301
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Li CSR, Sinha R. Inhibitory control and emotional stress regulation: neuroimaging evidence for frontal-limbic dysfunction in psycho-stimulant addiction. Neurosci Biobehav Rev 2007; 32:581-97. [PMID: 18164058 PMCID: PMC2263143 DOI: 10.1016/j.neubiorev.2007.10.003] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 09/21/2007] [Accepted: 10/28/2007] [Indexed: 10/22/2022]
Abstract
This review focuses on neuroimaging studies that examined stress processing and regulation and cognitive inhibitory control in patients with psycho-stimulant addiction. We provide an overview of these studies, summarizing converging evidence and discrepancies as they occur in the literature. We also adopt an analytic perspective and dissect these psychological processes into their sub-components, to identify the neural pathways specific to each component process and those that are more specifically involved in psycho-stimulant addiction. To this aim we refer frequently to studies conducted in healthy individuals. Despite the separate treatment of stress/affect regulation, stress-related craving or compulsive drug seeking, and inhibitory control, neural underpinnings of these processes overlap significantly. In particular, the ventromedial prefrontal regions including the anterior cingulate cortex, amygdala and the striatum are implicated in psychostimulant dependence. Our overarching thesis is that prefrontal activity ensures intact emotional stress regulation and inhibitory control. Altered prefrontal activity along with heightened striatal responses to addicted drug and drug-related salient stimuli perpetuates habitual drug seeking. Further studies that examine the functional relationships of these neural systems will likely provide the key to understanding the mechanisms underlying compulsive drug use behaviors in psycho-stimulant dependence.
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Affiliation(s)
- Chiang-shan Ray Li
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center S103, New Haven, CT 06519, USA.
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302
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Mazzone SB, McLennan L, McGovern AE, Egan GF, Farrell MJ. Representation of Capsaicin-evoked Urge-to-Cough in the Human Brain Using Functional Magnetic Resonance Imaging. Am J Respir Crit Care Med 2007; 176:327-32. [PMID: 17575093 DOI: 10.1164/rccm.200612-1856oc] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
RATIONALE Coughing in humans is typically preceded by a desire (or urge) to cough. The neural circuitry involved in sensing airway irritation and generating the urge-to-cough in humans is essentially unknown. OBJECTIVES The aim of the present study was to use functional brain imaging to describe the supramedullary regions that are activated in humans during capsaicin inhalation. METHODS Experiments were performed on 10 healthy subjects (5 males, 5 females). Capsaicin doses were individually tailored to evoke a transient and reversible urge-to-cough. Blood oxygen level-dependent (BOLD) functional magnetic resonance measures were collected during repeated 24-second challenges with capsaicin or saline inhalation and subjects were asked to rate the urge-to-cough intensity of each challenge. MEASUREMENTS AND MAIN RESULTS Capsaicin inhalation reliably evoked an urge-to-cough, which was associated with activations in a variety of brain regions, including the insula cortex, anterior midcingulate cortex, primary sensory cortex, orbitofrontal cortex, supplementary motor area, and cerebellum. CONCLUSIONS These data provide the first insights into the cortical neuronal network involved in sensing airway irritation and modulating coughing in humans.
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Affiliation(s)
- Stuart B Mazzone
- The Howard Florey Institute, University of Melbourne, Parkville, Victoria, Australia 3010.
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303
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Sullivan EV. Alcohol and Drug Dependence: Brain Mechanisms and Behavioral Impact. Neuropsychol Rev 2007; 17:235-8. [PMID: 17680366 DOI: 10.1007/s11065-007-9039-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 07/06/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine (MC5723), 401 Quarry Road, Stanford, CA 94305-5723, USA.
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304
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Jager G, de Win MM, Vervaeke HK, Schilt T, Kahn RS, van den Brink W, van Ree JM, Ramsey NF. Incidental use of ecstasy: no evidence for harmful effects on cognitive brain function in a prospective fMRI study. Psychopharmacology (Berl) 2007; 193:403-14. [PMID: 17476480 DOI: 10.1007/s00213-007-0792-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 03/21/2007] [Indexed: 11/25/2022]
Abstract
RATIONALE Heavy ecstasy use in humans has been associated with cognitive impairments and changes in cognitive brain function supposedly due to damage to the serotonin system. There is concern that even a single dose of 3,4-methylenedioxymethamphetamine may be neurotoxic, but very little is known about the consequences of a low dose of ecstasy for cognitive brain function. OBJECTIVES The objective of the study was to assess the effects of a low dose of ecstasy on human cognitive brain function using functional magnetic resonance imaging (fMRI). MATERIALS AND METHOD We prospectively studied, as part of the NeXT (Netherlands XTC toxicity) study, sustained effects of a low dose of ecstasy on brain function in 25 subjects before and after their first episode of ecstasy use (mean 2.0 +/- 1.4 ecstasy pills, on average 11.1 +/- 12.9 weeks since last ecstasy use), compared to 24 persistent ecstasy-naive controls, also measured twice and matched with the novice users on age, gender, IQ, and cannabis use. Cognitive brain function was measured in the domains of working memory, selective attention, and associative memory using fMRI. RESULTS No significant effects were found of a low dose of ecstasy on working memory, selective attention, or associative memory neither at the behavioral level nor at the neurophysiological level. CONCLUSIONS This study yielded no firm evidence for sustained effects of a low dose of ecstasy on human cognitive brain function. The present findings are relevant for the development of prevention and harm reduction strategies. Furthermore, the study is relevant to the discussion concerning potential therapeutic use of ecstasy.
