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Murray L, Frederick BB, Janes AC. Data-driven connectivity profiles relate to smoking cessation outcomes. Neuropsychopharmacology 2024; 49:1007-1013. [PMID: 38280945 PMCID: PMC11039768 DOI: 10.1038/s41386-024-01802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/29/2024]
Abstract
At a group level, nicotine dependence is linked to differences in resting-state functional connectivity (rs-FC) within and between three large-scale brain networks: the salience network (SN), default mode network (DMN), and frontoparietal network (FPN). Yet, individuals may display distinct patterns of rs-FC that impact treatment outcomes. This study used a data-driven approach, Group Iterative Multiple Model Estimation (GIMME), to characterize shared and person-specific rs-FC features linked with clinically-relevant treatment outcomes. 49 nicotine-dependent adults completed a resting-state fMRI scan prior to a two-week smoking cessation attempt. We used GIMME to identify group, subgroup, and individual-level networks of SN, DMN, and FPN connectivity. Regression models assessed whether within- and between-network connectivity of individual rs-FC models was associated with baseline cue-induced craving, and craving and use of regular cigarettes (i.e., "slips") during cessation. As a group, participants displayed shared patterns of connectivity within all three networks, and connectivity between the SN-FPN and DMN-SN. However, there was substantial heterogeneity across individuals. Individuals with greater within-network SN connectivity experienced more slips during treatment, while individuals with greater DMN-FPN connectivity experienced fewer slips. Individuals with more anticorrelated DMN-SN connectivity reported lower craving during treatment, while SN-FPN connectivity was linked to higher craving. In conclusion, in nicotine-dependent adults, GIMME identified substantial heterogeneity within and between the large-scale brain networks. Individuals with greater SN connectivity may be at increased risk for relapse during treatment, while a greater positive DMN-FPN and negative DMN-SN connectivity may be protective for individuals during smoking cessation treatment.
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Affiliation(s)
- Laura Murray
- Cognitive and Pharmacological Neuroimaging Unit, National Institute on Drug Abuse, Biomedical Research Center, 251 Bayview Blvd, Baltimore, MD, 21224, USA.
| | - Blaise B Frederick
- McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA
| | - Amy C Janes
- Cognitive and Pharmacological Neuroimaging Unit, National Institute on Drug Abuse, Biomedical Research Center, 251 Bayview Blvd, Baltimore, MD, 21224, USA
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2
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Rakesh G, Adams TG, Morey RA, Alcorn JL, Khanal R, Su AE, Himelhoch SS, Rush CR. Intermittent theta burst stimulation and functional connectivity in people living with HIV/AIDS who smoke tobacco cigarettes: a preliminary pilot study. Front Psychiatry 2024; 15:1315854. [PMID: 38501083 PMCID: PMC10945607 DOI: 10.3389/fpsyt.2024.1315854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/30/2024] [Indexed: 03/20/2024] Open
Abstract
Background People living with HIV (PLWHA) smoke at three times the rate of the general population and respond poorly to cessation strategies. Previous studies examined repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex (L. dlPFC) to reduce craving, but no studies have explored rTMS among PLWHA who smoke. The current pilot study compared the effects of active and sham intermittent theta-burst stimulation (iTBS) on resting state functional connectivity (rsFC), cigarette cue attentional bias, and cigarette craving in PLWHA who smoke. Methods Eight PLWHA were recruited (single-blind, within-subject design) to receive one session of iTBS (n=8) over the L. dlPFC using neuronavigation and, four weeks later, sham iTBS (n=5). Cigarette craving and attentional bias assessments were completed before and after both iTBS and sham iTBS. rsFC was assessed before iTBS (baseline) and after iTBS and sham iTBS. Results Compared to sham iTBS, iTBS enhanced rsFC between the L. dlPFC and bilateral medial prefrontal cortex and pons. iTBS also enhanced rsFC between the right insula and right occipital cortex compared to sham iTBS. iTBS also decreased cigarette craving and cigarette cue attentional bias. Conclusion iTBS could potentially offer a therapeutic option for smoking cessation in PLWHA.
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Affiliation(s)
- Gopalkumar Rakesh
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Thomas G. Adams
- Department of Psychology, College of Arts & Sciences, University of Kentucky, Lexington, KY, United States
| | - Rajendra A. Morey
- Brain Imaging and Analyses Center (BIAC), Duke University Medical Center, Durham, NC, United States
| | - Joseph L. Alcorn
- Department of Behavioral Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Rebika Khanal
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Amanda E. Su
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Seth S. Himelhoch
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Craig R. Rush
- Department of Behavioral Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
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Wanger TJ, de Moura FB, Ashare R, Loughead J, Lukas S, Lerman C, Janes AC. Brain and cortisol responses to smoking cues are linked in tobacco-smoking individuals. Addict Biol 2023; 28:e13338. [PMID: 38017638 DOI: 10.1111/adb.13338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 11/30/2023]
Abstract
Cues associated with smoking can induce relapse, which is likely driven by cue-induced neurobiological and physiological mechanisms. For instance, greater relapse vulnerability is associated with increases in cue-induced insula activation and heightened cortisol concentrations. Determining if there is a link between such cue-induced responses is critical given the need for biomarkers that can be easily measured in clinical settings and used to drive targeted treatment. Further, comprehensively characterising biological reactions to cues promises to aid in the development of therapies that address this specific relapse risk factor. To determine whether brain and cortisol responses to smoking cues are linked, this study recruited 27 nicotine-dependent tobacco-smoking individuals and acquired whole-brain functional activation during a cue reactivity task; salivary cortisol was measured before and after scanning. The results showed that increases in blood-oxygen-level-dependent activation in the right anterior insula and right dorsolateral prefrontal cortex (DLPFC) when viewing smoking versus neutral cues were positively correlated with a post-scan rise in salivary cortisol concentrations. These brain regions have been previously implicated in substance use disorders for their role in salience, interoception and executive processes. These findings show that those who have a rise in cortisol following smoking cue exposure also have a related rise in cue-induced brain reactivity, in brain regions previously linked with heightened relapse vulnerability. This is clinically relevant as measuring cue-induced cortisol responses is a more accessible proxy for assessing the engagement of cue-induced neurobiological processes associated with the maintenance of nicotine dependence.
