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Among these factors, pain sensitivity and pain\u2010related drinking motive can significantly promote alcohol use. In contrast, proactive avoidance \u2013 a beneficial strategy of initiating overt actions to avoid negative outcomes \u2013 reduces harmful consumption. Yet, these factors have not been assessed as potential predictors of future drinking behaviour. Here, in a longitudinal study we collected fMRI data in 50 drinkers who, at baseline, performed a probabilistic learning go\/nogo task that involved proactive avoidance of painful electric shocks. Pain\u2010related psychological measures and the neural correlates of proactive avoidance were examined in relation to participants' alcohol use and craving in the following 12\u2009months. We found that deficits in proactive avoidance were associated with future drinking severity. Importantly, diminished activation of the dorsal anterior cingulate cortex (dACC) during proactive avoidance also predicted subsequent percentage of heavy drinking days. Using Bayesian network modelling, we established a potential pathway in which drinkers' heightened pain sensitivity led to greater pain\u2010avoidance drinking motive and alcohol craving. Both craving and weakened dACC activation to proactive avoidance predicted higher levels of drinking during the follow\u2010up period. Taken together, our study identified pain sensitivity, pain\u2010avoidance drinking motive, and impaired proactive avoidance as predictors of future alcohol use severity. These findings highlight the roles of pain response, thus potentially informing interventions for individuals at risk of alcohol use disorders.<\/jats:p>","DOI":"10.1111\/adb.70020","type":"journal-article","created":{"date-parts":[[2025,2,15]],"date-time":"2025-02-15T03:00:22Z","timestamp":1739588422000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neural, Motivational, and Psychological Measures of Pain Avoidance Predict Future Alcohol Use in Adult Drinkers"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4196-8646","authenticated-orcid":false,"given":"Thang\u00a0M.","family":"Le","sequence":"first","affiliation":[{"name":"Department of Psychiatry Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.\u00a0AnNa","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Psychology Villanova University  Villanova Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9075-2622","authenticated-orcid":false,"given":"Takeyuki","family":"Oba","sequence":"additional","affiliation":[{"name":"Human Informatics and Interaction Research Institute, the National Institute of Advanced Industrial Science and Technology (AIST)  Tsukuba Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiang\u2010Shan\u00a0R.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Yale University School of Medicine  New Haven Connecticut USA"},{"name":"Department of Neuroscience Yale University School of Medicine  New Haven Connecticut USA"},{"name":"Interdepartmental Neuroscience Program Yale University School of Medicine  New Haven Connecticut USA"},{"name":"Wu Tsai Institute Yale University  New Haven Connecticut 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