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Affiliation(s)
- Gerry Jager
- Department of Neurosurgery, A.01.126, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
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305
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Cunningham CL, Patel P. Rapid induction of Pavlovian approach to an ethanol-paired visual cue in mice. Psychopharmacology (Berl) 2007; 192:231-41. [PMID: 17265074 DOI: 10.1007/s00213-007-0704-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 01/09/2007] [Indexed: 11/30/2022]
Abstract
RATIONALE Although many studies have shown Pavlovian conditioned approach to cues paired with natural reinforcers, it has been quite difficult to induce such behavior with drug reinforcers. OBJECTIVES This experiment tested a novel Pavlovian procedure for inducing approach to a conditioned stimulus (CS) paired with ethanol. METHODS Mice (NZB/B1NJ, DBA/2J) received intraperitoneal injections of ethanol (2 g/kg) immediately before 10-min exposure to a rectangular chamber that contained a distinctive visual cue (star) at one end (Paired group, CS+ trials). On alternate days, saline injection preceded apparatus exposure with no distinctive cues (CS- trials). Unpaired control mice received ethanol in the home cage 60-75 min after each CS+ trial. RESULTS NZB/B1NJ Paired group mice spent increasing amounts of time (>85% of the session) in proximity to the star, whereas Unpaired group mice did not. DBA/2J Paired group mice spent slightly more time on the star side than Unpaired group mice but did not show an acquisition curve. Postconditioning tests showed a strong preference for the star side in Paired groups from both strains after saline injection. However, only NZB/B1NJ mice showed a preference after ethanol. CONCLUSIONS This study provides the first unambiguous demonstration of Pavlovian conditioned approach to an ethanol-paired visual stimulus in the absence of any contingency between the animal's behavior and drug exposure. This effect, which is remarkable both in terms of its magnitude and the rapidity with which it was produced (within 2-3 trials), may be related to the cue-associated craving that accompanies alcohol and drug addiction.
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Affiliation(s)
- Christopher L Cunningham
- Department of Behavioral Neuroscience and Portland Alcohol Research Center, Oregon Health & Science University, Portland, OR 97239-3098, USA.
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306
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Sinha R, Li CSR. Imaging stress- and cue-induced drug and alcohol craving: association with relapse and clinical implications. Drug Alcohol Rev 2007; 26:25-31. [PMID: 17364833 DOI: 10.1080/09595230601036960] [Citation(s) in RCA: 344] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Stress- and drug-related cues are major factors contributing to high rates of relapse in addictive disorders. Brain imaging studies have begun to identify neural correlates of stress and drug cue-induced craving states. Findings indicate considerable overlap in neural circuits involved in processing stress and drug cues with activity in the corticostriatal limbic circuitry underlying both affective and reward processing. More recent efforts have begun to identify the relationships between neural activity during stress and drug cue exposure and drug relapse outcomes. Findings suggest medial prefrontal, anterior and posterior cingulate, striatal and posterior insula regions to be associated with relapse outcomes. Altered function in these brain regions is associated with stress-induced and drug cue-induced craving states and an increased susceptibility to relapse. Such alterations can serve as markers to identify relapse propensity and a more severe course of addiction. Efficacy of pharmacological and behavioral treatments that specifically target stress and cue-induced craving and arousal responses may also be assessed via alterations in these brain correlates.
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Affiliation(s)
- Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
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307
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Dayas CV, Liu X, Simms JA, Weiss F. Distinct patterns of neural activation associated with ethanol seeking: effects of naltrexone. Biol Psychiatry 2007; 61:979-89. [PMID: 17098214 PMCID: PMC2831298 DOI: 10.1016/j.biopsych.2006.07.034] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 06/23/2006] [Accepted: 07/19/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcoholism, like other substance abuse disorders, is a chronically relapsing condition. Compared with other abused drugs, however, little is known about the neural mechanisms mediating ethanol (EtOH)-craving and -seeking behavior leading to relapse. This study, therefore, was conducted to identify candidate brain regions that are recruited by an EtOH-associated contextual stimulus (S(+)). A secondary objective was to determine whether EtOH S(+)-elicited neural recruitment patterns are modified by the opiate antagonist naltrexone (NTX), a compound that reduces cue-induced craving in alcoholics and attenuates ethanol seeking in animal models of relapse. METHODS Rats were tested in a conditioned reinstatement model of relapse with subsequent examination of brain c-fos expression patterns elicited by an EtOH S(+) versus a cue associated with nonreward (S(-)). In addition, modification of these expression patterns by NTX was examined. RESULTS The EtOH S(+) reinstated extinguished responding and increased c-fos expression within the prefrontal cortex, hippocampus, nucleus accumbens, and hypothalamic paraventricular nucleus (PVN). Naltrexone suppressed the S(+)-induced reinstatement and attenuated hippocampal CA3 c-fos expression, while increasing neural activity in the extended amygdala and PVN. CONCLUSIONS Ethanol-associated contextual stimuli recruit key brain regions that regulate associative learning, goal-directed behavior, and Pavlovian conditioning of emotional significance to previously neutral stimuli. In addition, the data implicate the hippocampus, amygdala, and PVN as potential substrates for the inhibitory effects of NTX on conditioned reinstatement.
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Affiliation(s)
- Christopher V Dayas
- Molecular and Integrative Neurosciences Department, The Scripps Research Institute, La Jolla, California 92037, USA.
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308
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Wrase J, Schlagenhauf F, Kienast T, Wüstenberg T, Bermpohl F, Kahnt T, Beck A, Ströhle A, Juckel G, Knutson B, Heinz A. Dysfunction of reward processing correlates with alcohol craving in detoxified alcoholics. Neuroimage 2007; 35:787-94. [PMID: 17291784 DOI: 10.1016/j.neuroimage.2006.11.043] [Citation(s) in RCA: 349] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 11/07/2006] [Accepted: 11/15/2006] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Alcohol dependence may be associated with dysfunction of mesolimbic circuitry, such that anticipation of nonalcoholic reward fails to activate the ventral striatum, while alcohol-associated cues continue to activate this region. This may lead alcoholics to crave the pharmacological effects of alcohol to a greater extent than other conventional rewards. The present study investigated neural mechanisms underlying these phenomena. METHODS 16 detoxified male alcoholics and 16 age-matched healthy volunteers participated in two fMRI paradigms. In the first paradigm, alcohol-associated and affectively neutral pictures were presented, whereas in the second paradigm, a monetary incentive delay task (MID) was performed, in which brain activation during anticipation of monetary gain and loss was examined. For both paradigms, we assessed the association of alcohol craving with neural activation to incentive cues. RESULTS Detoxified alcoholics showed reduced activation of the ventral striatum during anticipation of monetary gain relative to healthy controls, despite similar performance. However, alcoholics showed increased ventral striatal activation in response to alcohol-associated cues. Reduced activation in the ventral striatum during expectation of monetary reward, and increased activation during presentation of alcohol cues were correlated with alcohol craving in alcoholics, but not healthy controls. CONCLUSIONS These results suggest that mesolimbic activation in alcoholics is biased towards processing of alcohol cues. This might explain why alcoholics find it particularly difficult to focus on conventional reward cues and engage in alternative rewarding activities.