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Affiliation(s)
- Timothy J Wanger
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando B de Moura
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - James Loughead
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott Lukas
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Amy C Janes
- Neuroimaging Research Branch, National Institute on Drug Abuse (NIDA), Intramural Research Program, National Institutes of Health, Baltimore, Maryland, USA
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Luo M, Gan Q, Fu Y, Chen Z. Cue-reactivity targeted smoking cessation intervention in individuals with tobacco use disorder: a scoping review. Front Psychiatry 2023; 14:1167283. [PMID: 37743997 PMCID: PMC10512743 DOI: 10.3389/fpsyt.2023.1167283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Cue-reactivity is a critical step leading to the emergence of addictive psychology and the triggering of addictive behaviors within the framework of addiction theory and is considered a significant risk factor for addiction-related behaviors. However, the effect of cue-reactivity targeted smoking cessation intervention and the cue-reactivity paradigms used in the randomized controlled trials varies, which introduces more heterogeneity and makes a side-by-side comparison of cessation responses difficult. Therefore, the scoping review aims to integrate existing research and identify evidence gaps. Methods We searched databases in English (PubMed and Embase) and Chinese (CNKI and Wanfang) using terms synonymous with 'cue' and 'tobacco use disorder (TUD)' to April 2023, and via hand-searching and reference screening of included studies. Studies were included if they were randomized controlled trials taking cue-reactivity as an indicator for tobacco use disorder (TUD) defined by different kinds of criteria. Results Data were extracted on each study's country, population, methods, timeframes, outcomes, cue-reactivity paradigms, and so on. Of the 2,944 literature were retrieved, 201 studies met the criteria and were selected for full-text screening. Finally, 67 pieces of literature were selected for inclusion and data extraction. The results mainly revealed that non-invasive brain stimulation and exercise therapy showed a trend of greater possibility in reducing subjective craving compared to the remaining therapies, despite variations in the number of research studies conducted in each category. And cue-reactivity paradigms vary in materials and mainly fall into two main categories: behaviorally induced craving paradigm or visually induced craving paradigm. Conclusion The current studies are still inadequate in terms of comparability due to their heterogeneity, cue-reactivity can be conducted in the future by constructing a standard library of smoking cue materials. Causal analysis is suggested in order to adequately screen for causes of addiction persistence, and further explore the specific objective cue-reactivity-related indicators of TUD.
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Affiliation(s)
- Miaoling Luo
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
| | - Quan Gan
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Yu Fu
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
| | - Zhuangfei Chen
- Medical School, Kunming University of Science and Technology, Kunming, China
- Brain Science and Visual Cognition Research Center, Medical School of Kunming University of Science and Technology, Kunming, China
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5
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Conti AA, Baldacchino AM. Early-onset smoking theory of compulsivity development: a neurocognitive model for the development of compulsive tobacco smoking. Front Psychiatry 2023; 14:1209277. [PMID: 37520221 PMCID: PMC10372444 DOI: 10.3389/fpsyt.2023.1209277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
According to the literature, individuals who start tobacco smoking during adolescence are at greater risk of developing severe tobacco addiction and heavier smoking behavior in comparison with individuals who uptake tobacco smoking during subsequent developmental stages. As suggested by animal models, this may be related to the unique neuroadaptive and neurotoxic effects of nicotine on adolescents' fronto-striatal brain regions modulating cognitive control and impulsivity. Previous research has proposed that these neuroadaptive and neurotoxic effects may cause a heightened reward-oriented impulsive behavior that may foster smoking relapses during quit attempts. However, developments in the field of addiction neuroscience have proposed drug addiction to represent a type of compulsive behavior characterized by the persistent use of a particular drug despite evident adverse consequences. One brain region that has received increased attention in recent years and that has been proposed to play a central role in modulating such compulsive drug-seeking and using behavior is the insular cortex. Lesion studies have shown that structural damages in the insular cortex may disrupt smoking behavior, while neuroimaging studies reported lower gray matter volume in the anterior insular cortex of chronic smokers compared with non-smokers, in addition to correlations between gray matter volume in the anterior insular cortex and measures of compulsive cigarette smoking. Based on the findings of our recent study reporting on early-onset smokers (mean age at regular smoking initiation = 13.2 years) displaying lower gray matter and white matter volume in the anterior insular cortex compared to late-onset smokers (mean age at regular smoking initiation = 18.0 years), we propose that the anterior insular cortex may play a central role in mediating the association between smoking uptake during adolescence and smoking heaviness/tobacco addiction during adulthood.
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Affiliation(s)
- Aldo Alberto Conti
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- Division of Population and Behavioral Science, University of St Andrews School of Medicine, St Andrews, United Kingdom
| | - Alexander Mario Baldacchino
- Division of Population and Behavioral Science, University of St Andrews School of Medicine, St Andrews, United Kingdom
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Cushnie AK, Tang W, Heilbronner SR. Connecting Circuits with Networks in Addiction Neuroscience: A Salience Network Perspective. Int J Mol Sci 2023; 24:9083. [PMID: 37240428 PMCID: PMC10219092 DOI: 10.3390/ijms24109083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Human neuroimaging has demonstrated the existence of large-scale functional networks in the cerebral cortex consisting of topographically distant brain regions with functionally correlated activity. The salience network (SN), which is involved in detecting salient stimuli and mediating inter-network communication, is a crucial functional network that is disrupted in addiction. Individuals with addiction display dysfunctional structural and functional connectivity of the SN. Furthermore, while there is a growing body of evidence regarding the SN, addiction, and the relationship between the two, there are still many unknowns, and there are fundamental limitations to human neuroimaging studies. At the same time, advances in molecular and systems neuroscience techniques allow researchers to manipulate neural circuits in nonhuman animals with increasing precision. Here, we describe attempts to translate human functional networks to nonhuman animals to uncover circuit-level mechanisms. To do this, we review the structural and functional connections of the salience network and its homology across species. We then describe the existing literature in which circuit-specific perturbation of the SN sheds light on how functional cortical networks operate, both within and outside the context of addiction. Finally, we highlight key outstanding opportunities for mechanistic studies of the SN.
