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Mann K, Vollstädt-Klein S, Reinhard I, Leménager T, Fauth-Bühler M, Hermann D, Hoffmann S, Zimmermann US, Kiefer F, Heinz A, Smolka MN. Predicting naltrexone response in alcohol-dependent patients: the contribution of functional magnetic resonance imaging. Alcohol Clin Exp Res 2015; 38:2754-62. [PMID: 25421512 DOI: 10.1111/acer.12546] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 08/11/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Effect sizes of pharmacotherapy in alcoholism are modest. They might improve if subjects could be divided into more homogeneous subgroups and would then be treated targeted to their neurobiological profile. In such an effort, we tested neural cue reactivity as a potential predictor of treatment response to naltrexone. Alcohol-associated cues cause brain activations in mesocorticolimbic networks due to the positive reinforcing properties of alcohol. These activations were reported to be associated with relapse behavior. Naltrexone, an antagonist at the mu-opioid receptor, improves drinking behavior in some but not all patients probably by blocking the positive reinforcement of alcohol. Conversely, acamprosate is proposed to modulate negative reinforcement (withdrawal and cue-induced withdrawal). Identifying subjects with elevated cue reactivity and testing their response to medical treatment could thus improve our understanding of some of the mechanisms underlying pharmacotherapy response. METHODS A picture-perception task featuring alcohol-related and neutral stimuli was presented to 64 recently detoxified alcohol-dependent patients. Patients came from 1 center of a larger double-blind randomized multicenter clinical trial (the "PREDICT Study"). They were scanned prior to being randomized to either naltrexone or acamprosate. We examined the interaction between medication and functional magnetic resonance imaging (fMRI) cue reactivity, as measured by the percentage of voxels activated, using the time to the first severe relapse as the outcome criterion. Our a priori formulated hypothesis was that naltrexone but not acamprosate should be efficacious in subjects with high cue reactivity. RESULTS We observed an interaction effect between pretreatment brain activation induced by alcohol images and medication (acamprosate/naltrexone) on relapse behavior. In line with our hypothesis, this interaction was driven by treatment response to naltrexone in patients with elevated pretreatment cue reactivity in the ventral striatum. CONCLUSIONS fMRI has the potential for predicting treatment response to naltrexone in a subgroup of alcohol-dependent patients. However, this approach will be limited to researching the mechanisms and principles of treatment response.
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Affiliation(s)
- Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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152
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Garbusow M, Sebold M, Beck A, Heinz A. Too difficult to stop: mechanisms facilitating relapse in alcohol dependence. Neuropsychobiology 2015; 70:103-10. [PMID: 25359490 DOI: 10.1159/000362838] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 04/13/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND In alcohol and other substance dependencies, patients often suffer relapse despite better knowledge and their intention to remain abstinent. A variety of neurotransmitter systems and their respective alterations due to the chronic drug intake are involved in mechanisms that facilitate relapse. It has been postulated that these neurotransmitter systems are related to changes in motivational and learning mechanisms, and engender a shift from goal-directed to habitual behavior in dependent patients that facilitates drug-seeking behavior. METHODS We review learning mechanisms facilitating relapse, as identified and tested to date. We focus on studies examining the interaction between alcohol-related changes in monoaminergic neurotransmission and their respective effects on pavlovian and operant learning mechanisms in alcohol dependence. RESULTS Animal experiments and first human studies suggest that chronic alcohol intake impairs goal-directed behavior and facilitates habitual drug intake. Key symptoms of alcohol dependence such as tolerance development, withdrawal, craving and reduced control of alcohol intake can be explained by alcohol-induced alteration of dopaminergic neurotransmission and its GABAergic and glutamatergic modulation and their respective effects on pavlovian and operant conditioning as well as pavlovian-to-instrumental transfer. CONCLUSION Chronic alcohol intake impairs neurotransmitter systems that regulate prefrontal-striatal circuits and interfere with goal-directed decision-making and the acquisition of new, non-drug-related behavior patterns. Alcohol craving induced by pavlovian conditioned cues can facilitate habitual drug intake. Such learning mechanisms and their alterations by chronic alcohol intake might be targeted by specific interventions.
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Affiliation(s)
- Maria Garbusow
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
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153
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Brumback T, Squeglia LM, Jacobus J, Pulido C, Tapert SF, Brown SA. Adolescent heavy drinkers' amplified brain responses to alcohol cues decrease over one month of abstinence. Addict Behav 2015; 46:45-52. [PMID: 25796007 DOI: 10.1016/j.addbeh.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/22/2015] [Accepted: 03/02/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Heavy drinking during adolescence is associated with increased reactivity to alcohol related stimuli and to differential neural development. Alcohol cue reactivity has been widely studied among adults with alcohol use disorders, but little is known about the neural substrates of cue reactivity in adolescent drinkers. The current study aimed to identify changes in blood-oxygen level dependent (BOLD) signal during a cue reactivity task pre- and post-monitored abstinence from alcohol. METHOD Demographically matched adolescents (16.0-18.9 years, 54% female) with histories of heavy episodic drinking (HD; n=22) and light or non-drinking control teens (CON; n=16) were recruited to participate in a month-long study. All participants completed a functional Magnetic Resonance Imaging (fMRI) scan with an alcohol cue reactivity task and substance use assessments at baseline and after 28 days of monitored abstinence from alcohol and drugs (i.e., urine toxicology testing every 48-72 h). Repeated-measure analysis of variance (ANOVA) examined main effects of group, time, and group×time interactions on BOLD signal response in regions of interest defined by functional differences at baseline. RESULTS The HD group exhibited greater (p<.01) BOLD activation than CON to alcohol cues relative to neutral cues in all regions of interest (ROIs; bilateral striatum/globus pallidus, left anterior cingulate, bilateral cerebellum, and parahippocampal gyrus extending to the thalamus/substantia nigra) across time points. Group×time effects showed that HD exhibited greater BOLD activation to alcohol cues than CON at baseline in left anterior cingulate cortex and in the right cerebellar region, but these decreased to non-significance after one month of monitored abstinence. CONCLUSIONS In all ROIs examined, HD exhibited greater BOLD response than CON to alcohol relative to neutral beverage picture cues at baseline, indicating heightened cue reactivity to alcohol cues in heavy drinking adolescents prior to the onset of any alcohol use diagnosis. Across the majority of these brain regions, differences in BOLD response were no longer apparent following a month of abstinence, suggesting a decrease in alcohol cue reactivity among adolescent non-dependent heavy drinkers as a consequence of abstaining from alcohol. These results highlight the malleability of adolescent brain function despite no formal intervention targeting cue reactivity. Increased understanding of the neural underpinnings of cue reactivity could have implications for prevention and intervention strategies in adolescent heavy alcohol users.
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Affiliation(s)
- Ty Brumback
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Lindsay M Squeglia
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA
| | - Joanna Jacobus
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Carmen Pulido
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Susan F Tapert
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Sandra A Brown
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.
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154
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Kwako LE, Schwandt ML, Sells JR, Ramchandani VA, Hommer DW, George DT, Sinha R, Heilig M. Methods for inducing alcohol craving in individuals with co-morbid alcohol dependence and posttraumatic stress disorder: behavioral and physiological outcomes. Addict Biol 2015; 20:733-46. [PMID: 24806358 DOI: 10.1111/adb.12150] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Alcohol addiction is a chronic relapsing disorder that presents a substantial public health problem, and is frequently co-morbid with posttraumatic stress disorder (PTSD). Craving for alcohol is a predictor of relapse to alcohol use, and is triggered by cues associated with alcohol and trauma. Identification of reliable and valid laboratory methods for craving induction is an important objective for alcoholism and PTSD research. The present study compares two methods for induction of craving via stress and alcohol cues in individuals with co-morbid alcohol dependence (AD) and PTSD: the combined Trier social stress test and cue reactivity paradigm (Trier/CR), and a guided imagery (Scripts) paradigm. Outcomes include self-reported measures of craving, stress and anxiety as well as endocrine measures. Subjects were 52 individuals diagnosed with co-morbid AD and PTSD seeking treatment at the National Institute on Alcohol Abuse and Alcoholism inpatient research facility. They participated in a 4-week inpatient study of the efficacy of a neurokinin 1 antagonist to treat co-morbid AD and PTSD, and which included the two challenge procedures. Both the Trier/CR and Scripts induced craving for alcohol, as well as elevated levels of subjective distress and anxiety. The Trier/CR yielded significant increases in adrenocorticotropic hormone and cortisol, while the Scripts did not. Both paradigms are effective laboratory means of inducing craving for alcohol. Further research is warranted to better understand the mechanisms behind craving induced by stress versus alcohol cues, as well as to understand the impact of co-morbid PTSD and AD on craving.
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Affiliation(s)
- Laura E. Kwako
- Laboratory for Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
| | - Melanie L. Schwandt
- Laboratory for Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
| | - Joanna R. Sells
- Laboratory for Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
| | - Vijay A. Ramchandani
- Laboratory for Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
| | - Daniel W. Hommer
- Laboratory for Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
| | - David T. George
- Laboratory for Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
| | - Rajita Sinha
- The Yale Stress Center; Department of Psychiatry; Yale University School of Medicine; New Haven CT USA
| | - Markus Heilig
- Laboratory for Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
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155
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Lichenstein SD, Jones BL, O'Brien JW, Zezza N, Stiffler S, Holmes B, Hill SY. Familial risk for alcohol dependence and developmental changes in BMI: the moderating influence of addiction and obesity genes. Pharmacogenomics 2015; 15:1311-21. [PMID: 25155933 DOI: 10.2217/pgs.14.86] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Familial loading for alcohol dependence (AD) and variation in genes reported to be associated with AD or BMI were tested in a longitudinal study. MATERIALS & METHODS Growth curve analyses of BMI data collected at approximately yearly intervals and obesity status (BMI > 30) were examined. RESULTS High-risk males were found to have higher BMI than low-risk males, beginning at age 15 years (2.0 kg/m(2) difference; p = 0.046), persisting through age 19 years (3.3 kg/m(2) difference; p = 0.005). CHRM2 genotypic variance predicted longitudinal BMI and obesity status. Interactions with risk status and sex were also observed for DRD2 and FTO gene variation. CONCLUSION Variation at loci implicated in addiction may be influential in determining susceptibility to increased BMI in childhood and adolescence.