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Affiliation(s)
- Jana Wrase
- Department of Psychiatry and Psychotherapy, Charité, Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Berlin, Germany
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309
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MacKillop J, Menges DP, McGeary JE, Lisman SA. Effects of craving and DRD4 VNTR genotype on the relative value of alcohol: an initial human laboratory study. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2007; 3:11. [PMID: 17309802 PMCID: PMC1805446 DOI: 10.1186/1744-9081-3-11] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 02/19/2007] [Indexed: 11/12/2022]
Abstract
BACKGROUND Craving for alcohol is a highly controversial subjective construct and may be clarified by Loewenstein's visceral theory, which emphasizes craving's behavioral effects on the relative value of alcohol. Based on the visceral theory, this study examined the effects of a craving induction on the relative value of alcohol as measured by a behavioral choice task. In addition, based on previous evidence of its role in the expression of craving, the influence of DRD4 VNTR genotype (DRD4-L vs. DRD4-S) was also examined. METHODS Thirty-five heavy drinkers (54% male; 31% DRD4-L) were randomly assigned to receive either a craving induction (exposure to personally relevant alcohol cues) or a control induction (exposure to neutral cues), which was followed by an alcohol-money choice task. Participants were assessed for craving and positive/negative affect throughout the procedure, and relative value of alcohol was derived from participant choices for alcohol versus money. DRD4 VNTR status was assessed retrospectively via buccal samples using previously established protocols. RESULTS Factorial analysis of the craving induction revealed that it was associated with significant increase in craving (p < .001), but not greater relative value of alcohol. Factorial analyses including DRD4 VNTR genotype of did not suggest an influence on reactivity to the craving induction, although this analysis was substantially compromised by small cell sample sizes. Continuous analyses revealed that craving was significantly associated with the relative value of alcohol (p < .05) and possession of the DRD4-L allele further amplified this relationship (p < .001). CONCLUSION These results are interpreted as generally supporting Loewenstein's visceral theory of craving and evidence of a functional role of DRD4 VNTR genotype in the expression of craving for alcohol. Methodological limitations, mechanisms underlying these findings, and future directions are discussed.
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Affiliation(s)
- James MacKillop
- Department of Psychology, State University of New York at Binghamton, PO Box 6000, Binghamton, NY 13902-6000, USA
- Center for Alcohol and Addiction Studies, Brown University, Box G-BH, Providence RI 02906, USA
| | - David P Menges
- Department of Psychology, State University of New York at Binghamton, PO Box 6000, Binghamton, NY 13902-6000, USA
| | - John E McGeary
- Center for Alcohol and Addiction Studies, Brown University, Box G-BH, Providence RI 02906, USA
- Providence Veteran Affairs Medical Center, Providence RI 02909, USA
| | - Stephen A Lisman
- Department of Psychology, State University of New York at Binghamton, PO Box 6000, Binghamton, NY 13902-6000, USA
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310
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Abstract
A number of brain systems have been implicated in addictive behavior, but none have yet been shown to be necessary for maintaining the addiction to cigarette smoking. We found that smokers with brain damage involving the insula, a region implicated in conscious urges, were more likely than smokers with brain damage not involving the insula to undergo a disruption of smoking addiction, characterized by the ability to quit smoking easily, immediately, without relapse, and without persistence of the urge to smoke. This result suggests that the insula is a critical neural substrate in the addiction to smoking.
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Affiliation(s)
- Nasir H. Naqvi
- Division of Cognitive Neuroscience, Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - David Rudrauf
- Division of Cognitive Neuroscience, Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
- Laboratory of Computational Neuroimaging, Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Hanna Damasio
- Dornsife Cognitive Neuroscience Imaging Center, SGM 501, University of Southern California, Los Angeles, CA 90089, USA
- Brain and Creativity Institute, HNB B26, University of Southern California, Los Angeles, CA 90089, USA
| | - Antoine Bechara
- Division of Cognitive Neuroscience, Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
- Dornsife Cognitive Neuroscience Imaging Center, SGM 501, University of Southern California, Los Angeles, CA 90089, USA
- Brain and Creativity Institute, HNB B26, University of Southern California, Los Angeles, CA 90089, USA
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311
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McBride D, Barrett SP, Kelly JT, Aw A, Dagher A. Effects of expectancy and abstinence on the neural response to smoking cues in cigarette smokers: an fMRI study. Neuropsychopharmacology 2006; 31:2728-38. [PMID: 16598192 DOI: 10.1038/sj.npp.1301075] [Citation(s) in RCA: 239] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cues associated with drug taking can trigger relapse, drug seeking, and craving in addicted individuals. Behavioral studies suggest that drug availability and withdrawal can affect the individual response to drug cues. Moreover, the importance of subjective craving in cue-induced relapse has been questioned and an alternative model put forward according to which drug cues trigger habitual drug-seeking behaviors independently of craving. We used functional magnetic resonance imaging to compare the brain response to smoking and control videotapes in 20 healthy smokers, while varying their expectancy to smoke and abstinence levels. The neural response to cigarette cues was strongly modulated by expectancy and, to a lesser extent, abstinence. In people expecting to smoke immediately after the scan, smoking cues activated brain areas implicated in arousal, attention, and cognitive control. However, when subjects knew they would not be allowed to smoke for 4 h, there was almost no brain activation in response to smoking cues, despite equivalent reported levels of craving. In the dorsolateral prefrontal cortex, the neural response was a function of both craving and expectancy. Thalamo-cingulate connectivity, thought to be an index of arousal, was greater during expectancy than nonexpectancy. Our findings confirm the importance of expectancy in the neural response to drug cues, and lend support to the theory that these cues act on brain areas involved in arousal and attention.