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Affiliation(s)
- Adriana K. Cushnie
- Department of Neuroscience, University of Minnesota Twin Cities, 2-164 Jackson Hall, 321 Church St. SE, Minneapolis, MN 55455, USA;
| | - Wei Tang
- Department of Computer Science, Indiana University Bloomington, Bloomington, IN 47408, USA
| | - Sarah R. Heilbronner
- Department of Neuroscience, University of Minnesota Twin Cities, 2-164 Jackson Hall, 321 Church St. SE, Minneapolis, MN 55455, USA;
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA
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7
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Wadsley M, Ihssen N. A Systematic Review of Structural and Functional MRI Studies Investigating Social Networking Site Use. Brain Sci 2023; 13:brainsci13050787. [PMID: 37239257 PMCID: PMC10216498 DOI: 10.3390/brainsci13050787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
An understanding of the neurocognitive profile underlying the use of social networking sites (SNSs) can help inform decisions about the classification of problematic SNS use as an addictive disorder and elucidate how/when 'SNS addiction' might develop. The present review aimed to synthesize structural and functional MRI research investigating problematic/compulsive forms of SNS use or regular (non-addicted) SNS use behaviours. We conducted a systematic search for research articles published in English using the Web of Science, PubMed, and Scopus databases up to October 2022. Studies meeting our inclusion criteria were assessed for quality and a narrative synthesis of the results was conducted. Twenty-eight relevant articles were identified comprising structural MRI (n = 9), resting-state fMRI (n = 6) and task-based fMRI studies (n = 13). Current evidence suggests that problematic SNS use might be characterised by (1) reduced volume of the ventral striatum, amygdala, subgenual anterior cingulate cortex, orbitofrontal cortex and posterior insula; (2) increased ventral striatum and precuneus activity in response to SNS cues; (3) abnormal functional connectivity involving the dorsal attention network; (4) inter-hemispheric communication deficits. Regular SNS use behaviours appear to recruit regions involved in the mentalising network, the self-referential cognition network, the salience network, the reward network and the default mode network. Such findings are at least partially consistent with observations from the substance addiction literature and provide some provisional support for the addictive potential of SNSs. Nonetheless, the present review is limited by the small number of eligible studies and large heterogeneity in the methods employed, and so our conclusions should remain tentative. Moreover, there is a lack of longitudinal evidence suggesting SNSs cause neuroadaptations and thus conclusions that problematic SNS use represents a disease process akin to substance use addictions are premature. More well-powered longitudinal research is needed to establish the neural consequences of excessive and problematic SNS use.
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Affiliation(s)
- Michael Wadsley
- Department of Psychology, Durham University, Durham DH1 3LE, UK
| | - Niklas Ihssen
- Department of Psychology, Durham University, Durham DH1 3LE, UK
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8
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Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study. SCHIZOPHRENIA 2022; 8:6. [PMID: 35217662 PMCID: PMC8881463 DOI: 10.1038/s41537-022-00224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022]
Abstract
Patients with schizophrenia have a high prevalence of cigarette smoking and respond poorly to conventional treatments, highlighting the need for new therapies. We conducted a mechanistic, proof-of-concept study using bilateral deep repetitive transcranial magnetic stimulation (dTMS) of insular and prefrontal cortices at high frequency, using the specialized H4 coil. Feasibility of dTMS was tested for disruption of tobacco self-administration, insula target engagement, and insula circuit modulation, all of which were a priori outcomes of interest. Twenty patients completed the study, consisting of weekday dTMS sessions (randomization to active dTMS or sham; double-blind; 10 patients per group), a laboratory tobacco self-administration paradigm (pre/post assessments), and multimodal imaging (three MRI total sessions). Results showed that participants assigned to active dTMS were slower to initiate smoking their first cigarette compared with sham, consistent with smoking disruption. The imaging analyses did not reveal significant Time × Group interactions, but effects were in the anticipated directions. In arterial spin labeling analyses testing for target engagement, an overall decrease in insula blood flow, measured during a post-treatment MRI versus baseline, was numerically more pronounced in the active dTMS group than sham. In fMRI analyses, resting-state connectivity between the insula and default mode network showed a numerically greater change from baseline in the active dTMS group than sham, consistent with a functional change to insula circuits. Exploratory analyses further suggested a therapeutic effect of dTMS on symptoms of psychosis. These initial observations pave the way for future confirmatory studies of dTMS in smoking patients with schizophrenia.
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Gibson BC, Claus ED, Sanguinetti J, Witkiewitz K, Clark VP. A review of functional brain differences predicting relapse in substance use disorder: Actionable targets for new methods of noninvasive brain stimulation. Neurosci Biobehav Rev 2022; 141:104821. [PMID: 35970417 DOI: 10.1016/j.neubiorev.2022.104821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/17/2022]
Abstract
Neuroimaging studies have identified a variety of brain regions whose activity predicts substance use (i.e., relapse) in patients with substance use disorder (SUD), suggesting that malfunctioning brain networks may exacerbate relapse. However, this knowledge has not yet led to a marked improvement in treatment outcomes. Noninvasive brain stimulation (NIBS) has shown some potential for treating SUDs, and a new generation of NIBS technologies offers the possibility of selectively altering activity in both superficial and deep brain structures implicated in SUDs. The goal of the current review was to identify deeper brain structures involved in relapse to SUD and give an account of innovative methods of NIBS that might be used to target them. Included studies measured fMRI in currently abstinent SUD patients and tracked treatment outcomes, and fMRI results were organized with the framework of the Addictions Neuroclinical Assessment (ANA). Four brain structures were consistently implicated: the anterior and posterior cingulate cortices, ventral striatum and insula. These four deeper brain structures may be appropriate future targets for the treatment of SUD using these innovative NIBS technologies.