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Affiliation(s)
- Sarah D Lichenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
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156
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Sawyer KS, Poey A, Ruiz SM, Marinkovic K, Oscar-Berman M. Measures of skin conductance and heart rate in alcoholic men and women during memory performance. PeerJ 2015; 3:e941. [PMID: 26020002 PMCID: PMC4435500 DOI: 10.7717/peerj.941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 04/16/2015] [Indexed: 11/20/2022] Open
Abstract
We examined abnormalities in physiological responses to emotional stimuli associated with long-term chronic alcoholism. Skin conductance responses (SCR) and heart rate (HR) responses were measured in 32 abstinent alcoholic (ALC) and 30 healthy nonalcoholic (NC) men and women undergoing an emotional memory task in an MRI scanner. The task required participants to remember the identity of two emotionally-valenced faces presented at the onset of each trial during functional magnetic resonance imaging (fMRI) scanning. After viewing the faces, participants saw a distractor image (an alcoholic beverage, nonalcoholic beverage, or scrambled image) followed by a single probe face. The task was to decide whether the probe face matched one of the two encoded faces. Skin conductance measurements (before and after the encoded faces, distractor, and probe) were obtained from electrodes on the index and middle fingers on the left hand. HR measurements (beats per minute before and after the encoded faces, distractor, and probe) were obtained by a pulse oximeter placed on the little finger on the left hand. We expected that, relative to NC participants, the ALC participants would show reduced SCR and HR responses to the face stimuli, and that we would identify greater reactivity to the alcoholic beverage stimuli than to the distractor stimuli unrelated to alcohol. While the beverage type did not differentiate the groups, the ALC group did have reduced skin conductance and HR responses to elements of the task, as compared to the NC group.
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Affiliation(s)
- Kayle S. Sawyer
- Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Alan Poey
- Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Mosher Ruiz
- Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Ksenija Marinkovic
- University of California at San Diego, CA, USA
- Psychology Department, San Diego State University, CA, USA
| | - Marlene Oscar-Berman
- Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
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157
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Romanczuk-Seiferth N, Koehler S, Dreesen C, Wüstenberg T, Heinz A. Pathological gambling and alcohol dependence: neural disturbances in reward and loss avoidance processing. Addict Biol 2015; 20:557-69. [PMID: 24754423 DOI: 10.1111/adb.12144] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pathological gambling (PG) shares clinical characteristics such as craving and loss of control with substance use disorders and is thus considered a behavioral addiction. While functional alterations in the mesolimbic reward system have been correlated with craving and relapse in substance use disorders, only a few studies have examined this brain circuit in PG, and no direct comparison has been conducted so far. Thus, we investigated the neuronal correlates of reward processing in PG in contrast to alcohol-dependent (AD) patients and healthy subjects. Eighteen PG patients, 15 AD patients and 17 controls were investigated with a monetary incentive delay task, in which visual cues predict the consequence (monetary gain, avoidance of loss, none) of a fast response to a subsequent target stimulus. Functional magnetic resonance imaging data were analyzed to account for possible confounding factors such as local gray matter volume. Activity in the right ventral striatum during loss anticipation was increased in PG patients compared with controls and AD patients. Moreover, PG patients showed decreased activation in the right ventral striatum and right medial prefrontal cortex during successful loss avoidance compared with controls, which was inversely associated with severity of gambling behavior. Thus, despite neurobiological similarities to substance use disorders in reward processing, as reported by previous studies, we found relevant differences with respect to the anticipation of loss as well as its avoidance (negative reinforcement), which further contributes to the understanding of PG.
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Affiliation(s)
- Nina Romanczuk-Seiferth
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
| | - Saskia Koehler
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
- Berlin School of Mind and Brain and The Mind-Brain Institute; Humboldt-Universität zu Berlin; Berlin Germany
- Department of Psychology; Humboldt-Universität zu Berlin; Berlin Germany
| | - Caspar Dreesen
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy; Charité-Universitätsmedizin Berlin, Campus Mitte; Berlin Germany
- Berlin School of Mind and Brain and The Mind-Brain Institute; Humboldt-Universität zu Berlin; Berlin Germany
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158
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Weinstein A, Lejoyeux M. New developments on the neurobiological and pharmaco‐genetic mechanisms underlying internet and videogame addiction. Am J Addict 2015; 24:117-125. [DOI: 10.1111/ajad.12110] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/11/2013] [Accepted: 08/10/2013] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Michel Lejoyeux
- Department of Psychiatry and Addictive MedicineBichat Hospital AP‐HP and Maison Blanche HospitalParisFrance
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159
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Bull C, Syed WA, Minter SC, Bowers MS. Differential response of glial fibrillary acidic protein-positive astrocytes in the rat prefrontal cortex following ethanol self-administration. Alcohol Clin Exp Res 2015; 39:650-8. [PMID: 25833026 PMCID: PMC4384186 DOI: 10.1111/acer.12683] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/19/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Prefrontal cortex (PFC) dysfunction is believed to contribute to the transition from controlled substance use to abuse. Because astrocytes have been suggested to play a key role in the development and maintenance of drug-seeking behaviors, we sought to determine whether PFC astrocytes are affected by ethanol (EtOH) self-administration. METHODS EtOH consumption was modeled in rats by 3 self-administration paradigms where EtOH was made concurrently available with water in the home cage either continuously (CEA) or intermittently (IEA). In the third paradigm, EtOH was only available in the operant chamber (OEA). To avoid the potential confound of acute EtOH effects, all rats were sacrificed after either 24-hour or 3-week abstinence. In all groups, the effect of EtOH consumption on PFC astrocytes was measured using unbiased stereological counting of cells expressing the astrocyte marker glial fibrillary acidic protein (GFAP). GFAP immunoreactivity commonly changes in response to pharmacological insult or injury. RESULTS GFAP-positive astrocyte number increased in the prelimbic and anterior cingulate cortex regions of the PFC after IEA. No change was found in the infralimbic or orbitofrontal cortex after IEA. After 3-week abstinence, there was a reduction of astrocytes in the prelimbic and orbitofrontal cortex of the CEA cohort as well as a reduction in the orbitofrontal cortex of the OEA cohort. CONCLUSIONS These findings demonstrate that discrete PFC subregions contain GFAP-positive astrocyte populations that respond differentially to distinct EtOH consumption paradigms. A better understanding of how specific astrocyte populations uniquely adapt to EtOH consumption could provide insight for targeted therapeutic interventions.
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Affiliation(s)
- Cecilia Bull
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA 23223, USA
| | - Wahab A. Syed
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA 23223, USA
| | - Sabrina C. Minter
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA 23223, USA
| | - M. Scott Bowers
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA 23223, USA
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA 23223, USA
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160
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Witteman J, Post H, Tarvainen M, de Bruijn A, Perna EDSF, Ramaekers JG, Wiers RW. Cue reactivity and its relation to craving and relapse in alcohol dependence: a combined laboratory and field study. Psychopharmacology (Berl) 2015; 232:3685-96. [PMID: 26257163 PMCID: PMC4562995 DOI: 10.1007/s00213-015-4027-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 07/06/2015] [Indexed: 12/21/2022]
Abstract
The present study investigated the nature of physiological cue reactivity and craving in response to alcohol cues among alcohol-dependent patients (N = 80) who were enrolled in detoxification treatment. Further, the predictive value with regard to future drinking of both the magnitude of the physiological and craving response to alcohol cues while in treatment and the degree of alcohol-cue exposure in patients' natural environment was assessed. Physiological reactivity and craving in response to experimental exposure to alcohol and soft drink advertisements were measured during detoxification treatment using heart rate variability and subjective rating of craving. Following discharge, patients monitored exposure to alcohol advertisements for five consecutive weeks with a diary and were followed up with an assessment of relapse at 5 weeks and 3 months post-discharge. The results indicated that the presence of alcohol cues such as the portrayal of the drug and drinking behaviour induced physiological cue reactivity and craving. Additionally, cue reactivity and craving were positively correlated, and cue reactivity was larger for patients with shorter histories of alcohol dependence. Further, patients reported a substantial daily exposure to alcohol cues. The magnitude of cue reactivity and the craving response to alcohol cues at baseline and degree of exposure to alcohol cues in patients' natural environment did not predict relapse. It is concluded that the presence of alcohol cues such as portrayal of alcoholic beverages and drinking behaviour induces cue reactivity and craving in alcohol dependence through a conditioned appetitive response.
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Affiliation(s)
- Jurriaan Witteman
- Faculty of Humanities, Leiden University Center for Linguistics, Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands,
| | - Hans Post
- />VICTAS Addiction centre, Utrecht, The Netherlands
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161
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Alba-Ferrara L, Fernandez F, Salas R, de Erausquin GA. Transcranial Magnetic Stimulation and Deep Brain Stimulation in the treatment of alcohol dependence. ADDICTIVE DISORDERS & THEIR TREATMENT 2014; 13:159-169. [PMID: 25598743 PMCID: PMC4292849 DOI: 10.1097/adt.0b013e31829cf047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alcohol dependence is a major social, economic, and public health problem. Alcoholism can lead to damage of the gastrointestinal, nervous, cardiovascular, and respiratory systems and it can be lethal, costing hundreds of billions to the health care system. Despite the existence of cognitive-behavioral therapy, psychosocial interventions, and spiritually integrated treatment to treat it, alcohol dependence has a high relapse rate and poor prognosis, albeit with high interindividual variability. In this review, we discuss the use of two neuromodulation techniques, namely repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS), and their advantages and disadvantages compared to first-line pharmacological treatment for alcohol dependence. We also discuss rTMS and DBS targets for alcohol dependence treatment, considering experimental animal and human evidence, with careful consideration of methodological issues preventing the identification of feasible targets for neuromodulation treatments, as well as inter-individual variability factors influencing alcoholism prognosis. Lastly, we anticipate future research aiming to tailor the treatment to each individual patient by combining neurofunctional, neuroanatomical and neurodisruptive techniques optimizing the outcome.
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Affiliation(s)
- L. Alba-Ferrara
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - F. Fernandez
- Institute for Research in Psychiatry, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - R. Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - G. A. de Erausquin
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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162
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Hone-Blanchet A, Wensing T, Fecteau S. The use of virtual reality in craving assessment and cue-exposure therapy in substance use disorders. Front Hum Neurosci 2014; 8:844. [PMID: 25368571 PMCID: PMC4201090 DOI: 10.3389/fnhum.2014.00844] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/01/2014] [Indexed: 12/24/2022] Open
Abstract
Craving is recognized as an important diagnosis criterion for substance use disorders (SUDs) and a predictive factor of relapse. Various methods to study craving exist; however, suppressing craving to successfully promote abstinence remains an unmet clinical need in SUDs. One reason is that social and environmental contexts recalling drug and alcohol consumption in the everyday life of patients suffering from SUDs often initiate craving and provoke relapse. Current behavioral therapies for SUDs use the cue-exposure approach to suppress salience of social and environmental contexts that may induce craving. They facilitate learning and cognitive reinforcement of new behavior and entrain craving suppression in the presence of cues related to drug and alcohol consumption. Unfortunately, craving often overweighs behavioral training especially in real social and environmental contexts with peer pressure encouraging the use of substance, such as parties and bars. In this perspective, virtual reality (VR) is gaining interest in the development of cue-reactivity paradigms and practices new skills in treatment. VR enhances ecological validity of traditional craving-induction measurement. In this review, we discuss results from (1) studies using VR and alternative virtual agents in the induction of craving and (2) studies combining cue-exposure therapy with VR in the promotion of abstinence from drugs and alcohol use. They used virtual environments, displaying alcohol and drugs to SUD patients. Moreover, some environments included avatars. Hence, some studies have focused on the social interactions that are associated with drug-seeking behaviors and peer pressure. Findings indicate that VR can successfully increase craving. Studies combining cue–exposure therapy with virtual environment, however, reported mitigated success so far.