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Affiliation(s)
- Dharma McBride
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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312
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Noël X, Colmant M, Van Der Linden M, Bechara A, Bullens Q, Hanak C, Verbanck P. Time Course of Attention for Alcohol Cues in Abstinent Alcoholic Patients: The Role of Initial Orienting. Alcohol Clin Exp Res 2006; 30:1871-7. [PMID: 17067351 DOI: 10.1111/j.1530-0277.2006.00224.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Addicted people are characterized by enhanced attention for drug cues leading to drug use. However, there is little research on the component processes of attention in individuals with alcoholism. Here, we examine 2 distinct components of attention in abstinent alcohol-dependent individuals and social drinkers of alcohol, that is to say, the initial orienting to alcohol-related cues, and the maintenance of attention to them. METHOD The present study used an "alcohol" version of the visual probe detection task with alcohol-related or neutral pictures being presented briefly (i.e., 50 ms), to assess initial orienting, or longer (i.e., 500 and 1,250 ms), to assess the maintenance of attention. RESULTS Only alcoholic patients were faster in detecting a probe displayed immediately after pictures related to alcohol presented for 50 ms than in detecting the same probe replacing non-alcohol-related pictures. However, when pictures were presented for 500 ms, only social alcohol drinkers were faster in detecting the probe replacing alcohol scenes. At a stimulus of 1,250 ms duration, no group showed attentional bias toward alcohol cues. In addition, the severity of alcoholism measured by the total number of prior detoxification treatments was positively correlated with the attentional bias (or "attraction") for alcohol pictures presented for 50 ms. CONCLUSIONS These results show that, subsequent to initial visual orienting to alcohol-related cues, abstinent patients' attention was disengaged from these stimuli, thus suggesting a visual approach-disengagement attentional pattern. The influence of these findings on relapse was discussed.
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Affiliation(s)
- Xavier Noël
- Clinic of Addictions, Brugmann Hospital, Université Libre de Bruxelles, 4 place Van Gehuchten, 1020 Brussels, Belgium.
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313
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Matthews PM, Honey GD, Bullmore ET. Applications of fMRI in translational medicine and clinical practice. Nat Rev Neurosci 2006; 7:732-44. [PMID: 16924262 DOI: 10.1038/nrn1929] [Citation(s) in RCA: 187] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Functional MRI (fMRI) has had a major impact in cognitive neuroscience. fMRI now has a small but growing role in clinical neuroimaging, with initial applications to neurosurgical planning. Current clinical research has emphasized novel concepts for clinicians, such as the role of plasticity in recovery and the maintenance of brain functions in a broad range of diseases. There is a wider potential for clinical fMRI in applications ranging from presymptomatic diagnosis, through drug development and individualization of therapies, to understanding functional brain disorders. Realization of this potential will require changes in the way clinical neuroimaging services are planned and delivered.
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Affiliation(s)
- Paul M Matthews
- Centre for Functional Magnetic Resonance Imaging of the Brain, Dept. of Clinical Neurology, University of Oxford, UK.
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314
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Lapish CC, Seamans JK, Chandler LJ. Glutamate-dopamine cotransmission and reward processing in addiction. Alcohol Clin Exp Res 2006; 30:1451-65. [PMID: 16930207 DOI: 10.1111/j.1530-0277.2006.00176.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While Dale's principle of "one neuron, one neurotransmitter" has undergone revisions to incorporate evidence of the corelease of atypical neurotransmitters such as neuropeptides, the corelease of classical neurotransmitters has only recently been realized. Surprisingly, numerous studies now indicate that the corelease of neurotransmitters in the mammalian central nervous system is not an obscure and rare phenomenon but is widespread and involves most classical neurotransmitters systems. However, the suggestion that glutamate can be coreleased with dopamine (DA) has remained controversial. Furthermore, glutamate-DA cotransmission has not yet been seriously considered in the context of the neurocircuitry of addiction. If glutamate is in fact coreleased with DA as some evidence now suggests, this may have significant implications for advancing our understanding of the interactive role that these 2 neurotransmitters play in cognitive and reward processes. In this commentary, we review the evidence for and against glutamate as a cotransmitter and discuss the potential role of glutamate-DA corelease in addiction. In particular, we describe a recently proposed model in which coreleased glutamate transmits a temporally precise prediction error signal of reward described by Schultz et al., whereas the function of coreleased DA is to exert prolonged modulatory influences on neuronal activity. In addition, we suggest that as alcohol consumption transitions from recreational use to addiction, there is a corresponding transition in the reward valence signal from better than predicted to worse than predicted.
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Affiliation(s)
- Christopher C Lapish
- Department of Neurosciences and the Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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315
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Hermann D, Smolka MN, Wrase J, Klein S, Nikitopoulos J, Georgi A, Braus DF, Flor H, Mann K, Heinz A. Blockade of cue-induced brain activation of abstinent alcoholics by a single administration of amisulpride as measured with fMRI. Alcohol Clin Exp Res 2006; 30:1349-54. [PMID: 16899037 DOI: 10.1111/j.1530-0277.2006.00174.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Once alcohol dependence is established, alcohol-associated cues may induce dopamine release in the reward system, which is accompanied by alcohol craving and may lead to relapse. In cocaine addicts, dopamine release in the thalamus was positively correlated with cocaine craving. We tested the effects of the atypical dopamine D(2/3) blocker amisulpride on cue-induced brain activation in a functional magnetic resonance imaging (fMRI) paradigm. METHODS Alcohol-associated and neutral pictures were presented in a block design to 10 male abstinent alcoholics (1-3 weeks after detoxification) and 10 healthy men during fMRI. The fMRI scans were acquired before and 2 hours after the oral application of 400 mg amisulpride. Before and after each scan, alcohol craving was measured with visual analogue scales. RESULTS Before the application of amisulpride, alcohol versus control cues elicited a higher blood oxygen level-dependent (BOLD) signal in the left frontal and orbitofrontal lobe, left cingulate gyrus, bilateral parietal lobe, and bilateral hippocampus in alcoholics compared with healthy controls. After amisulpride, alcoholics showed a reduced activation in the right thalamus compared with the first scan. Alcoholics no longer showed significant differences in their cue-elicited BOLD response after amisulpride medication compared with medication-free controls. Self-reported craving was not affected by amisulpride medication. CONCLUSIONS Amisulpride medication was associated with reduced cue-induced activation of the thalamus, a brain region closely connected with frontostriatal circuits that regulate behavior and may influence relapse risk.
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Affiliation(s)
- Derik Hermann
- Central Institute of Mental Health, Mannheim, Germany
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316
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Abstract
If there is no further intervention, relapse rates in detoxified alcoholics are high, up to 85%, even after complete remission of bodily withdrawal symptoms. It has been suggested that one relevant mechanism contributing to the relapse risk is the exposure to stimuli (cues) that have regularly been associated with alcohol intake. Such stimuli can become conditioned cues that elicit alcohol craving and intake as conditioned responses. Current brain imaging studies indicate that dysfunction of dopaminergic, glutamatergic, and opioidergic neurotransmission in the brain reward system (ventral striatum including the nucleus accumbens) is associated with alcohol craving and brain activation elicited by alcohol-associated pictures. These findings point to specific indications for psychotherapeutic and additive pharmacological treatment options.