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Affiliation(s)
- Benjamin C Gibson
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA; The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM 87106, USA
| | - Eric D Claus
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jay Sanguinetti
- The Center for Consciousness Studies, University of Arizona, Tucson, AZ 85719, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA; Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA; The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM 87106, USA.
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10
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Ghareh H, Alonso-Lozares I, Schetters D, Herman RJ, Heistek TS, Van Mourik Y, Jean-Richard-Dit-Bressel P, Zernig G, Mansvelder HD, De Vries TJ, Marchant NJ. Role of anterior insula cortex in context-induced relapse of nicotine-seeking. eLife 2022; 11:75609. [PMID: 35536612 PMCID: PMC9119676 DOI: 10.7554/elife.75609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Tobacco use is the leading cause of preventable death worldwide, and relapse during abstinence remains the critical barrier to successful treatment of tobacco addiction. During abstinence, environmental contexts associated with nicotine use can induce craving and contribute to relapse. The insular cortex (IC) is thought to be a critical substrate of nicotine addiction and relapse. However, its specific role in context-induced relapse of nicotine-seeking is not fully known. In this study, we report a novel rodent model of context-induced relapse to nicotine-seeking after punishment-imposed abstinence, which models self-imposed abstinence through increasing negative consequences of excessive drug use. Using the neuronal activity marker Fos we find that the anterior (aIC), but not the middle or posterior IC, shows increased activity during context-induced relapse. Combining Fos with retrograde labeling of aIC inputs, we show projections to aIC from contralateral aIC and basolateral amygdala exhibit increased activity during context-induced relapse. Next, we used fiber photometry in aIC and observed phasic increases in aIC activity around nicotine-seeking responses during self-administration, punishment, and the context-induced relapse tests. Next, we used chemogenetic inhibition in both male and female rats to determine whether activity in aIC is necessary for context-induced relapse. We found that chemogenetic inhibition of aIC decreased context-induced nicotine-seeking after either punishment- or extinction-imposed abstinence. These findings highlight the critical role nicotine-associated contexts play in promoting relapse, and they show that aIC activity is critical for this context-induced relapse following both punishment and extinction-imposed abstinence.
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Affiliation(s)
- Hussein Ghareh
- Department of Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Isis Alonso-Lozares
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dustin Schetters
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Rae J Herman
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Tim S Heistek
- Department of Integrative Neurophysiology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Yvar Van Mourik
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Gerald Zernig
- Department of Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Huibert D Mansvelder
- Department of Integrative Neurophysiology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Taco J De Vries
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Nathan J Marchant
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Amsterdam, Netherlands
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11
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Chen Y, Chaudhary S, Wang W, Li CSR. Gray matter volumes of the insula and anterior cingulate cortex and their dysfunctional roles in cigarette smoking. ADDICTION NEUROSCIENCE 2022; 1:100003. [PMID: 37220533 PMCID: PMC10201991 DOI: 10.1016/j.addicn.2021.100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The salience network, including the insula and anterior cingulate cortex (ACC), has been implicated in nicotine addiction. Structural imaging studies have reported diminished insula and ACC gray matter volumes (GMVs) in smokers as compared to nonsmokers. However, it remains unclear how insula and ACC GMVs may relate to years of smoking, addiction severity, or behavioral traits known to dispose individuals to smoking. Here, with a dataset curated from the Human Connectome Project and voxel-based morphometry, we replicated the findings of smaller GMVs of the insula and medial prefrontal cortex, including the dorsal ACC and supplementary motor area (dACC/SMA), in (70 heavy < 209 light < 209 never) smokers matched in age, sex, and average daily num ber of drinks. The GMVs of the insula or dACC/SMA were not significantly correlated with years of smoking or Fagerstrom Test for Nicotine Dependence (FTND) scores. Heavy relative to never smokers demonstrated higher externalizing and internalizing scores, as evaluated by the NIH Emotion. In heavy smokers, the dACC/SMA but not insula GMV was positively correlated with both externalizing and internalizing scores. The findings together confirm volumetric changes in the salience network in heavy smokers and suggest potentially distinct dysfunctional roles of the insula and dACC/SMA in chronic smoking.
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Affiliation(s)
- Yu Chen
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Shefali Chaudhary
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Wuyi Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chiang-Shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, United States
- Wu Tsai Institute, Yale University, New Haven, CT, United States
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12
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Conti AA, Baldacchino AM. Chronic tobacco smoking, impaired reward-based decision-making, and role of insular cortex: A comparison between early-onset smokers and late-onset smokers. Front Psychiatry 2022; 13:939707. [PMID: 36090372 PMCID: PMC9459116 DOI: 10.3389/fpsyt.2022.939707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The literature suggests that tobacco smoking may have a neurotoxic effect on the developing adolescent brain. Particularly, it may impair the decision-making process of early-onset smokers (<16 years), by rendering them more prone to impulsive and risky choices toward rewards, and therefore more prone to smoking relapses, in comparison to late-onset smokers (≥16 years). However, no study has ever investigated reward-based decision-making and structural brain differences between early-onset smokers and late-onset smokers. METHODS Computerized measures of reward-based decision-making [Cambridge Gambling Task (CGT); 5-trials adjusting delay discounting task (ADT-5)] were administered to 11 early-onset smokers (mean age at regular smoking initiation = 13.2 years), 17 late-onset smokers (mean age at regular smoking initiation = 18.0 years), and 24 non-smoker controls. Voxel-based morphometry (VBM) was utilized to investigate the gray matter (GM) and white matter (WM) volume differences in fronto-cortical and striatal brain regions between early-onset smokers, late-onset smokers, and non-smokers. RESULTS Early-onset smokers displayed a riskier decision-making behavior in comparison to non-smokers as assessed by the CGT (p < 0.01, Cohen's f = 0.48). However, no significant differences (p > 0.05) in reward-based decision-making were detected between early-onset smokers and late-onset smokers. VBM results revealed early-onset smokers to present lower GM volume in the bilateral anterior insular cortex (AI) in comparison to late-onset smokers and lower WM volume in the right AI in comparison to late-onset smokers. CONCLUSION Impairments in reward-based decision-making may not be affected by tobacco smoking initiation during early adolescence. Instead, lower GM and WM volume in the AI of early-onset smokers may underline a vulnerability to develop compulsive tobacco seeking and smoking behavior during adulthood.