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Affiliation(s)
- Antoine Hone-Blanchet
- Laboratory of Canada Research Chair in Cognitive Neuroscience, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche l'Institut Universitaire en Santé Mentale de Québec, Faculté de Médecine, Université Laval , Quebec, QC , Canada
| | - Tobias Wensing
- Laboratory of Canada Research Chair in Cognitive Neuroscience, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche l'Institut Universitaire en Santé Mentale de Québec, Faculté de Médecine, Université Laval , Quebec, QC , Canada
| | - Shirley Fecteau
- Laboratory of Canada Research Chair in Cognitive Neuroscience, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Centre de Recherche l'Institut Universitaire en Santé Mentale de Québec, Faculté de Médecine, Université Laval , Quebec, QC , Canada ; Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
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163
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State dependent effect of transcranial direct current stimulation (tDCS) on methamphetamine craving. Int J Neuropsychopharmacol 2014; 17:1591-8. [PMID: 24825251 DOI: 10.1017/s1461145714000686] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been shown to modulate subjective craving ratings in drug dependents by modification of cortical excitability in dorsolateral prefrontal cortex (DLPFC). Given the mechanism of craving in methamphetamine (meth) users, we aimed to test whether tDCS of DLPFC could also alter self-reported craving in abstinent meth users while being exposed to meth cues. In this double-blinded, crossover, sham-controlled study, thirty two right-handed abstinent male meth users were recruited. We applied 20 min 'anodal' tDCS (2 mA) or 'sham' tDCS over right DLPFC in a random sequence while subjects performed a computerized cue-induced craving task (CICT) starting after 10 min of stimulation. Immediate craving was assessed before the stimulation, after 10 min of tDCS, and after tDCS termination by visual analog scale (VAS) of 0 to 100. Anodal tDCS of rDLPFC altered craving ratings significantly. We found a significant reduction of craving at rest in real tDCS relative to the sham condition (p = 0.016) after 10 min of stimulation. On the other hand, cue-induced VAS craving was rated significantly higher in the real condition in comparison with sham stimulation (p = 0.012). Our findings showed a state dependent effect of tDCS: while active prefrontal tDCS acutely reduced craving at rest in the abstinent meth users, it increased craving during meth-related cue exposure. These findings reflect the important role of the prefrontal cortex in both cue saliency evaluation and urge to meth consumption.
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164
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Herrold AA, Kletzel SL, Harton BC, Chambers RA, Jordan N, Pape TLB. Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders. Neural Regen Res 2014; 9:1712-30. [PMID: 25422632 PMCID: PMC4238159 DOI: 10.4103/1673-5374.143408] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/13/2022] Open
Abstract
Alcohol use disorder (AUD), mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD) commonly co-occur (AUD + mTBI + PTSD). These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation (rTMS) is non-invasive and may be an ideal treatment for co-occurring AUD + mTBI + PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD + mTBI + PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD + mTBI + PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD + mTBI + PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.
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Affiliation(s)
- Amy A. Herrold
- Edward Hines Jr. VA Hospital, Research Service PO Box 5000 (M/C 151H), Hines, IL, USA
- The Department of Veterans Affairs (VA), Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, #7-200, Chicago, IL, USA
| | - Sandra L. Kletzel
- The Department of Veterans Affairs (VA), Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL, USA
| | - Brett C. Harton
- Chicago Association for Research and Education in Science, Hines, IL, USA
| | - R. Andrew Chambers
- Department of Psychiatry, Laboratory for Translational Neuroscience of Dual Diagnosis & Development, Neuroscience Research Center, Indiana University School of Medicine, 320 West 15 Street, Indianapolis, IN, USA
| | - Neil Jordan
- The Department of Veterans Affairs (VA), Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL, USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, #7-200, Chicago, IL, USA
| | - Theresa Louise-Bender Pape
- Edward Hines Jr. VA Hospital, Research Service PO Box 5000 (M/C 151H), Hines, IL, USA
- The Department of Veterans Affairs (VA), Center for Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL, USA
- Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, Office of Medical Educ. (1574), 345 E. Superior St., Chicago, IL, USA
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165
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Varenicline effects on drinking, craving and neural reward processing among non-treatment-seeking alcohol-dependent individuals. Psychopharmacology (Berl) 2014; 231:3799-807. [PMID: 24647921 PMCID: PMC4146648 DOI: 10.1007/s00213-014-3518-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE The α4β2 nicotinic acetylcholine receptor partial agonist varenicline has been reported to reduce drinking among both heavy-drinking smokers and primary alcoholics, and this effect may be related to varenicline-mediated reduction of alcohol craving. Among smokers, varenicline has been reported to modulate cigarette cue-elicited brain activation in several reward-related areas. OBJECTIVES This pilot study tested varenicline's effects on drinking, alcohol craving, and alcohol cue-elicited activation of reward-related brain areas among non-treatment-seeking alcohol-dependent individuals. METHODS Thirty-five such individuals (mean age = 30, 57 % male, 76 % heavy drinking days in the past month, 15 smokers) were randomized to either varenicline (titrated to 2 mg) or placebo for 14 days, and were administered an alcohol cue reactivity fMRI task on day 14. A priori regions of interest (ROIs) were bilateral and medial orbitofrontal cortex (OFC), right ventral striatum (VS), and medial prefrontal cortex (mPFC). RESULTS Despite good medication adherence, varenicline did not reduce heavy drinking days or other drinking parameters. It did, however, increase self-reported control over alcohol-related thoughts and reduced cue-elicited activation bilaterally in the OFC, but not in other brain areas. CONCLUSIONS These data indicate that varenicline reduces alcohol craving and some of the neural substrates of alcohol cue reactivity. However, varenicline effects on drinking mediated by cue-elicited brain activation and craving might be best observed among treatment-seekers motivated to reduce their alcohol consumption.
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166
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Killing two birds with one stone: The potential role of aripiprazole for patients with comorbid major depressive disorder and nicotine dependence via altering brain activity in the anterior cingulate cortex. Med Hypotheses 2014; 83:407-9. [DOI: 10.1016/j.mehy.2014.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 06/27/2014] [Accepted: 07/11/2014] [Indexed: 11/20/2022]
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167
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Stice E, Yokum S. Brain reward region responsivity of adolescents with and without parental substance use disorders. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:805-15. [PMID: 24128289 PMCID: PMC3986351 DOI: 10.1037/a0034460] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study tested the competing hypotheses that adolescents at risk for future substance abuse and dependence by virtue of parental substance use disorders show either weaker or stronger responsivity of brain regions implicated in reward relative to youth without parental history of substance use disorders. Adolescents (n = 52) matched on demographics with and without parental substance use disorders, as determined by diagnostic interviews, who denied substance use in the past year were compared on functional MRI (fMRI) paradigms assessing neural response to receipt and anticipated receipt of monetary and food reward. Parental-history-positive versus -negative adolescents showed greater activation in the left dorsolateral prefrontal cortex and bilateral putamen, and less activation in the fusiform gyrus and inferior temporal gyrus in response to anticipating winning money, as well as greater activation in the left midbrain and right paracentral lobule, and less activation in the right middle frontal gyrus in response to milkshake receipt. Results indicate that adolescents at risk for future onset of substance use disorders show elevated responsivity of brain regions implicated in reward, extending results from 2 smaller prior studies that found that individuals with versus without parental alcohol use disorders showed greater reward region response to anticipated monetary reward and pictures of alcohol. Collectively, results provide support for the reward surfeit model of substance use disorders, rather than the reward deficit model.
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168
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McCane AM, Czachowski CL, Lapish CC. Tolcapone suppresses ethanol intake in alcohol-preferring rats performing a novel cued access protocol. Alcohol Clin Exp Res 2014; 38:2468-78. [PMID: 25257296 PMCID: PMC4260468 DOI: 10.1111/acer.12515] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/30/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dopamine (DA) has been shown to play a central role in regulating motivated behavior and encoding reward. Chronic drug abuse elicits a state of hypodopaminergia in the mesocorticolimbic (MCL) system in both humans and preclinical rodent models of addiction, including those modeling alcohol use disorders (AUD). METHODS Working under the hypothesis that reductions in the bioavailability of DA play an integral role in the expression of the excessive drinking phenotype, the catechol-O-methyltransferase (COMT) inhibitor tolcapone was used as a means to amplify cortical DA concentration and drinking behaviors were then assessed. Sucrose and ethanol (EtOH) consumption were measured in P and Wistar rats in both a free choice drinking protocol and a novel cued access protocol. RESULTS Tolcapone attenuated the consumption of EtOH, and to a lesser extent sucrose, in P rats in the cued access protocol, while no effect was observed in the free choice drinking protocol. Tolcapone also decreased EtOH consumption in high drinking Wistar rats. A follow-up experiment using the indirect DA agonist d-amphetamine showed no change in EtOH consumption. CONCLUSIONS Collectively, these data suggest that COMT inhibitors may be capable of alleviating the extremely motivating or salient nature of stimuli associated with alcohol. The hypothesis is put forth that the relative specificity of tolcapone for cortical DA systems may mediate the suppression of the high seeking/drinking phenotype.