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Affiliation(s)
- J Wrase
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Germany
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317
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Woodward JJ, Ron D, Winder D, Roberto M. From blue states to up states: a regional view of NMDA-ethanol interactions. Alcohol Clin Exp Res 2006; 30:359-67. [PMID: 16441285 DOI: 10.1111/j.1530-0277.2006.00040.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article summarizes the proceedings of a symposium at the 2005 Research Society on Alcoholism Meeting in Santa Barbara, California, organized and cochaired by John J. Woodward and Dorit Ron. The purpose of the symposium was to discuss recent findings that extend our understanding of the importance of the N-methyl-D-aspartate (NMDA) receptor as a target for ethanol action in the brain. These receptors are ligand-gated ion channels that are activated by the neurotransmitter glutamate and are critically involved in many forms of synaptic plasticity including those associated with learning and memory. In the first presentation, Dorit Ron presented data showing how activation of Fyn or Src tyrosine kinases differentially regulated the cell surface expression and activity of NR2A and NR2B containing NMDA receptors. Danny Winder discussed the effects of ethanol on NMDA receptor-dependent long-term potentiation in the bed nucleus of the stria terminalis (BNST), a brain region associated with the interaction between stress and drug/alcohol use. In the third presentation, Marisa Roberto described adaptations in the expression and function of NMDA receptors in the central nucleus of the amygdala following chronic exposure to ethanol. Finally, John Woodward described the effects of ethanol on the activity of neurons in deep layers of the prefrontal cortex using a novel slice coculture preparation.
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Affiliation(s)
- John J Woodward
- Department of Neurosciences and Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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318
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Gau SSF, Liu CY, Lee CS, Chang JC, Chang CJ, Li CF, Chen CC, Cheng ATA. Development of a Chinese Version of the Yale-Brown Obsessive Compulsive Scale for Heavy Drinking. Alcohol Clin Exp Res 2006; 29:1172-9. [PMID: 16046872 DOI: 10.1097/01.alc.0000172167.20119.9f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Measurement of craving is an important component in the investigation of the etiology and clinical pictures of alcoholism and dependence of other substances in different cultures. The aim of this study was to develop a Chinese version of the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd-C), the instrument most frequently used in assessing the severity of alcohol craving in Taiwan. METHODS Four hundred twenty Han Chinese (220 with alcohol use disorders) and 218 Bunun aborigines (150 with alcohol use disorders) in Taiwan were interviewed by mental health professionals with the YBOCS-hd-C and a Chinese version of the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry to establish the psychiatric diagnosis. Validity and reliability of the YBOCS-hd-C were examined. RESULTS The YBOCS-hd-C was found to have acceptable interrater reliability (intraclass correlation, 0.89-0.96), internal consistency (Cronbach's alpha = 0.99), construct validity, concurrent validity, and cross-cultural validity. The correlations between 10 items of the YBOCS-hd-C and 11 items of the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry adjusted for age, gender, and ethnicity ranged from 0.39 to 1.00. The YBOCS-hd-C also discriminated effectively among individuals with alcohol dependence, alcohol abusers, and normal drinkers. CONCLUSIONS This study demonstrated that the YBOCS-hd-C is a reliable and valid instrument for assessing the extent of craving for alcohol in Taiwanese Han and Bunun individuals.
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Affiliation(s)
- Susan S F Gau
- Department of Psychiatry, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
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319
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Lingford-Hughes AR, Daglish MRC, Stevenson BJ, Feeney A, Pandit SA, Wilson SJ, Myles J, Grasby PM, Nutt DJ. Imaging alcohol cue exposure in alcohol dependence using a PET 15O-H2O paradigm: results from a pilot study. Addict Biol 2006; 11:107-15. [PMID: 16759343 DOI: 10.1111/j.1369-1600.2006.00001.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Craving is a commonly used term to describe an intense desire for a substance or behaviour; however, its underlying neurobiology is not fully characterized. We have successfully used a cue exposure paradigm with functional neuro-imaging (H2 15O PET; PET, positron emission tomography) in abstinent opiate addicts. This study showed that salient cue exposure results in activation in the left anterior cingulate/mediofrontal cortex and elicited craving correlated with activity in the left orbitofrontal cortex. We therefore aimed to replicate this study in alcohol dependence to see if a similar pattern of neural activation occurred. We recruited six abstinent alcohol-dependent and six non-dependent subjects who each underwent a 12-run PET scan using H2 15O to measure changes in regional blood flow during exposure to an alcoholic drink or its visually matched non-alcoholic drink. Physiological data and subjective ratings were also recorded. Statistical parametric mapping (SPM99) was used to analyse the PET images. Compared with control subjects, abstinent alcohol-dependent subjects rated their alcohol craving higher at baseline and throughout the study, but there was no significant change in the scores in response to the cues in either group. SPM analysis across all subjects showed significant activation in the occipital cortex in response to the alcohol cue as compared with the neutral one. Analysis of the same regions that were activated in the opiate study, revealed significant increases in signal activation in the left medial prefrontal area, but only in abstinent alcohol-dependent subjects. In conclusion, in abstinent alcohol dependence we suggest that a simple cue exposure paradigm is not sufficiently powerful in functional imaging studies to determine the underlying neurobiology of subjective craving. Comparisons with the finding in opiate dependence suggest a shared region, the anterior cingulate/left medial prefrontal cortex is involved in the cue response in dependent subjects but not controls.