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Affiliation(s)
- Aldo Alberto Conti
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alexander Mario Baldacchino
- Division of Population and Behavioral Science, University of St Andrews School of Medicine, St Andrews, United Kingdom
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Precision Preventive Medicine of Relapse in Smoking Cessation: Can MRI Inform the Search of Intermediate Phenotypes? BIOLOGY 2021; 11:biology11010035. [PMID: 35053034 PMCID: PMC8773102 DOI: 10.3390/biology11010035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary Addiction to tobacco is a serious health and economical problem because it is one of the most addictive and the most consumed substance in the world. Although well documented, and despite the desire of numerous smokers to quit, maintenance of abstinence is a daily challenge for most of them. The heterogeneity in achieving this maintenance raises the question of potential differences in brain reactivity. An emerging field of research has been interested in brain markers helping to identify individuals who are the most likely to relapse. Using brain imaging techniques such as Magnetic Resonance Imaging (MRI), one can hope it will be possible to offer tailored care for each patient. Abstract Chronic tobacco smoking remains a major health problem worldwide. Numerous smokers wish to quit but most fail, even if they are helped. The possibility of identifying neuro-biomarkers in smokers at high risk of relapse could be of incredible progress toward personalized prevention therapy. Our aim is to provide a scoping review of this research topic in the field of Magnetic Resonance Imaging (MRI) and to review the studies that investigated if MRI defined markers predicted smoking cessation treatment outcome (abstainers versus relapsers). Based on the available literature, a meta-analysis could not be conducted. We thus provide an overview of the results obtained and take stock of methodological issues that will need to be addressed to pave the way toward precision medicine. Based on the most consistent findings, we discuss the pivotal role of the insula in light of the most recent neurocognitive models of addiction.
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Ghahremani DG, Pochon JB, Perez Diaz M, Tyndale RF, Dean AC, London ED. Functional connectivity of the anterior insula during withdrawal from cigarette smoking. Neuropsychopharmacology 2021; 46:2083-2089. [PMID: 34035468 PMCID: PMC8505622 DOI: 10.1038/s41386-021-01036-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022]
Abstract
Currently available therapies for smoking cessation have limited efficacy, and potential treatments that target specific brain regions are under evaluation, with a focus on the insula. The ventral and dorsal anterior subregions of the insula serve distinct functional networks, yet our understanding of how these subregions contribute to smoking behavior is unclear. Resting-state functional connectivity (RSFC) provides a window into network-level function associated with smoking-related internal states. The goal of this study was to determine potentially distinct relationships of ventral and dorsal anterior insula RSFC with cigarette withdrawal after brief abstinence from smoking. Forty-seven participants (24 women; 18-45 years old), who smoked cigarettes daily and were abstinent from smoking overnight (~12 h), provided self-reports of withdrawal and underwent resting-state fMRI before and after smoking the first cigarette of the day. Correlations between withdrawal and RSFC were computed separately for ventral and dorsal anterior insula seed regions in whole-brain voxel-wise analyses. Withdrawal was positively correlated with RSFC of the right ventral anterior insula and dorsal anterior cingulate cortex (dACC) before but not after smoking. The correlation was mainly due to a composite effect of craving and physical symptoms of withdrawal. These results suggest a role of right ventral anterior insula-dACC connectivity in the internal states that maintain smoking behavior (e.g., withdrawal) and present a specific neural target for brain-based therapies seeking to attenuate withdrawal symptoms in the critical early stages of smoking cessation.
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Affiliation(s)
- Dara G. Ghahremani
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA USA
| | - Jean-Baptiste Pochon
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA USA
| | - Maylen Perez Diaz
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA USA
| | - Rachel F. Tyndale
- grid.17063.330000 0001 2157 2938Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON Canada
| | - Andy C. Dean
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Brain Research Institute, University of California, Los Angeles, CA USA
| | - Edythe D. London
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Brain Research Institute, University of California, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA USA
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Better living through understanding the insula: Why subregions can make all the difference. Neuropharmacology 2021; 198:108765. [PMID: 34461066 DOI: 10.1016/j.neuropharm.2021.108765] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
Insula function is considered critical for many motivated behaviors, with proposed functions ranging from attention, behavioral control, emotional regulation, goal-directed and aversion-resistant responding. Further, the insula is implicated in many neuropsychiatric conditions including substance abuse. More recently, multiple insula subregions have been distinguished based on anatomy, connectivity, and functional contributions. Generally, posterior insula is thought to encode more somatosensory inputs, which integrate with limbic/emotional information in middle insula, that in turn integrate with cognitive processes in anterior insula. Together, these regions provide rapid interoceptive information about the current or predicted situation, facilitating autonomic recruitment and quick, flexible action. Here, we seek to create a robust foundation from which to understand potential subregion differences, and provide direction for future studies. We address subregion differences across humans and rodents, so that the latter's mechanistic interventions can best mesh with clinical relevance of human conditions. We first consider the insula's suggested roles in humans, then compare subregional studies, and finally describe rodent work. One primary goal is to encourage precision in describing insula subregions, since imprecision (e.g. including both posterior and anterior studies when describing insula work) does a disservice to a larger understanding of insula contributions. Additionally, we note that specific task details can greatly impact recruitment of various subregions, requiring care and nuance in design and interpretation of studies. Nonetheless, the central ethological importance of the insula makes continued research to uncover mechanistic, mood, and behavioral contributions of paramount importance and interest. This article is part of the special Issue on 'Neurocircuitry Modulating Drug and Alcohol Abuse'.