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Affiliation(s)
- Aqilah M. McCane
- Department of Psychology, Indiana University Purdue University Indianapolis, LD 124, 402 N. Blackford St., Indianapolis, IN 46202-3275
| | - Cristine L. Czachowski
- Department of Psychology, Indiana University Purdue University Indianapolis, LD 124, 402 N. Blackford St., Indianapolis, IN 46202-3275
- Stark Neuroscience Institute, Indiana University Purdue University Indianapolis, LD 124, 402 N. Blackford St., Indianapolis, IN 46202-3275
| | - Christopher C. Lapish
- Department of Psychology, Indiana University Purdue University Indianapolis, LD 124, 402 N. Blackford St., Indianapolis, IN 46202-3275
- Stark Neuroscience Institute, Indiana University Purdue University Indianapolis, LD 124, 402 N. Blackford St., Indianapolis, IN 46202-3275
- Institute for Mathematical Modeling and Computational Sciences, Indiana University Purdue University Indianapolis, LD 124, 402 N. Blackford St., Indianapolis, IN 46202-3275
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169
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Kim SM, Han DH, Min KJ, Kim BN, Cheong JH. Brain activation in response to craving- and aversion-inducing cues related to alcohol in patients with alcohol dependence. Drug Alcohol Depend 2014; 141:124-31. [PMID: 24939441 DOI: 10.1016/j.drugalcdep.2014.05.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Episodes of alcohol consumption produce use-limiting aversive effects as well as use-promoting euphoric effects. The brain regions associated with the reward circuit in patients with alcohol dependence (PAD) show signs of conditioning for alcohol craving. Alternatively, brain structures in the medial temporal region are known to be crucial for aversive conditioning. In this study, we compare differences in patterns of brain activation in response to cues that induce cravings versus aversion in PAD. METHODS Thirty-eight PAD and 26 healthy volunteers were administered cue reactivity tasks while undergoing functional magnetic resonance imaging (fMRI) to examine brain response to craving-inducing cues (CIC) and aversion-inducing cues (AIC). RESULTS Activation of the right medial frontal gyrus (right orbitofrontal cortex) during CIC was greater in PAD than in healthy volunteers. Participants in the PAD group displayed less activation in the right amygdala and the right middle temporal gyrus during AIC than did the healthy volunteers. Brain reactivity within the right medial frontal gyrus in response to CIC was positively correlated with the scores of PAD on the Korean Alcohol Urge Questionnaire (AUQ-K) and the Michigan Alcohol Screening Test (MAST). Reactivity within the amygdala in response to AIC was negatively correlated with AUQ-K scores among PAD. CONCLUSION The dysfunction of the orbitofrontal cortex that results from repeated exposure to alcohol accounts for craving and relapse in PAD. Additionally, PAD seem to be less sensitive to cues related to aversive consequences of alcohol overuse in comparison with healthy individuals.
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Affiliation(s)
- Sun Mi Kim
- Department of Psychiatry, Chung-Ang University, College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 156-755, Republic of Korea.
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University, College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 156-755, Republic of Korea.
| | - Kyung Joon Min
- Department of Psychiatry, Chung-Ang University, College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 156-755, Republic of Korea.
| | - Bung-Nyun Kim
- Department of Psychiatry, Seoul National University, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
| | - Jae Hoon Cheong
- Uimyung Research Institute for Neuroscience, Samyook University, Gongneung 2-dong, Nowon-gu, Seoul 139-742, Republic of Korea.
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170
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Rømer Thomsen K, Fjorback LO, Møller A, Lou HC. Applying incentive sensitization models to behavioral addiction. Neurosci Biobehav Rev 2014; 45:343-9. [PMID: 25036890 DOI: 10.1016/j.neubiorev.2014.07.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/01/2014] [Accepted: 07/08/2014] [Indexed: 01/05/2023]
Abstract
The incentive sensitization theory is a promising model for understanding the mechanisms underlying drug addiction, and has received support in animal and human studies. So far the theory has not been applied to the case of behavioral addictions like Gambling Disorder, despite sharing clinical symptoms and underlying neurobiology. We examine the relevance of this theory for Gambling Disorder and point to predictions for future studies. The theory promises a significant contribution to the understanding of behavioral addiction and opens new avenues for treatment.
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Affiliation(s)
- Kristine Rømer Thomsen
- Centre of Functionally Integrative Neuroscience, University of Aarhus, 8000 Aarhus C, Denmark.
| | - Lone O Fjorback
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Arne Møller
- Centre of Functionally Integrative Neuroscience, University of Aarhus, 8000 Aarhus C, Denmark
| | - Hans C Lou
- Centre of Functionally Integrative Neuroscience, University of Aarhus, 8000 Aarhus C, Denmark
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171
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Le Foll B, Pushparaj A, Pryslawsky Y, Forget B, Vemuri K, Makriyannis A, Trigo JM. Translational strategies for therapeutic development in nicotine addiction: rethinking the conventional bench to bedside approach. Prog Neuropsychopharmacol Biol Psychiatry 2014; 52:86-93. [PMID: 24140878 PMCID: PMC4002666 DOI: 10.1016/j.pnpbp.2013.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 12/16/2022]
Abstract
Tobacco produces an impressive burden of disease resulting in premature death in half of users. Despite effective smoking cessation medications (nicotine replacement therapies, bupropion and varenicline), there is a very high rate of relapse following quit attempts. The use of efficient strategies for the development of novel treatments is a necessity. A 'bench to bedside strategy' was initially used to develop cannabinoid CB1 receptor antagonists for the treatment of nicotine addiction. Unfortunately, after being tested on experimental animals, what seemed to be an interesting approach for the treatment of nicotine addiction resulted in serious unwanted side effects when tested in humans. Current research is focusing again on pre-clinical models in an effort to eliminate unwanted side effects while preserving the initially observed efficacy. A 'bed side to bench strategy' was used to study the role of the insula (part of the frontal cortex) in nicotine addiction. This line of research started based on clinical observations that patients suffering stroke-induced lesions to the insula showed a greater likelihood to report immediate smoking cessation without craving or relapse. Subsequently, animal models of addiction are used to explore the role of insula in addiction. Due to the inherent limitations existing in clinical versus preclinical studies, the possibility of close interaction between both models seems to be critical for the successful development of novel therapeutic strategies for nicotine dependence.
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Affiliation(s)
- Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada; Alcohol Research and Treatment Clinic, Addiction Medicine Services, Ambulatory Care and Structured Treatments, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry and Institute of Medical Sciences, University of Toronto, Toronto, Canada.
| | - Abhiram Pushparaj
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Yaroslaw Pryslawsky
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Benoit Forget
- Integrative Neurobiology of Cholinergic Systems, Department of Neuroscience, Pasteur Institute, 25 rue du Dr. Roux, Paris 75724, France
| | - Kiran Vemuri
- Center for Drug Discovery, Northeastern University, Boston, MA 02115-5005, United States; Department of Pharmaceutical Sciences, Northeastern University, Boston, MA 02115-5005, United States; Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA 02115-5005, United States
| | - Alexandros Makriyannis
- Center for Drug Discovery, Northeastern University, Boston, MA 02115-5005, United States; Department of Pharmaceutical Sciences, Northeastern University, Boston, MA 02115-5005, United States; Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA 02115-5005, United States
| | - Jose M Trigo
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada
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172
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Dager AD, Anderson BM, Rosen R, Khadka S, Sawyer B, Jiantonio-Kelly RE, Austad CS, Raskin SA, Tennen H, Wood RM, Fallahi CR, Pearlson GD. Functional magnetic resonance imaging (fMRI) response to alcohol pictures predicts subsequent transition to heavy drinking in college students. Addiction 2014; 109:585-95. [PMID: 24304235 PMCID: PMC3951577 DOI: 10.1111/add.12437] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/16/2013] [Accepted: 11/26/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Young adults show the highest rates of escalating drinking, yet the neural risk mechanisms remain unclear. Heavy drinkers show variant functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) response to alcohol cues, which may presage increasing drinking. In this longitudinal study, we ascertained whether BOLD response to alcohol pictures predicted subsequent heavy drinking among college students. METHODS Participants were 43 18-21-year-olds in the United States who underwent BOLD scanning and completed monthly substance use surveys over the following year. Participants were categorized according to baseline and follow-up drinking into 13 continuously moderate drinkers, 16 continuously heavy drinkers and 14 transitioners who drank moderately at baseline but heavily by follow-up. During fMRI scanning at baseline, participants viewed alcohol and matched non-alcohol beverage images. RESULTS We observed group differences in alcohol cue-elicited BOLD response in bilateral caudate, orbitofrontal cortex, medial frontal cortex/anterior cingulate and left insula (clusters > 2619 ml, voxelwise F(2,40) > 3.23, P < 0.05, whole-brain corrected P < 0.05), where transitioners hyperactivated compared with moderate and heavy drinkers (all Tukey P < 0.05). Exploratory factor analysis revealed a single brain network differentiating those who subsequently increased drinking. Exploratory regressions showed that, compared with other risk factors (e.g., alcoholism family history, impulsivity), BOLD response best predicted escalating drinking amount and alcohol-related problems. CONCLUSIONS Neural response to pictures of alcohol is substantially enhanced among United States college students who subsequently escalate drinking. Greater cue-reactivity is associated with larger increases in drinking and alcohol-related problems, regardless of other baseline factors. Thus, neural cue-reactivity could uniquely facilitate identifying individuals at greatest risk for future problematic drinking.
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Affiliation(s)
- Alecia D. Dager
- Yale University Department of Psychiatry,Olin Neuropsychiatry Research Center, Hartford Hospital
| | | | - Rivkah Rosen
- Olin Neuropsychiatry Research Center, Hartford Hospital
| | - Sabin Khadka
- Olin Neuropsychiatry Research Center, Hartford Hospital
| | | | | | | | | | | | | | | | - Godfrey D. Pearlson
- Yale University Department of Psychiatry,Yale University Department of Neurobiology,Olin Neuropsychiatry Research Center, Hartford Hospital
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173
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Haass-Koffler CL, Leggio L, Kenna GA. Pharmacological approaches to reducing craving in patients with alcohol use disorders. CNS Drugs 2014; 28:343-60. [PMID: 24573997 PMCID: PMC3990000 DOI: 10.1007/s40263-014-0149-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Research on the concept of craving may lead to better understanding of the biobehavioural circuitries that contribute to the complexity of alcohol use disorders (AUDs). The experiences described as craving or desire to drink are often associated with physical responses such as increased salivation and heart rate, and alteration of stress hormones, as well as psychological responses such as anxiety and depression. Greater craving has been associated with an increased probability of alcohol relapse. Reversal of craving, which is understood as a symptom of protracted abstinence, offers the possibility of preventing relapses and treating alcoholism. Various medications have been studied to establish whether they are able to reduce craving; however, the results obtained from clinical studies have been inconsistent. Here, we review the interdisciplinary models developed to evaluate craving, then the different approaches used to assess and measure craving and, finally, the medications utilized and tested to lessen craving in patients suffering from AUDs.
