reactivity between the racial trauma and PTSD cue, and the racial trauma and alcohol cue. In this Black woman with AUD+PTSD, the racial trauma cue elicited unique activation patterns in sensorimotor and interoceptive brain regions. These patterns partially overlapped with but were distinct from activations observed during PTSD and alcohol cues. Racial trauma showed greater activation than the PTSD cue in self-referential (e.g. posterior cingulate cortex) and sensorimotor regions, and broader activation than the alcohol cue across temporal, occipital, and frontal regions. These findings suggest racial trauma may engage unique neural pathways related to emotional pain, self-referential processing, and hypervigilance. While preliminary, this case study offers insights into the neurobiological signature of racial trauma and underscores the need to include culturally specific stressors in trauma and addiction research.