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Smoking-induced craving relief relates to increased DLPFC-striatal coupling in nicotine-dependent women. Drug Alcohol Depend 2021; 221:108593. [PMID: 33611027 PMCID: PMC8026729 DOI: 10.1016/j.drugalcdep.2021.108593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Craving is a major contributor to drug-seeking and relapse. Although the ventral striatum (VS) is a primary neural correlate of craving, strategies aimed at manipulating VS function have not resulted in efficacious treatments. This incongruity may be because the VS does not influence craving in isolation. Instead, craving is likely mediated by communication between the VS and other neural substrates. Thus, we examined how striatal functional connectivity (FC) with key nodes of networks involved in addiction affects relief of craving, which is an important step in identifying viable treatment targets. METHODS Twenty-four nicotine-dependent non-abstinent women completed two resting-state (rs) fMRI scans, one before and one following smoking a cigarette in the scanner, and provided craving ratings before and after smoking the cigarette. A seed-based approach was used to examine rsFC between the VS, putamen and germane craving-related brain regions; the dorsolateral prefrontal cortex (dlPFC), the posterior cingulate cortex, and the anterior ventral insula. RESULTS Smoking a cigarette was associated with a decrease in craving. Relief of craving correlated with increases in right dlPFC- bilateral VS (r = 0.57, p = 0.003, corrected) as did increased right dlPFC-left putamen coupling (r = 0.62, p = 0.001, corrected). CONCLUSIONS Smoking-induced relief of craving is associated with enhanced rsFC between the dlPFC, a region that plays a pivotal role in decision making, and the striatum, the neural structure underlying motivated behavior. These findings are highly consistent with a burgeoning literature implicating dlPFC-striatal interactions as a neurobiological substrate of craving.
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Lutz JA, Childs E. Alcohol conditioned contexts enhance positive subjective alcohol effects and consumption. Behav Processes 2021; 187:104340. [PMID: 33545315 DOI: 10.1016/j.beproc.2021.104340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/15/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
Associations between alcohol and the places it is consumed are important at all stages of alcohol abuse and addiction. However, it is not clear how the associations are formed in humans or how they influence drinking, and there are few effective strategies to prevent their pathological effects on alcohol use. We used a human laboratory model to study the effects of alcohol environments on alcohol consumption. Healthy regular binge drinkers completed conditioned place preference (CPP) with 0 vs. 80 mg/100 mL alcohol (Paired Group). Control participants (Unpaired Group) completed sessions without explicit alcohol-room pairings. After conditioning, participants completed alcohol self-administration in either the alcohol- or no alcohol-paired room. Paired group participants reported greater subjective stimulation and euphoria, and consumed more alcohol in the alcohol-paired room in comparison to the no alcohol-paired room, and controls tested in either room. Moreover, the strength of conditioning significantly predicted drinking; participants who exhibited the strongest CPP consumed the most alcohol in the alcohol-paired room. This is the first empirical evidence that laboratory-conditioned alcohol environments directly influence drinking. The results also confirm the viability of the model to examine the mechanisms by which alcohol environments stimulate drinking and to test strategies to counteract their influence on behavior.
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Affiliation(s)
- Joseph A Lutz
- University of Illinois at Chicago, Department of Psychiatry, 1601 W Taylor St MC912, Chicago, IL, 60612, USA
| | - Emma Childs
- University of Illinois at Chicago, Department of Psychiatry, 1601 W Taylor St MC912, Chicago, IL, 60612, USA; University of Chicago, Department of Psychiatry and Behavioral Neuroscience, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
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Tsai PJ, Keeley RJ, Carmack SA, Vendruscolo JCM, Lu H, Gu H, Vendruscolo LF, Koob GF, Lin CP, Stein EA, Yang Y. Converging Structural and Functional Evidence for a Rat Salience Network. Biol Psychiatry 2020; 88:867-878. [PMID: 32981657 DOI: 10.1016/j.biopsych.2020.06.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/10/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The salience network (SN) is dysregulated in many neuropsychiatric disorders, including substance use disorder. Though the SN was initially described in humans, identification of a rodent SN would provide the ability to mechanistically interrogate this network in preclinical models of neuropsychiatric disorders. METHODS We used modularity analysis on resting-state functional magnetic resonance imaging data of rats (n = 32) to parcellate rat insula into functional subdivisions and to identify a potential rat SN based on functional connectivity patterns from the insular subdivisions. We then used mouse tract tracing data from the Allen Brain Atlas to confirm the network's underlying structural connectivity. We next compared functional connectivity profiles of the SN across rats, marmosets (n = 10), and humans (n = 30). Finally, we assessed the rat SN's response to conditioned cues in rats (n = 21) with a history of heroin self-administration. RESULTS We identified a putative rat SN, which consists of primarily the ventral anterior insula and anterior cingulate cortex, based on functional connectivity patterns from the ventral anterior insular division. Functional connectivity architecture of the rat SN is supported by the mouse neuronal tracer data. Moreover, the anatomical profile of the identified rat SN is similar to that of nonhuman primates and humans. Finally, we demonstrated that the rat SN responds to conditioned cues and increases functional connectivity to the default mode network during conditioned heroin withdrawal. CONCLUSIONS The neurobiological identification of a rat SN, together with a demonstration of its functional relevance, provides a novel platform with which to interrogate its functional significance in normative and neuropsychiatric disease models.