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Affiliation(s)
| | - Lorenzo Leggio
- Center for Alcohol & Addiction Studies, Brown University, Providence, Rhode Island, USA
- Intramural Research Program, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Baltimore, Maryland, USA
| | - George A. Kenna
- Center for Alcohol & Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
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174
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Holla B, Viswanath B, Agarwal SM, Kalmady SV, Maroky AS, Jayarajan D, Bharath RD, Venkatasubramanian G, Benegal V. Visual Image-Induced Craving for Ethanol (VICE): Development, Validation, and a Pilot fMRI Study. Indian J Psychol Med 2014; 36:164-9. [PMID: 24860218 PMCID: PMC4031585 DOI: 10.4103/0253-7176.130984] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Craving induction in a controlled environment is helpful in the research of craving mechanism and its role in development of alcohol dependence (AD). We describe a novel tool Visual Image-induced Craving for Ethanol (VICE) and its effects on brain activation with pilot functional magnetic resonance imaging (fMRI). MATERIALS AND METHODS Alcohol-related visual cues (ARCs) in 5 scenarios were photographed, which included pictures of bars, alcoholic beverage bottles, pouring of alcohol into glasses, glasses filled with alcohol, and scenes of people sipping alcohol, counterbalanced with neutral pictures (involving water, milk etc.,). Craving scores were obtained from 15 hospitalized patients with AD to validate this tool. In the pilot fMRI (3-Tesla) study, 5 patients were examined using VICE in a symptom provocation model. Group level-fixed effect analysis of brain activation differences was done using SPM8. RESULTS VICE showed a high internal consistency with Cronbach's α coefficient of 0.86, which confirmed its reliability. Concurrent validity of VICE was demonstrated via its convergence with the Penn Alcohol Craving Scale. ARCs had significantly greater mean craving scores than neutral cues in all the 5 scenarios (intentional validity). In the pilot fMRI, patients were found to have greater activation while viewing ARCs compared to the neutral cues in right insular cortex and deficient activation in right orbitofrontal cortex. CONCLUSIONS The VICE is a reliable and valid measure of alcohol craving with promising clinical and translational research implications. Preliminary fMRI findings indicate it can be used as a symptom provocation tool for fMRI experiments.
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Affiliation(s)
- Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India
| | - Sri Mahavir Agarwal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India
| | - Sunil Vasu Kalmady
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India
| | - Ami Sebastian Maroky
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Deepak Jayarajan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rose Dawn Bharath
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India ; Department of Translational Psychiatry Lab, Cognitive Neurobiology Division, Neurobiology Research Centere, Bangalore, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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175
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Resting state functional connectivity of the nucleus accumbens in youth with a family history of alcoholism. Psychiatry Res 2014; 221:210-9. [PMID: 24440571 PMCID: PMC3943736 DOI: 10.1016/j.pscychresns.2013.12.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/22/2022]
Abstract
Adolescents with a family history of alcoholism (FHP) are at heightened risk for developing alcohol use disorders (AUDs). The nucleus accumbens (NAcc), a key brain region for reward processing, is implicated in the development of AUDs. Thus, functional connectivity of the NAcc may be an important marker of risk in FHP youth. Resting state functional magnetic resonance imaging (rs-fcMRI) was used to examine the intrinsic connectivity of the NAcc in 47 FHP and 50 family history negative (FHN) youth, ages 10-16 years old. FHP and FHN adolescents showed significant group differences in resting state synchrony between the left NAcc and bilateral inferior frontal gyri and the left postcentral gyrus (PG). Additionally, FHP youth differed from FHN youth in right NAcc functional connectivity with the left orbitofrontal cortex (OFC), left superior temporal gyrus, right cerebellum, left PG, and right occipital cortex. These results indicate that FHP youth have less segregation between the NAcc and executive functioning brain regions, and less integration with reward-related brain areas, such as the OFC. The findings of the current study highlight that premorbid atypical connectivity of appetitive systems, in the absence of heavy alcohol use, may be a risk marker in FHP adolescents.
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176
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Silveri MM. GABAergic contributions to alcohol responsivity during adolescence: insights from preclinical and clinical studies. Pharmacol Ther 2014; 143:197-216. [PMID: 24631274 DOI: 10.1016/j.pharmthera.2014.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 02/28/2014] [Indexed: 01/04/2023]
Abstract
There is a considerable body of literature demonstrating that adolescence is a unique age period, which includes rapid and dramatic maturation of behavioral, cognitive, hormonal and neurobiological systems. Most notably, adolescence is also a period of unique responsiveness to alcohol effects, with both hyposensitivity and hypersensitivity observed to the various effects of alcohol. Multiple neurotransmitter systems are undergoing fine-tuning during this critical period of brain development, including those that contribute to the rewarding effects of drugs of abuse. The role of developmental maturation of the γ-amino-butyric acid (GABA) system, however, has received less attention in contributing to age-specific alcohol sensitivities. This review integrates GABA findings from human magnetic resonance spectroscopy studies as they may translate to understanding adolescent-specific responsiveness to alcohol effects. Better understanding of the vulnerability of the GABA system both during adolescent development, and in psychiatric conditions that include alcohol dependence, could point to a putative mechanism, boosting brain GABA, that may have increased effectiveness for treating alcohol use disorders.
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Affiliation(s)
- Marisa M Silveri
- Neurodevelopmental Laboratory on Addictions and Mental Health, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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177
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Developing Neurobiological Endophenotypes that Reflect Failure to Control Alcohol Consumption and Dependence. CURRENT ADDICTION REPORTS 2014. [DOI: 10.1007/s40429-013-0007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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178
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김지희, Young-Ho Lee. The Effects of Smoking Urges and Withdrawal Symptoms on Maintenance of Smoking Cessation: The Moderating Effects of Coping and Perceived Smoking Cessation Effects. ACTA ACUST UNITED AC 2014. [DOI: 10.17315/kjhp.2014.19.1.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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179
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Cope LM, Vincent GM, Jobelius JL, Nyalakanti PK, Calhoun VD, Kiehl KA. Psychopathic traits modulate brain responses to drug cues in incarcerated offenders. Front Hum Neurosci 2014; 8:87. [PMID: 24605095 PMCID: PMC3932519 DOI: 10.3389/fnhum.2014.00087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/04/2014] [Indexed: 11/15/2022] Open
Abstract
Recent neuroscientific evidence indicates that psychopathy is associated with abnormal function and structure in limbic and paralimbic areas. Psychopathy and substance use disorders are highly comorbid, but clinical experience suggests that psychopaths abuse drugs for different reasons than non-psychopaths, and that psychopaths do not typically experience withdrawal and craving upon becoming incarcerated. These neurobiological abnormalities may be related to psychopaths' different motivations for—and symptoms of—drug use. This study examined the modulatory effect of psychopathic traits on the neurobiological craving response to pictorial drug stimuli. Drug-related pictures and neutral pictures were presented and rated by participants while hemodynamic activity was monitored using functional magnetic resonance imaging. These data were collected at two correctional facilities in New Mexico using the Mind Research Network mobile magnetic resonance imaging system. The sample comprised 137 incarcerated adult males and females (93 females) with histories of substance dependence. The outcome of interest was the relation between psychopathy scores (using the Hare Psychopathy Checklist-Revised) and hemodynamic activity associated with viewing drug-related pictures vs. neutral pictures. There was a negative association between psychopathy scores and hemodynamic activity for viewing drug-related cues in the anterior cingulate, posterior cingulate, hippocampus, amygdala, caudate, globus pallidus, and parts of the prefrontal cortex. Psychopathic traits modulate the neurobiological craving response and suggest that individual differences are important for understanding and treating substance abuse.
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Affiliation(s)
- Lora M Cope
- Department of Psychology, University of New Mexico Albuquerque, NM, USA ; The Mind Research Network Albuquerque, NM, USA
| | - Gina M Vincent
- Department of Psychiatry, University of Massachusetts Medical School Worcester, MA, USA
| | | | | | - Vince D Calhoun
- The Mind Research Network Albuquerque, NM, USA ; Department of Electrical and Computer Engineering, University of New Mexico Albuquerque, NM, USA
| | - Kent A Kiehl
- Department of Psychology, University of New Mexico Albuquerque, NM, USA ; The Mind Research Network Albuquerque, NM, USA
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180
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Zhang S, Hu S, Bednarski SR, Erdman E, Li CSR. Error-related functional connectivity of the thalamus in cocaine dependence. NEUROIMAGE-CLINICAL 2014; 4:585-92. [PMID: 24936409 PMCID: PMC4053644 DOI: 10.1016/j.nicl.2014.01.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/13/2014] [Accepted: 01/26/2014] [Indexed: 11/30/2022]
Abstract
Error processing is a critical component of cognitive control, an executive function that has been widely implicated in substance misuse. In previous studies we showed that error related activations of the thalamus predicted relapse to drug use in cocaine addicted individuals (Luo et al., 2013). Here, we investigated whether the error-related functional connectivity of the thalamus is altered in cocaine dependent patients (PCD, n = 54) as compared to demographically matched healthy individuals (HC, n = 54). The results of a generalized psychophysiological interaction analysis showed negative thalamic connectivity with the ventral medial prefrontal cortex (vmPFC), in the area of perigenual and subgenual anterior cingulate cortex, in HC but not PCD (p < 0.05, corrected, two-sample t test). This difference in functional connectivity was not observed for task-residual signals, suggesting that it is specific to task-related processes during cognitive control. Further, the thalamic-vmPFC connectivity is positively correlated with the amount of cocaine use in the prior month for female but not for male PCD. These findings add to recent literature and provide additional evidence for circuit-level biomarkers of cocaine dependence. Error-related thalamic-vmPFC connectivity is altered in cocaine misuse. This altered connectivity is associated with impaired self control. This deficit is associated with recent cocaine use in women but not men.
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Affiliation(s)
- Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Sien Hu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Sarah R Bednarski
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Emily Erdman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA ; Inter-departmental Neuroscience Program, Yale University, New Haven, CT 06520, USA ; Department of Neurobiology, Yale University School of Medicine, New Haven, CT 06520, USA
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181
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Abstract
A major block to recovery from alcoholism is substantial alcohol craving and the chronic relapsing nature of the illness. This chapter reviews relevant structural and functional neuroimaging studies and discusses neural mechanisms underlying alcohol craving and relapse in the context of influential risk factors (i.e., alcohol, alcohol cue, and stress). Review of neuroimaging studies suggests that neuroadaptations in the cortico-striatal-limbic circuit encompassing the medial prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, striatum, and amygdala significantly contribute to overwhelming alcohol craving and early relapse after a period of abstinence. The cortico-striatal-limbic circuit plays an important role in the modulation of emotion, reward, and decision making. As functional and structural chronic alcohol-related neuroadaptations are consistently reported in this circuit, it is likely that sensitization of this circuit from continued alcohol abuse may contribute to high alcohol craving and early relapse via impairments in the prefrontal executive function related to emotion regulation and decision making. This vulnerable neurobiologic state may be manifested as compulsive craving and intense urge to resume alcohol drinking in the face of environmental risk factors, including alcohol, alcohol cue, or stressful live events.