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320
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Volkow ND, Wang GJ, Ma Y, Fowler JS, Wong C, Ding YS, Hitzemann R, Swanson JM, Kalivas P. Activation of orbital and medial prefrontal cortex by methylphenidate in cocaine-addicted subjects but not in controls: relevance to addiction. J Neurosci 2006; 25:3932-9. [PMID: 15829645 PMCID: PMC6724925 DOI: 10.1523/jneurosci.0433-05.2005] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Drugs of abuse are rewarding to addicted and nonaddicted subjects, but they trigger craving and compulsive intake only in addicted subjects. Here, we used positron emission tomography (PET) and [18F] deoxyglucose to compare the brain metabolic responses (marker of brain function) of cocaine-addicted subjects (n = 21) and controls (n = 15) to identify brain regions that are uniquely activated in addicted subjects by intravenous methylphenidate (a drug that cocaine-addicted subjects report to be similar to cocaine). In parallel, we also measured the changes in dopamine (DA) induced by intravenous methylphenidate (using PET and [11C] raclopride) in the striatum and in the thalamus. Metabolic responses between groups differed significantly only in the right medial orbital prefrontal cortex [Brodmann's area (BA) 25 and medial BA 11], where methylphenidate increased metabolism in addicted subjects but decreased metabolism in controls. These changes were associated in all subjects with increased "desire for methylphenidate" and in the addicted subjects with "cocaine craving." In addicted subjects, increases in BA 25 were also associated with mood elevation. Methylphenidate-induced increases in metabolism in the medial orbital prefrontal cortex were associated with its increase of DA in the thalamus but not in the striatum. These findings provide evidence that enhanced sensitivity of BA 25 (region involved with emotional reactivity) and BA 11 (region involved with salience attribution and motivation) in cocaine-addicted subjects may underlie the strong emotional response to the drug and the intense desire to procure it that results in craving and compulsive drug intake. It also suggests that the mesothalamic DA pathway may contribute to these processes.
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Affiliation(s)
- Nora D Volkow
- National Institute of Drug Abuse, Rockville, Maryland 20857, USA.
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321
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Wilson SJ, Sayette MA, Delgado MR, Fiez JA. Instructed smoking expectancy modulates cue-elicited neural activity: a preliminary study. Nicotine Tob Res 2006; 7:637-45. [PMID: 16085533 PMCID: PMC2633119 DOI: 10.1080/14622200500185520] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In recent years, research applying functional neuroimaging to the study of cue-elicited drug craving has emerged. This research has begun to identify a distributed system of brain activity during drug craving. A review of this literature suggested that expectations regarding the opportunity to use a drug affected the pattern of neural responses elicited by drug cues. Using functional magnetic resonance imaging (fMRI), we examined the effects of smoking expectancy on the neural response to neutral (e.g., roll of tape) and smoking-related (a cigarette) stimuli in male cigarette smokers deprived of nicotine for 8 hr. As predicted, several brain regions (e.g., the anterior cingulate cortex) exhibited differential activation during cigarette versus neutral cue exposure. Moreover, we found that subregions of the prefrontal cortex (i.e., ventromedial, ventrolateral, and dorsolateral prefrontal cortices) showed cue-elicited activation that was modulated by smoking expectancy. These results highlight the importance of perceived drug use opportunity in the neurobiological response to drug cues.
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Affiliation(s)
- Stephen J Wilson
- Department of Psychology, University of Pittsburgh and Center for the Neural Basis of Cognition, Pittsburgh, PA 15260, USA.
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322
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Cox WM, Fadardi JS, Pothos EM. The Addiction-Stroop test: Theoretical considerations and procedural recommendations. Psychol Bull 2006; 132:443-76. [PMID: 16719569 DOI: 10.1037/0033-2909.132.3.443] [Citation(s) in RCA: 280] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Decisions about using addictive substances are influenced by distractions by addiction-related stimuli, of which the user might be unaware. The addiction-Stroop task is a paradigm used to assess this distraction. The empirical evidence for the addiction-Stroop effect is critically reviewed, and meta-analyses of alcohol-related and smoking-related studies are presented. Studies finding the strongest effects were those in which participants had strong current concerns about an addictive substance or such concerns were highlighted through experimental manipulations, especially those depriving participants of the substance. Theories to account for addiction-related attentional bias are discussed, of which the motivational theory of current concerns appears to provide the most complete account of the phenomenon. Recommendations are made for maximizing the precision of the addiction-Stroop test in future research.
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Affiliation(s)
- W Miles Cox
- School of Psychology, University of Wales, Bangor, United Kingdom.
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323
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McKay JR, Franklin TR, Patapis N, Lynch KG. Conceptual, methodological, and analytical issues in the study of relapse. Clin Psychol Rev 2005; 26:109-27. [PMID: 16371242 DOI: 10.1016/j.cpr.2005.11.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article examines conceptual, methodological, and analytic issues in research on relapse to alcohol and other drug use. The review notes the continued move in relapse research from a primary reliance on retrospective assessment of factors surrounding the onset of relapse episodes to an increased focus on the use of new technologies to obtain "near real time" data on proximal factors in relapses. Recent advances in neurobiology have yielded important gains in our understanding of vulnerability to relapse in alcohol and other drug abusers. New statistical techniques are also available to analyze data on relapse. From a theoretical standpoint, there has been an increasing appreciation for the complicated and dynamic interplay of distal and proximal factors in the relapse process. At this point, the strongest and most detailed data on factors in the onset and course of relapse have been generated by studies of smoking relapses that have made use of Ecological Momentary Assessment (EMA) technology. However, there is still limited "near real" time data on proximal factors in alcohol and other drug relapses, and no such data on factors that influence the course of these relapses, once they have begun. Nevertheless, important methodological advances have been and continue to be made in the study of relapse, and our knowledge about the nature and process of relapse has increased considerably over the past 10 years.
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Affiliation(s)
- James R McKay
- University of Pennsylvania, Treatment Research Center, Philadelphia 19104, USA.