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Affiliation(s)
- Pei-Jung Tsai
- Neuroimaging Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Robin J Keeley
- Neuroimaging Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Stephanie A Carmack
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Janaina C M Vendruscolo
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Hanbing Lu
- Neuroimaging Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Hong Gu
- Neuroimaging Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Leandro F Vendruscolo
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - George F Koob
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.
| | - Elliot A Stein
- Neuroimaging Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
| | - Yihong Yang
- Neuroimaging Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland.
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Temporal Dynamics of Large-Scale Networks Predict Neural Cue Reactivity and Cue-Induced Craving. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:1011-1018. [PMID: 32900658 DOI: 10.1016/j.bpsc.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/17/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cue reactivity, a core characteristic of substance use disorders, commonly recruits brain regions that are key nodes in neurocognitive networks, including the default mode network (DMN) and salience network (SN). Whether resting-state temporal dynamic properties of these networks relate to subsequent cue reactivity and cue-induced craving is unknown. METHODS The resting-state data of 46 nicotine-dependent participants were assessed to define temporal dynamic properties of DMN and SN states. Temporal dynamics focused on the total time across the scan session that brain activity resides in these specific states. Using regression models, we examined how the total time in each state related to neural reactivity to smoking cues within key DMN (posterior cingulate cortex, medial prefrontal cortex) or SN (anterior insula, dorsal anterior cingulate cortex) nodes. Mediation analyses were subsequently conducted to study how neural cue reactivity mediates the relationship between total time in state at rest and subjective cue-induced craving. RESULTS Increased time spent in the DMN state and decreased time spent in the SN state predicted subsequent cue-induced increases in the anterior insula and dorsal anterior cingulate cortex, respectively. Cue-induced anterior insula and dorsal anterior cingulate cortex activity significantly mediated the relationship between time spent in DMN/SN and cue-induced subjective craving. CONCLUSIONS Our findings showed a significant relationship between resting-state dynamics of the DMN/SN and task-activated SN nodes that together predicted cue-induced craving changes in nicotine-dependent individuals. These findings propose a neurobiological pathway for cue-induced craving that begins with resting-state temporal dynamics, suggesting that brain responding to external stimuli is driven by resting temporal dynamics.
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Ketcherside A, Jagannathan K, Dolui S, Hager N, Spilka N, Nutor C, Rao H, Franklin T, Wetherill R. Baclofen-induced Changes in the Resting Brain Modulate Smoking Cue Reactivity: A Double-blind Placebo-controlled Functional Magnetic Resonance Imaging Study in Cigarette Smokers. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:289-302. [PMID: 32329309 PMCID: PMC7242101 DOI: 10.9758/cpn.2020.18.2.289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/01/2019] [Accepted: 01/04/2020] [Indexed: 01/04/2023]
Abstract
Objective Smoking cue-(SC) elicited craving can lead to relapse in SC-vulnerable individuals. Thus, identifying treatments that target SC-elicited craving is a top research priority. Reduced drug cue neural activity is associated with recovery and is marked by a profile of greater tonic (resting) activation in executive control regions, and increased connectivity between executive and salience regions. Evidence suggests the GABA-B agonist baclofen can reduce drug cue-elicited neural activity, potentially through its actions on the resting brain. Based on the literature, we hypothesize that baclofen’s effects in the resting brain can predict its effects during SC exposure. Methods In this longitudinal, double blind, placebo-controlled neuropharmacological study 43 non-abstinent, sated treatment-seeking cigarette smokers (63% male) participated in an fMRI resting-state scan and a SC-reactivity task prior to (T1) and 3 weeks following randomization (T2; baclofen: 80 mg/day; n = 21). Subjective craving reports were acquired before and after SC exposure to explicitly examine SC-induced craving. Results Whole-brain full-factorial analysis revealed a group-by-time interaction with greater resting brain activation of the right dorsolateral prefrontal cortex (dlPFC) at T2 in the baclofen group (BAC) (pFWEcorr = 0.02), which was associated with reduced neural responses to SCs in key cue-reactive brain regions; the anterior ventral insula and ventromedial prefrontal cortex (pFWEcorr < 0.01). BAC, but not the placebo group reported decreased SC-elicited craving (p = 0.02). Conclusion Results suggest that baclofen mitigates the reward response to SCs through an increase in tonic activation of the dlPFC, an executive control region. Through these mechanisms, baclofen may offer SC-vulnerable smokers protection from SC-induced relapse.
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Affiliation(s)
- Ariel Ketcherside
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kanchana Jagannathan
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sudipto Dolui
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nathan Hager
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Nathaniel Spilka
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Chaela Nutor
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hengyi Rao
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Teresa Franklin
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Reagan Wetherill
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Molokotos E, Peechatka AL, Wang KS, Pizzagalli DA, Janes AC. Caudate reactivity to smoking cues is associated with increased responding to monetary reward in nicotine-dependent individuals. Drug Alcohol Depend 2020; 209:107951. [PMID: 32145666 PMCID: PMC7127934 DOI: 10.1016/j.drugalcdep.2020.107951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/20/2023]
Abstract
Quitting smoking is challenging in part because environmental smoking cues can trigger the desire to smoke. Neurobiological responses to smoking cues are often observed in reward-related brain regions such as the caudate and nucleus accumbens (NAc). While reward plays a well-established role in the formation of cue reactivity, whether general reward responsiveness contributes to individual differences in cue-reactivity among chronic smokers is unclear; establishing such link could provide insight into the mechanisms maintaining cue reactivity. The current study explored this relationship by assessing smoking cue reactivity during functional magnetic imaging followed by an out-of-scanner probabilistic reward task (PRT) in 24 nicotine-dependent smokers (14 women). In addition, owing to sex differences in cue reactivity and reward function, this same relationship was examined as a function of sex. Following recent smoking, greater reward responsiveness on the PRT was associated with enhanced left caudate reactivity to smoking cues. No relationship was found in any other striatal subregion. The positive relationship between reward responsiveness and caudate smoking cue reactivity was significant only in male smokers, fitting with the idea that males and females respond to the reinforcing elements of smoking cues differently. These findings are clinically relevant as they show that, following recent smoking, nicotine-dependent individuals who are more cue reactive are also more likely to be responsive to non-drug rewards, which may be useful for making individualized treatment decisions that involve behavioral reward contingencies.