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Affiliation(s)
- Dongju Seo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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182
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Krienke UJ, Nikesch F, Spiegelhalder K, Hennig J, Olbrich HM, Langosch JM. Impact of alcohol-related video sequences on functional MRI in abstinent alcoholics. Eur Addict Res 2014; 20:33-40. [PMID: 23921439 DOI: 10.1159/000349909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 02/07/2013] [Indexed: 11/19/2022]
Abstract
The object of this study was the identification of brain areas that were significantly more connected than other regions with a previously identified reference region, the posterior cingulate cortex, during the presentation of visual cues in alcoholics. Alcohol-related and neutral video sequences were presented to 30 alcoholics who had been abstinent for at least 4 days. Participants underwent a psychometric assessment before and after the presentation of the video sequences. Functional MRI data were acquired. Psychophysiological interaction analyses were carried out. Participants reported a significant increase in craving and arousal after the presentation of alcohol-related video sequences. The simple contrast alcohol versus neutral was found not to be significantly different in the present study. The brain regions that were found to correlate significantly more with the posterior cingulate cortex under the alcohol-related condition were the inferior parietal lobe, the medial temporal lobe, the inferior frontal gyrus, the postcentral gyrus, and the precuneus. The involvement of these regions in processes of memory, self-control, and self-reflection with a particular focus on alcohol dependence and craving will be discussed.
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Affiliation(s)
- Ute J Krienke
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
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183
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Nathan PJ, Phan KL, Harmer CJ, Mehta MA, Bullmore ET. Increasing pharmacological knowledge about human neurological and psychiatric disorders through functional neuroimaging and its application in drug discovery. Curr Opin Pharmacol 2013; 14:54-61. [PMID: 24565013 DOI: 10.1016/j.coph.2013.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 11/15/2013] [Accepted: 11/15/2013] [Indexed: 02/02/2023]
Abstract
Functional imaging methods such as fMRI have been widely used to gain greater understanding of brain circuitry abnormalities in CNS disorders and their underlying neurochemical basis. Findings suggest that: (1) drugs with known clinical efficacy have consistent effects on disease relevant brain circuitry, (2) brain activation changes at baseline or early drug effects on brain activity can predict long-term efficacy; and (3) fMRI together with pharmacological challenges could serve as experimental models of disease phenotypes and be used for screening novel drugs. Together, these observations suggest that drug related modulation of disease relevant brain circuitry may serve as a promising biomarker/method for use in drug discovery to demonstrate target engagement, differential efficacy, dose-response relationships, and prediction of clinically relevant changes.
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Affiliation(s)
- Pradeep J Nathan
- Brain Mapping Unit, Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK; School of Psychology and Psychiatry, Monash University, Australia; New Medicines, UCB Pharma, Belgium.
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, USA; Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, USA
| | | | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
| | - Edward T Bullmore
- Brain Mapping Unit, Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK; GSK Clinical Unit Cambridge, GlaxoSmithKline, UK
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184
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Li X, Malcolm RJ, Huebner K, Hanlon CA, Taylor JJ, Brady KT, George MS, See RE. Low frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex transiently increases cue-induced craving for methamphetamine: a preliminary study. Drug Alcohol Depend 2013; 133:641-6. [PMID: 24028801 PMCID: PMC4196687 DOI: 10.1016/j.drugalcdep.2013.08.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/08/2013] [Accepted: 08/12/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) can temporarily interrupt or facilitate activity in a focal brain region. Several lines of evidence suggest that rTMS of the dorsolateral prefrontal cortex (DLPFC) can affect processes involved in drug addiction. We hypothesized that a single session of low-frequency rTMS of the left DLPFC would modulate cue-induced craving for methamphetamine (MA) when compared to a sham rTMS session. METHODS In this single-blind, sham-controlled crossover study, 10 non-treatment seeking MA-dependent users and 8 healthy controls were randomized to receive 15 min of sham and real (1 Hz) DLPFC rTMS in two experimental sessions separated by 1h. During each rTMS session, participants were exposed to blocks of neutral cues and MA-associated cues. Participants rated their craving after each cue block. RESULTS In MA users, real rTMS over the left DLPFC increased self-reported craving as compared to sham stimulation (17.86 ± 1.46 vs. 24.85 ± 1.57, p=0.001). rTMS had no effect on craving in healthy controls. One Hertz rTMS of the left DLPFC was safe and tolerable for all participants. CONCLUSIONS Low frequency rTMS of the left DLPFC transiently increased cue-induced craving in MA participants. These preliminary results suggest that 1 Hz rTMS of the left DLPFC may increase craving by inhibiting the prefrontal cortex or indirectly activating subcortical regions involved in craving.
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Affiliation(s)
- Xingbao Li
- Medical University of South Carolina, United States.
| | | | | | | | | | - Kathleen T. Brady
- Medical University of South Carolina, United States,Ralph H. Johnson VA Medical Center, United States
| | - Mark S. George
- Medical University of South Carolina, United States,Ralph H. Johnson VA Medical Center, United States
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185
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White matter microstructure alterations: a study of alcoholics with and without post-traumatic stress disorder. PLoS One 2013; 8:e80952. [PMID: 24260518 PMCID: PMC3832443 DOI: 10.1371/journal.pone.0080952] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/13/2013] [Indexed: 02/07/2023] Open
Abstract
Many brain imaging studies have demonstrated reductions in gray and white matter volumes in alcoholism, with fewer investigators using diffusion tensor imaging (DTI) to examine the integrity of white matter pathways. Among various medical conditions, alcoholism and post-traumatic stress disorder (PTSD) are two comorbid diseases that have similar degenerative effects on the white matter integrity. Therefore, understanding and differentiating these effects would be very important in characterizing alcoholism and PTSD. Alcoholics are known to have neurocognitive deficits in decision-making, particularly in decisions related to emotionally-motivated behavior, while individuals with PTSD have deficits in emotional regulation and enhanced fear response. It is widely believed that these types of abnormalities in both alcoholism and PTSD are related to fronto-limbic dysfunction. In addition, previous studies have shown cortico-limbic fiber degradation through fiber tracking in alcoholism. DTI was used to measure white matter fractional anisotropy (FA), which provides information about tissue microstructure, possibly indicating white matter integrity. We quantitatively investigated the microstructure of white matter through whole brain DTI analysis in healthy volunteers (HV) and alcohol dependent subjects without PTSD (ALC) and with PTSD (ALC+PTSD). These data show significant differences in FA between alcoholics and non-alcoholic HVs, with no significant differences in FA between ALC and ALC+PTSD in any white matter structure. We performed a post-hoc region of interest analysis that allowed us to incorporate multiple covariates into the analysis and found similar results. HV had higher FA in several areas implicated in the reward circuit, emotion, and executive functioning, suggesting that there may be microstructural abnormalities in white matter pathways that contribute to neurocognitive and executive functioning deficits observed in alcoholics. Furthermore, our data do not reveal any differences between ALC and ALC+PTSD, suggesting that the effect of alcohol on white matter microstructure may be more significant than any effect caused by PTSD.
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186
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Jasinska AJ, Stein EA, Kaiser J, Naumer MJ, Yalachkov Y. Factors modulating neural reactivity to drug cues in addiction: a survey of human neuroimaging studies. Neurosci Biobehav Rev 2013; 38:1-16. [PMID: 24211373 DOI: 10.1016/j.neubiorev.2013.10.013] [Citation(s) in RCA: 358] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/04/2013] [Accepted: 10/29/2013] [Indexed: 12/16/2022]
Abstract
Human neuroimaging studies suggest that neural cue reactivity is strongly associated with indices of drug use, including addiction severity and treatment success. However, little is known about factors that modulate cue reactivity. The goal of this review, in which we survey published fMRI and PET studies on drug cue reactivity in cocaine, alcohol, and tobacco cigarette users, is to highlight major factors that modulate brain reactivity to drug cues. First, we describe cue reactivity paradigms used in neuroimaging research and outline the brain circuits that underlie cue reactivity. We then discuss major factors that have been shown to modulate cue reactivity and review specific evidence as well as outstanding questions related to each factor. Building on previous model-building reviews on the topic, we then outline a simplified model that includes the key modulatory factors and a tentative ranking of their relative impact. We conclude with a discussion of outstanding challenges and future research directions, which can inform future neuroimaging studies as well as the design of treatment and prevention programs.
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Affiliation(s)
- Agnes J Jasinska
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA.
| | - Elliot A Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, USA
| | - Jochen Kaiser
- Institute of Medical Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Marcus J Naumer
- Institute of Medical Psychology, Goethe-University, Frankfurt am Main, Germany
| | - Yavor Yalachkov
- Institute of Medical Psychology, Goethe-University, Frankfurt am Main, Germany.
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187
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Leyton M, Vezina P. Striatal ups and downs: their roles in vulnerability to addictions in humans. Neurosci Biobehav Rev 2013; 37:1999-2014. [PMID: 23333263 PMCID: PMC3743927 DOI: 10.1016/j.neubiorev.2013.01.018] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 01/05/2023]
Abstract
Susceptibility to addictive behaviors has been related to both increases and decreases in striatal function. Both profiles have been reported in humans as well as in animal models. Yet, the mechanisms underlying these opposing effects and the manner in which they relate to the behavioral development and expression of addiction remain unclear. In the present review of human studies, we describe a number of factors that could influence whether striatal hyper- or hypo-function is observed and propose a model that integrates the influence of these opposite responses on the expression of addiction related behaviors. Central to this model is the role played by the presence versus absence of addiction related cues and their ability to regulate responding to abused drugs and other rewards. Striatal function and incentive motivational states are increased in the presence of these cues and decreased in their absence. Alternations between these states might account for the progressive narrowing of interests as addictions develop and point to relevant processes to target in treatment.
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Affiliation(s)
- Marco Leyton
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1 Canada.
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188
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Goldman RL, Canterberry M, Borckardt JJ, Madan A, Byrne TK, George MS, O'Neil PM, Hanlon CA. Executive control circuitry differentiates degree of success in weight loss following gastric-bypass surgery. Obesity (Silver Spring) 2013; 21:2189-2196. [PMID: 24136926 PMCID: PMC4196691 DOI: 10.1002/oby.20575] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/28/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE While overall success rates of bariatric surgery are high, approximately 20% of patients either regain or never lose the expected amount of weight. The purpose of this study was to determine whether, after gastric-bypass surgery, the degree of weight loss can be differentiated based on the neural response to food cues. DESIGN AND METHODS In this functional MRI study, 31 post-surgical patients viewed food and neutral images in two counterbalanced runs during which they were either instructed to "crave" or to "resist" craving. The neural response to food cues was assessed within and between runs for all participants, and further analyzed between more successful (n = 24) and less successful (n = 7) groups. More successful was defined by meeting 50% excess weight loss. RESULTS Overall, instructions to "crave" elicited significant activity in the dorsomedial prefrontal cortex (PFC) whereas "resist" elicited significant activity in the dorsolateral PFC (DLPFC). Between groups there was no brain difference when instructed to "crave." The more successful participants however had significantly more activity in the DLPFC when instructed to "resist." CONCLUSIONS These findings suggest that the ability to mobilize neural circuits involved in executive control post-gastric-bypass surgery may be a unique component of successful outcome post-surgery.