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324
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Hines LM, Ray L, Hutchison K, Tabakoff B. Alcoholism: the dissection for endophenotypes. DIALOGUES IN CLINICAL NEUROSCIENCE 2005. [PMID: 16262210 PMCID: PMC3181729 DOI: 10.31887/dcns.2005.7.2/lhines] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alcohol dependence (alcoholism) is a complex disorder attributed to the interaction of genetic and environmental factors that form a collage of "disease" predisposition, which is not identical for every alcohol-dependent individual. There is considerable evidence to demonstrate that genetic predisposition accounts for roughly half the risk in the development of alcohol dependence. Both family and population studies have identified a number of genomic regions with suggestive links to alcoholism, yet there have been relatively few definitive findings with regard to genetic determinants of alcoholism. This ambiguity can be attributed to a multitude of complications of studying complex mental disorders, such as clinical heterogeneity, polygenic determinants, reduced penetrance, and epistatic effects. Complex mental disorders are clinical manifestations described by combinations of various signs and symptoms. One approach to overcoming the ambiguity in studying the association between genetic risk factors and disease is to dissect the complex, heterogeneous disorder by using intermediate phenotypes--or endophenotypes--to generate more homogeneous diagnostic groupings than an all-encompassing definition, such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-derived term "alcohol dependence" or the commonly used term "alcoholism." The advantage of using endophenotypes is that the number of influential factors that contribute to these characteristics should be fewer and more easily identified than the number of factors affecting the heterogeneous entity of alcohol dependence (alcoholism). A variety of alcohol-related characteristics have been investigated in epidemiological, clinical, and basic research as potential endophenotypes of alcohol dependence. These include phenotypes related to alcohol metabolism, physiological and endocrine measures, neural imaging, electrophysiology, personality, drinking behavior, and responses to alcohol and alcohol-derived cues. This review summarizes the current literature, focused on human data, of promising endophenotypes for dissecting alcoholism.
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Affiliation(s)
- Lisa M Hines
- Department of Pharmacology, University of Colorado School of Medicine, Aurora, Co 80045-0511, USA
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325
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Abstract
In the United States, efforts to treat addiction are hampered by prejudice and a public view that treats it as a disorder of self-control, not a disease. We highlight select advances in addiction research that, if disseminated to the public, could reverse these misconceptions and facilitate changes in policy to improve treatment access and care delivery for this highly prevalent disease.
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Affiliation(s)
- Charles Dackis
- Department of Psychiatry, 3900 Chestnut Street, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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326
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Rhodes JS, Ryabinin AE, Crabbe JC. Patterns of brain activation associated with contextual conditioning to methamphetamine in mice. Behav Neurosci 2005; 119:759-71. [PMID: 15998197 DOI: 10.1037/0735-7044.119.3.759] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Classical conditioning is thought to play a key role in addiction. The authors used c-Fos immunohistochemistry to demonstrate a conditioned physiological response to methamphetamine (meth) in mice. Male outbred mice were placed into an environment where they had previously experienced 2 mg/kg meth or saline. The meth-paired mice displayed increased c-Fos in several brain regions, including the nucleus accumbens, prefrontal cortex, orbitofrontal cortex, basolateral amygdala, and bed nucleus of the stria terminalis. No conditioned locomotor activity was observed, but individual activity levels strongly correlated with c-Fos in many regions. A batch effect among immunohistochemical assays was demonstrated. Results implicate specific brain regions in classical conditioning to meth and demonstrate the importance of considering locomotor activity and batch in a c-Fos study.
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Affiliation(s)
- Justin S Rhodes
- Portland Alcohol Research Center, Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, USA.
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327
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Dom G, Sabbe B, Hulstijn W, van den Brink W. Substance use disorders and the orbitofrontal cortex: systematic review of behavioural decision-making and neuroimaging studies. Br J Psychiatry 2005; 187:209-20. [PMID: 16135857 DOI: 10.1192/bjp.187.3.209] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Orbitofrontal cortex dysfunctions have been frequently documented in people with substance use disorders. The exact role of this cortical region, however, remains unspecified. AIMS To assess the functionality of the orbitofrontal cortex in people with substance use disorders. METHOD Reports of studies using behavioural decision-making tasks and/or neuroimaging techniques to investigate orbitofrontal cortex functioning in cases of substance misuse were reviewed. Studies focusing exclusively on tobacco-smoking and gambling were excluded. RESULTS Fifty-two research articles were evaluated. Most studies showed significant deficits in decision-making in people with substance use disorders. A consistent finding in the neuroimaging studies was hypoactivity of the orbitofrontal cortex after detoxification. The association between hyperactivity of this region and craving or cue reactivity was not consistent across studies. CONCLUSIONS The orbitofrontal cortex has an important role in addictive behaviours. Further studies are needed to elucidate the underlying neuronal substrates of cue reactivity, craving and decision-making, and the implications for treatment and relapse prevention.
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Affiliation(s)
- G Dom
- Psychiatric Centre Brothers Alexians, Boechout, Belgium.
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328
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Soyka M, Koch W, Tatsch K. Thalamic hypofunction in alcohol hallucinosis: FDG PET findings. Psychiatry Res 2005; 139:259-62. [PMID: 16043330 DOI: 10.1016/j.pscychresns.2005.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2004] [Revised: 04/25/2005] [Accepted: 05/05/2005] [Indexed: 11/21/2022]
Abstract
We report findings obtained with positron emission tomography with fluorodeoxyglucose-F18 (FDG PET) as tracer in two patients with acute alcohol hallucinosis. In line with previous findings, both patients had a significant hypometabolism in the left relative to the right thalamus. When the second patient was retested after clinical recovery, FDG PET findings were normalized, suggesting the probable thalamic dysfunction to be a functional rather than a structural abnormality.
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Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, University of Munich, Nussbaumstrasse 7, D-80336 Munich, Germany.
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329
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Breese GR, Overstreet DH, Knapp DJ. Conceptual framework for the etiology of alcoholism: a "kindling"/stress hypothesis. Psychopharmacology (Berl) 2005; 178:367-80. [PMID: 15765253 PMCID: PMC2958094 DOI: 10.1007/s00213-004-2016-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 08/23/2004] [Indexed: 12/25/2022]
Abstract
RATIONALE The rationale for proposing the "kindling"/stress hypothesis is to provide a conceptual basis for the insidious development and maintenance of alcohol abuse. OBJECTIVE AND RESULTS An objective of the hypothesis is to emphasize how continued alcohol abuse is linked to progressive neural adaptation. Work has shown that repeated withdrawals from chronic low levels of alcohol sensitize ("kindle") anxiety-like behavior ("anxiety") in rats, a finding consistent with multiple withdrawal kindling of seizure activity. Additionally, stress substitutes for initial cycles of the multiple withdrawal protocol to sensitize withdrawal-induced anxiety, which is indicative that stress is capable of facilitating neuroadaptive processes related to withdrawal. The persistence of adaptation caused by stress and multiple withdrawals is revealed by the appearance of withdrawal-induced anxiety following a future re-exposure to a single 5-day period of alcohol. This persisting adaptation also permits stress to induce anxiety during a period of abstinence--a response not observed in animals without previous exposure to alcohol. Furthermore, stress interacts with repeated withdrawals to enhance voluntary alcohol drinking. Results of other preclinical and clinical studies reported in the literature are integrated with these investigations in support of the proposed hypothesis. CONCLUSIONS The "kindling"/stress hypothesis is based on the premise that repeated withdrawals from cycles of chronic alcohol exposure contribute to a progressive development of persisting adaptive change that sensitizes withdrawal-induced anxiety and allows stress to evoke symptoms associated with negative affect during abstinence. Thus, these consequences of repeated withdrawals account for the evolution of major characteristics of alcoholism, which include worsened acute withdrawal symptoms and increased stress-induced negative affect during abstinence, both of which enhance the likelihood of relapse--and with relapse an inability to limit an abusive pattern of alcohol intake. The "kindling"/stress hypothesis provides a clear strategy for future studies to explore the advancing neural adaptation proposed to contribute to the pathogenesis of alcoholism.
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Affiliation(s)
- George R Breese
- Bowles Center for Alcohol Studies, Department of Psychiatry, University of North Carolina School of Medicine, 3007 Thurston-Bowles Building CB-7178, Chapel Hill, NC 27599-7178, USA.
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330
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Sullivan EV, Deshmukh A, De Rosa E, Rosenbloom MJ, Pfefferbaum A. Striatal and forebrain nuclei volumes: contribution to motor function and working memory deficits in alcoholism. Biol Psychiatry 2005; 57:768-76. [PMID: 15820234 DOI: 10.1016/j.biopsych.2004.12.012] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Revised: 11/24/2004] [Accepted: 12/08/2004] [Indexed: 01/29/2023]
Abstract
BACKGROUND Striatal structures are involved in dopaminergic alcohol reward mechanisms and aspects of motor control. Basal forebrain structures hold cholinergic mechanisms influencing memory formation, vulnerable to chronic alcoholism; however, alcoholism's effect on volumes of these structures has seldom been considered with in vivo measurement. METHODS We measured bilateral volumes of caudate nucleus, putamen, nucleus accumbens, and medial septal/diagonal band (MS/DB) in 25 men with alcohol dependence and 51 age-matched control men. Six alcoholic subjects had been drinking recently, and 19 had been sober. RESULTS Volumes of caudate and putamen were smaller in the alcoholics than in the control subjects, regardless of length of sobriety. Recent drinkers showed greater deficits in nucleus accumbens than sober alcoholics. Putamen volume was positively correlated with grip strength; MS/DB volume was positively correlated with verbal working memory independently of the negative association between age-standardized MS/DB and age in alcoholics. CONCLUSIONS Caudate and putamen volume deficits occur and endure in chronic alcoholism. Nucleus accumbens might be especially sensitive to recent alcohol exposure. Striatal volumes should be considered in functional imaging studies of alcohol craving that target striatal brain regions. The age-alcohol interaction for MS/DB volumes is consistent with a cholinergic mechanism for the working memory impairment observed in the alcoholics.
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Affiliation(s)
- Edith V Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5723, USA.
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331
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Li CSR, Kosten TR, Sinha R. Sex differences in brain activation during stress imagery in abstinent cocaine users: a functional magnetic resonance imaging study. Biol Psychiatry 2005; 57:487-94. [PMID: 15737663 DOI: 10.1016/j.biopsych.2004.11.048] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 11/17/2004] [Accepted: 11/26/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND Because stress mediates drug seeking and relapse, and sex differences have been observed in stress and in the development of cocaine addiction, in this study we used functional neuroimaging to examine the effect of sex on stress responses in abstinent cocaine users. METHODS In a functional magnetic resonance imaging session, 17 male and 10 female cocaine-dependent subjects participated in script-guided imagery of neutral or stress situations. Subjects rated imagery vividness, anxiety, and cocaine craving for each trial. Brain activation during the stress and neutral imagery periods relative to their own baseline was examined in individual subjects. Sex contrast was obtained in second-level group analysis. RESULTS Female subjects demonstrated more activation, compared with male subjects, in left middle frontal, anterior cingulate, and inferior frontal cortices and insula, and right cingulate cortex during stress imagery. Region of interest analysis showed that the change of activity in left anterior cingulate and right posterior cingulate cortices both correlated inversely with the change of craving rating during stress imagery. CONCLUSIONS The greater left frontolimbic activity in women suggests that women might use more verbal coping strategies than do men while experiencing stress. The results also suggest a distinct role of the cingulate cortices in modulating stress-induced cocaine craving.
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Affiliation(s)
- Chiang-Shan Ray Li
- Department of Psychiatry, Yale University, New Haven, Connecticut 06519, USA.
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332
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Wrobel E, Skrok-Wolska D, Ziolkowski M, Korkosz A, Habrat B, Woronowicz B, Kukwa A, Kostowski W, Bienkowski P, Scinska A. TASTE RESPONSES TO MONOSODIUM GLUTAMATE AFTER ALCOHOL EXPOSURE. Alcohol Alcohol 2004; 40:106-11. [PMID: 15596426 DOI: 10.1093/alcalc/agh129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of the present study was to evaluate the effects of acute and chronic exposure to alcohol on taste responses to a prototypic umami substance, monosodium glutamate (MSG). METHODS The rated intensity and pleasantness of MSG taste (0.03-10.0%) was compared in chronic male alcoholics (n = 35) and control subjects (n = 25). In a separate experiment, the effects of acute exposure of the oral mucosa to ethanol rinse (0.5-4.0%) on MSG taste (0.3-3.0%) were studied in 10 social drinkers. RESULTS The alcoholic and control group did not differ in terms of the rated intensity and pleasantness of MSG taste. Electrogustometric thresholds were significantly (P < 0.01) higher, i.e. worse, in the alcohol-dependent subjects. The difference remained significant after controlling for between-group differences in cigarette smoking and coffee drinking. Rinsing with ethanol did not alter either intensity or pleasantness of MSG taste in social drinkers. CONCLUSIONS The present results suggest that: (i) neither acute nor chronic alcohol exposure modifies taste responses to MSG; (ii) alcohol dependence may be associated with deficit in threshold taste reactivity, as assessed by electrogustometry.
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Affiliation(s)
- Elzbieta Wrobel
- Department of Pharmacology, Institute of Psychiatry and Neurology, Sobieskiego 9 St., PL-02957 Warsaw, Poland
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