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Affiliation(s)
- Rachel L. Goldman
- Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, USA
| | - Melanie Canterberry
- Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, USA
| | - Jeffrey J. Borckardt
- Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, USA
- Department of Anesthesiology and Perioperative Medicine, Charleston, South Carolina, USA
| | - Alok Madan
- Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, USA
| | - T. Karl Byrne
- Department of Surgery Department of Neurology and Radiology Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark S. George
- Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, USA
- Department of Surgery Department of Neurology and Radiology Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Patrick M. O'Neil
- Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, USA
| | - Colleen A. Hanlon
- Department of Psychiatry and Behavioral Sciences, Charleston, South Carolina, USA
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189
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Patel KT, Stevens MC, Meda SA, Muska C, Thomas AD, Potenza MN, Pearlson GD. Robust changes in reward circuitry during reward loss in current and former cocaine users during performance of a monetary incentive delay task. Biol Psychiatry 2013; 74:529-37. [PMID: 23778289 PMCID: PMC3775945 DOI: 10.1016/j.biopsych.2013.04.029] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 04/17/2013] [Accepted: 04/20/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Abnormal function in reward circuitry in cocaine addiction could predate drug use as a risk factor, follow drug use as a consequence of substance-induced alterations, or both. METHODS We used a functional magnetic resonance imaging monetary incentive delay task (MIDT) to investigate reward-loss neural response differences among 42 current cocaine users, 35 former cocaine users, and 47 healthy subjects who also completed psychological measures and tasks related to impulsivity and reward. RESULTS We found various reward processing-related group differences in several MIDT phases. Across task phases we found a control > current user > former user activation pattern, except for loss outcome, where former compared with current cocaine users activated ventral tegmental area more robustly. We also found regional prefrontal activation differences during loss anticipation between cocaine-using groups. Both groups of cocaine users scored higher than control subjects on impulsivity, compulsivity and reward-punishment sensitivity factors. In addition, impulsivity-related factors correlated positively with activation in amygdala and negatively with anterior cingulate activation during loss anticipation. CONCLUSIONS Compared with healthy subjects, both former and current users displayed abnormal brain activation patterns during MIDT performance. Both cocaine groups differed similarly from healthy subjects, but differences between former and current users were localized to the ventral tegmental area during loss outcome and to prefrontal regions during loss anticipation, suggesting that long-term cocaine abstinence does not normalize most reward circuit abnormalities. Elevated impulsivity-related factors that relate to loss processing in current and former users suggest that these tendencies and relationships may pre-exist cocaine addiction.
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Affiliation(s)
- Krishna T Patel
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, Connecticut.
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190
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Riggs NR, Tate EB, Ridenour TA, Reynolds MD, Zhai ZW, Vanyukov MM, Tarter RE. Longitudinal associations from neurobehavioral disinhibition to adolescent risky sexual behavior in boys: direct and mediated effects through moderate alcohol consumption. J Adolesc Health 2013; 53:465-70. [PMID: 23876782 PMCID: PMC3783650 DOI: 10.1016/j.jadohealth.2013.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE This longitudinal study tested the hypothesis that neurobehavioral disinhibition (ND) in childhood, mediated by alcohol use, portends risky sexual behavior (number of sexual partners) in midadolescence. METHODS Participants were 410 adolescent boys. Neurobehavioral disinhibition was assessed at 11.3 years of age. Frequency and quantity of alcohol use on a typical drinking occasion were assessed at 13.4 years of age at first follow-up, and sexual behavior at 16.0 years at second follow-up. RESULTS Quantity of alcohol consumed on a typical drinking occasion, but not frequency of alcohol use, mediated the relation between ND and number of sexual partners. CONCLUSIONS These findings indicate that number of sexual partners in midadolescence is predicted by individual differences in boys' psychological self-regulation during childhood and moderate alcohol consumption in early adolescence, and that ND may be a potential target for multi-outcome public health interventions.
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Affiliation(s)
- Nathaniel R. Riggs
- Colorado State University Department of Human Development and Family Studies
| | - Eleanor B. Tate
- University of Southern California Department of Preventive Medicine, Institute for Prevention Research
| | - Ty A. Ridenour
- University of Pittsburgh School of Pharmacy, Center for Education and Drug Abuse Research
| | - Maureen D. Reynolds
- University of Pittsburgh School of Pharmacy, Center for Education and Drug Abuse Research
| | - Zu W. Zhai
- University of Pittsburgh School of Pharmacy, Center for Education and Drug Abuse Research
| | - Michael M. Vanyukov
- University of Pittsburgh School of Pharmacy, Center for Education and Drug Abuse Research
| | - Ralph E. Tarter
- University of Pittsburgh School of Pharmacy, Center for Education and Drug Abuse Research
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Ray LA, Courtney KE, Hutchison KE, Mackillop J, Galvan A, Ghahremani DG. Initial evidence that OPRM1 genotype moderates ventral and dorsal striatum functional connectivity during alcohol cues. Alcohol Clin Exp Res 2013; 38:78-89. [PMID: 23876228 DOI: 10.1111/acer.12136] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 03/11/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Endogenous opioids and striatal dopamine have been implicated in cue-induced alcohol craving and have been hypothesized to play a role in goal-directed, as opposed to habitual, alcohol use. This initial study examines dorsal and ventral striatal functional connectivity during alcohol-cue processing as a function of the A118G single-nucleotide polymorphism of the mu-opioid receptor (OPRM1) gene. METHODS Seventeen individuals with alcohol dependence (6 females; 90% Caucasian; mean age = 29.4) underwent blood oxygen level-dependent functional magnetic resonance imaging, while performing an alcohol taste-cues task. Psychophysiological interaction analyses investigated associations of the OPRM1 genotype with ventral and dorsal striatum functional connectivity, using the ventral striatum and the caudate as the seed region, respectively. RESULTS Compared to A-allele homozygotes, G-allele carriers of the OPRM1 gene showed (i) greater activation of the insula and orbitofrontal cortex and (ii) stronger negative fronto-striatal functional connectivity for both ventral and dorsal striatal seed regions during processing of alcohol versus water cues. CONCLUSIONS These preliminary findings suggest that, relative to A-allele homozygotes, G-allele carriers show unstable frontal regulation over reward and/or habit-driven inputs from the striatum resulting from greater reward sensitivity combined with limited self-control resources.
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Affiliation(s)
- Lara A Ray
- Department of Psychology , University of California, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles, California
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192
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Seo D, Lacadie CM, Tuit K, Hong KI, Constable RT, Sinha R. Disrupted ventromedial prefrontal function, alcohol craving, and subsequent relapse risk. JAMA Psychiatry 2013; 70:727-39. [PMID: 23636842 PMCID: PMC3788824 DOI: 10.1001/jamapsychiatry.2013.762] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Alcohol dependence is a chronic relapsing illness; stress, alcohol-related cues, and neutral-relaxing states significantly influence craving and relapse risk. However, neural mechanisms underlying the association between these states and alcohol craving and relapse risk remain unclear. OBJECTIVES To identify neural correlates associated with alcohol craving and relapse outcomes in 45 treatment-engaged, 4- to 8-week abstinent alcohol-dependent (AD) patients, and to compare brain responses of 30 demographically matched AD patients and 30 healthy control subjects during stress, alcohol, and neutral-relaxing cues. DESIGN Functional magnetic resonance imaging study while participants were engaging in brief individualized script-driven imagery trials of stress, alcohol cues, and neutral-relaxing scenarios, and a prospective clinical outcome design to assess alcohol relapse 90 days postdischarge from inpatient treatment in the AD group. SETTINGS Inpatient treatment setting in a community mental health center and hospital-based research unit. PATIENTS Forty-five recovering AD patients in inpatient treatment for examining relapse, and 30 healthy control subjects demographically matched to 30 AD patients (subgroup of the relapse sample) for group comparisons. INTERVENTION Twelve-step recovery-based addiction treatment for the patient group. MAIN OUTCOMES AND MEASURES Brain response, alcohol craving, and relapse outcome measures (time to relapse and relapse severity). RESULTS Increased ventromedial prefrontal cortex (vmPFC) and anterior cingulate cortex (ACC) activation during neutral-relaxing trials was correlated with high alcohol cue-induced and stress-induced craving in early recovering AD patients (x = 6, y = 43, z = -6; P < .01, whole-brain corrected). This vmPFC/ACC hyperactivity significantly predicted subsequent alcohol relapse, with a hazards ratio greater than 8 for increased relapse risk. Additionally, vmPFC/ACC hyperactivation during neutral trials and reduced activity during stress trials were each predictive of greater days of alcohol used after relapse (P < .01, whole-brain corrected). In contrast, matched control subjects showed the reverse pattern of vmPFC/ACC responses to stress, alcohol cues, and relaxed trials (F = 6.42; P < .01, whole-brain corrected). CONCLUSIONS AND RELEVANCE Findings indicate that disrupted vmPFC/ACC function plays a role in jeopardizing recovery from alcoholism and may serve as a neural marker to identify those at risk for alcohol relapse.
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Affiliation(s)
- Dongju Seo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
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193
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Enhanced smoking cue salience associated with depression severity in nicotine-dependent individuals: a preliminary fMRI study. Int J Neuropsychopharmacol 2013; 16:997-1008. [PMID: 20604987 DOI: 10.1017/s1461145710000696] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The association between cigarette smoking and depression has been well documented; however, little research has been done to elucidate the neurobiological substrates of this highly prevalent comorbidity. We used multiple linear regression analysis to evaluate the relationship between depression severity as assessed by the Hamilton Depression Rating Scale (HAMD) and blood oxygen level-dependent (BOLD) responses to visual smoking cues in drug-free nicotine-dependent smokers (n=18). Two functional magnetic resonance imaging (fMRI) scans were completed over a single study day, following overnight smoking abstinence (pre-smoking scan) and after cigarette reinstatement (post-smoking scan). During the pre-smoking scan positive correlations between BOLD activity and HAMD scores were observed in areas of the mesocorticolimbic dopaminergic system [inferior frontal gyrus, middle frontal gyrus (MFG), hippocampus (HC), anterior cingulate gyrus] and areas of the visuospatial attention circuit (medial occipital lobe, middle cingulate cortex, superior frontal gyrus, angular gyrus). During the post-smoking scan positive correlations were observed in areas of the brain implicated in drug expectancy (MFG), memory (HC), attentional motivation (posterior cingulate cortex), and visual processing and attention (precuneus). These preliminary findings demonstrate that smokers with higher depression severity attribute greater incentive salience to smoking-related cues and this is especially pronounced during periods of acute abstinence. Such enhanced salience of smoking cues, even after smoking a cigarette, may play a critical role both in the maintenance of smoking in depression and in greater levels of nicotine dependence seen in this patient population.
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194
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Schacht JP, Anton RF, Randall PK, Li X, Henderson S, Myrick H. Effects of a GABA-ergic medication combination and initial alcohol withdrawal severity on cue-elicited brain activation among treatment-seeking alcoholics. Psychopharmacology (Berl) 2013; 227:627-37. [PMID: 23389755 PMCID: PMC3664140 DOI: 10.1007/s00213-013-2996-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/14/2013] [Indexed: 02/05/2023]
Abstract
RATIONALE Many studies have reported medication effects on alcohol cue-elicited brain activation or associations between such activation and subsequent drinking. However, few have combined the methodological rigor of a randomized clinical trial (RCT) with follow-up assessments to determine whether cue-elicited activation predicts relapse during treatment, the crux of alcoholism. OBJECTIVES This study analyzed functional magnetic resonance imaging (fMRI) data from 48 alcohol-dependent subjects enrolled in a 6-week RCT of an investigational pharmacotherapy. METHODS Subjects were randomized, based on their level of alcohol withdrawal (AW) at study entry, to receive either a combination of gabapentin (GBP; up to 1,200 mg for 39 days) and flumazenil (FMZ) infusions (2 days) or two placebos. Midway through the RCT, subjects were administered an fMRI alcohol cue reactivity task. RESULTS There were no main effects of medication or initial AW status on cue-elicited activation, but these factors interacted, such that the GBP/FMZ/higher AW and placebo/lower AW groups, which had previously been shown to have relatively reduced drinking, demonstrated greater dorsal anterior cingulate cortex (dACC) activation to alcohol cues. Further analysis suggested that this finding represented differences in task-related deactivation and was associated with greater control over alcohol-related thoughts. Among study completers, regardless of medication or AW status, greater left dorsolateral prefrontal cortex (DLPFC) activation predicted more post-scan heavy drinking. CONCLUSIONS These data suggest that alterations in task-related deactivation of dACC, a component of the default mode network, may predict better alcohol treatment response, while activation of DLPFC, an area associated with selective attention, may predict relapse drinking.
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Affiliation(s)
- Joseph P. Schacht
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Patrick K. Randall
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Xingbao Li
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Scott Henderson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Hugh Myrick
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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195
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Witkiewitz K, Lustyk MKB, Bowen S. Retraining the addicted brain: a review of hypothesized neurobiological mechanisms of mindfulness-based relapse prevention. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:351-365. [PMID: 22775773 PMCID: PMC3699602 DOI: 10.1037/a0029258] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Addiction has generally been characterized as a chronic relapsing condition (Leshner, 1999). Several laboratory, preclinical, and clinical studies have provided evidence that craving and negative affect are strong predictors of the relapse process. These states, as well as the desire to avoid them, have been described as primary motives for substance use. A recently developed behavioral treatment, mindfulness-based relapse prevention (MBRP), was designed to target experiences of craving and negative affect and their roles in the relapse process. MBRP offers skills in cognitive-behavioral relapse prevention integrated with mindfulness meditation. The mindfulness practices in MBRP are intended to increase discriminative awareness, with a specific focus on acceptance of uncomfortable states or challenging situations without reacting "automatically." A recent efficacy trial found that those randomized to MBRP, as compared with those in a control group, demonstrated significantly lower rates of substance use and greater decreases in craving following treatment. Furthermore, individuals in MBRP did not report increased craving or substance use in response to negative affect. It is important to note, areas of the brain that have been associated with craving, negative affect, and relapse have also been shown to be affected by mindfulness training. Drawing from the neuroimaging literature, we review several plausible mechanisms by which MBRP might be changing neural responses to the experiences of craving and negative affect, which subsequently may reduce risk for relapse. We hypothesize that MBRP may affect numerous brain systems and may reverse, repair, or compensate for the neuroadaptive changes associated with addiction and addictive-behavior relapse.
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Affiliation(s)
| | | | - Sarah Bowen
- Department of Psychiatry and Behavioral Sciences
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196
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Stice E, Yokum S, Burger KS. Elevated reward region responsivity predicts future substance use onset but not overweight/obesity onset. Biol Psychiatry 2013; 73:869-76. [PMID: 23312561 PMCID: PMC3774523 DOI: 10.1016/j.biopsych.2012.11.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 11/05/2012] [Accepted: 11/20/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND We tested the hypotheses that adolescents who show elevated reward region responsivity are at increased risk for initial onset of overweight/obesity and substance use, which is important because there have been no such prospective tests of the reward surfeit model of these motivated behaviors. METHODS One hundred sixty-two adolescents (mean age = 15.3±1.06 years) with healthy weights (mean body mass index = 20.8±1.90) completed functional magnetic resonance imaging paradigms that assessed neural activation in response to receipt and anticipated receipt of palatable food and monetary reward; body fat and substance use were assessed at baseline and 1-year follow-up. RESULTS Elevated caudate (r = .31, p<.001) and putamen (r = .28, p<.001) response to monetary reward predicted substance use onset over 1-year follow-up, but reward circuitry responsivity did not predict future overweight/obesity onset. Adolescents who reported substance use versus abstinence at baseline also showed less caudate (r =-.31, p<.001) response to monetary reward. DISCUSSION Results show that hyper-responsivity of reward circuitry increases risk for future substance use onset, providing novel support for the reward surfeit model. Results also imply that even a limited substance use history was associated with reduced reward region responsivity, extending results from studies that compared substance-dependent individuals with healthy control subjects and suggesting that substance use downregulates reward circuitry. However, aberrant reward region responsivity did not predict initial unhealthy weight gain.
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Affiliation(s)
- Eric Stice
- Oregon Research Institute, Eugene, Oregon, USA.
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197
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Cousijn J, Goudriaan AE, Ridderinkhof KR, van den Brink W, Veltman DJ, Wiers RW. Neural responses associated with cue-reactivity in frequent cannabis users. Addict Biol 2013; 18:570-80. [PMID: 22264344 DOI: 10.1111/j.1369-1600.2011.00417.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cue-reactivity reflects enhanced motivational processing underlying continued substance use and relapse in substance use disorders. Substance use disorders are associated with greater cue-reactivity in orbitofrontal cortex, anterior cingulate cortex, striatum, ventral tegmental area and amygdala. Here we examine whether this also holds for frequent cannabis users. Using functional magnetic resonance imaging (fMRI), neural responses to neutral and cannabis-related cues were compared between frequent cannabis users (n = 31), sporadic cannabis users (n = 20) and cannabis-naive controls (n = 21). In addition, fMRI findings were correlated with the level of cannabis use, problem severity and craving. In frequent users compared with sporadic users and controls, cannabis images engendered higher activation than control images in the ventral tegmental area. Activation of the orbitofrontal cortex, anterior cingulate cortex and striatum was only higher in a subgroup of frequent users with high compared with low-problem severity. Activity in the right putamen and right dorsolateral prefrontal cortex correlated negatively with subjective craving in frequent users. Activity was not correlated with level of cannabis use. These findings indicate that cannabis cues activate areas associated with addiction pathology in frequent cannabis users compared with sporadic users and controls. However, among frequent users, cue-reactivity seems to be primarily associated with problem severity, not with amount of cannabis use. These findings imply neural cue-reactivity as a tool in assessing problem severity of cannabis use.
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Affiliation(s)
- Janna Cousijn
- ADAPT-lab, Department of Psychology, University of Amsterdam, Weesperplein 4, Amsterdam, The Netherlands.
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198
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Li X, Hartwell KJ, Owens M, Lematty T, Borckardt JJ, Hanlon CA, Brady KT, George MS. Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex reduces nicotine cue craving. Biol Psychiatry 2013; 73:714-20. [PMID: 23485014 PMCID: PMC3615051 DOI: 10.1016/j.biopsych.2013.01.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 01/04/2013] [Accepted: 01/04/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) can noninvasively stimulate the brain and transiently amplify or block behaviors mediated through a region. We hypothesized that a single high-frequency rTMS session over the left dorsolateral prefrontal cortex (DLPFC) would reduce cue craving for cigarettes compared with a sham TMS session. METHODS Sixteen non-treatment-seeking, nicotine-dependent participants were randomized to receive either real high-frequency rTMS (10 Hz, 100% resting motor threshold, 5-sec on, 10-sec off for 15 min; 3000 pulses) or active sham (eSham) TMS over the DLPFC in two visits with 1 week between visits. The participants received cue exposure before and after rTMS and rated their craving after each block of cue presentation. RESULTS Stimulation of the left DLFPC with real, but not sham, rTMS reduced craving significantly from baseline (64.1±5.9 vs. 45.7±6.4, t = 2.69, p = .018). When compared with neutral cue craving, the effect of real TMS on cue craving was significantly greater than the effect of sham TMS (12.5±10.4 vs. -9.1±10.4; t = 2.07, p = .049). More decreases in subjective craving induced by TMS correlated positively with higher Fagerström Test for Nicotine Dependence score (r = .58, p = .031) and more cigarettes smoked per day (r = .57, p = .035). CONCLUSIONS One session of high-frequency rTMS (10 Hz) of the left DLPFC significantly reduced subjective craving induced by smoking cues in nicotine-dependent participants. Additional studies are needed to explore rTMS as an aid to smoking cessation.
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Affiliation(s)
- Xingbao Li
- Medical University of South Carolina, Charleston, SC 29425, USA.
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199
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Schmidt AF, Eulenbruch T, Langer C, Banger M. Interoceptive Awareness, Tension Reduction Expectancies and Self-Reported Drinking Behavior. Alcohol Alcohol 2013; 48:472-7. [DOI: 10.1093/alcalc/agt024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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200
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Karoly HC, Harlaar N, Hutchison KE. Substance use disorders: a theory-driven approach to the integration of genetics and neuroimaging. Ann N Y Acad Sci 2013; 1282:71-91. [DOI: 10.1111/nyas.12074] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Hollis C. Karoly
- Department of Psychology and Neuroscience; University of Colorado at Boulder; Boulder; Colorado
| | - Nicole Harlaar
- Department of Psychology and Neuroscience; University of Colorado at Boulder; Boulder; Colorado
| | - Kent E. Hutchison
- Department of Psychology and Neuroscience; University of Colorado at Boulder; Boulder; Colorado
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