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Affiliation(s)
- Elena Molokotos
- McLean Hospital, Belmont, MA, USA; Department of Psychology, Suffolk University, Boston, MA, USA.
| | | | - Kainan S. Wang
- McLean Hospital, Belmont, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Amy C. Janes
- McLean Hospital, Belmont, MA, USA,Harvard Medical School, Boston, MA, USA
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Allenby C, Falcone M, Wileyto EP, Cao W, Bernardo L, Ashare RL, Janes A, Loughead J, Lerman C. Neural cue reactivity during acute abstinence predicts short-term smoking relapse. Addict Biol 2020; 25:e12733. [PMID: 30806013 DOI: 10.1111/adb.12733] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
In smokers, neural responses to smoking cues can be sensitive to acute abstinence, but the degree to which abstinence-related cue reactivity contributes to relapse is not fully understood. This study addressed this question in a sample of 75 smokers who were motivated to quit smoking. Participants underwent blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) during presentation of visual smoking cues and neutral stimuli on two occasions: once during smoking satiety and once following 24-hour abstinence (order counterbalanced). Following the imaging sessions, participants received brief smoking cessation counseling prior to a short-term (7-day) quit attempt. The primary smoking cessation outcome was biochemically confirmed 7-day relapse. The secondary smoking cessation outcome measure was total number of self-reported days of abstinence. During abstinence (vs satiety), smoking cue reactivity was significantly increased only in the anterior cingulate cortex (ACC); other regions showing a cue (vs neutral) response did not exhibit an abstinence effect in the stringent whole-brain analysis. Participants who showed greater smoking cue reactivity in the ACC during acute abstinence (compared with smoking satiety) were more likely to relapse (OR = 2.10 per standard deviation increase in percent signal change [abstinence minus smoking satiety], 95% CI: 1.05 to 4.20, P = 0.036). Greater abstinence-induced change in ACC activation also predicted fewer total days abstinent (β = -0.63, 95% CI = 0.43 to 0.66, P < 0.0001). This study provides the first evidence that changes in smoking cue reactivity in the ACC during acute abstinence predict smoking relapse, thereby improving our understanding of the neurobiology of smoking cessation.
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Affiliation(s)
- Cheyenne Allenby
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Mary Falcone
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - E. Paul Wileyto
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of Pennsylvania Philadelphia PA USA
| | - Wen Cao
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Leah Bernardo
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Rebecca L. Ashare
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Amy Janes
- McLean Hospital, and the Department of Psychiatry, Harvard Medical SchoolMcLean Imaging Center Belmont MA USA
| | - James Loughead
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
| | - Caryn Lerman
- Department of PsychiatryUniversity of Pennsylvania Philadelphia PA USA
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Janes AC, Krantz NL, Nickerson LD, Frederick BB, Lukas SE. Craving and Cue Reactivity in Nicotine-Dependent Tobacco Smokers Is Associated With Different Insula Networks. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:76-83. [PMID: 31706906 DOI: 10.1016/j.bpsc.2019.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/02/2019] [Accepted: 09/15/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The insula has a well-established role in nicotine dependence and is a node of the salience network, which integrates internal and external information to guide behavior. Recent findings reveal that internal and external processing occurs in the ventral anterior insula (vAI) and dorsal anterior insula (dAI), respectively. Whether vAI/dAI network connectivity differentially reflects internally generated craving and externally triggered smoking cue reactivity was tested. METHODS Thirty-six male and female nicotine-dependent individuals smoked 1 hour before functional magnetic resonance imaging. Baseline craving was measured, followed by resting-state and smoking cue reactivity scans and then another assessment of craving. Craving and cue reactivity interactions were measured by focusing on specific nodes of the salience network: the vAI/dAI and anterior cingulate cortex. RESULTS Resting-state vAI/dAI networks overlapped with the prototypical salience network, yet they possessed distinct patterns, linking the vAI with nodes of the internally focused default mode network and the dAI with nodes of the external, goal-related frontoparietal network. Internally generated baseline craving was associated with enhanced vAI connectivity, whereas rostral anterior cingulate cortex reactivity to external smoking cues was associated with greater dAI connectivity. We also found that cue reactivity in the rostral anterior cingulate cortex was associated with a rise in subjective cue-induced craving, whereas baseline subjective craving did not influence brain cue reactivity. CONCLUSIONS These data show that brain reactivity to smoking cues is associated with a subsequent increase in craving. In addition, separate insula networks have a role in an individual's vulnerability to internally related craving and externally triggered cue reactivity, which could guide the development of new, neurobiologically targeted therapies.
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Affiliation(s)
- Amy C Janes
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Nathan L Krantz
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts
| | - Lisa D Nickerson
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Blaise B Frederick
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Scott E Lukas
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Abdolahi A, Williams GC, van Wijngaarden E. Implications of insular cortex laterality for treatment of nicotine addiction. Drug Alcohol Depend 2019; 201:178-181. [PMID: 31234014 PMCID: PMC6629032 DOI: 10.1016/j.drugalcdep.2019.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/17/2019] [Accepted: 04/30/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Damage to the insula disrupts nicotine-induced cravings and is associated with greater odds of cessation. The role of laterality in regulating these changes is unclear. Neuroimaging studies in cigarette smokers show left hemispheric activation during a period of forced withdrawal and right hemispheric activation after having just smoked. Among current smokers hospitalized for stroke involving their insula, we compared left versus right insular damage and its effect on smoking outcomes. METHODS A total of 37 smokers hospitalized with unilateral insular strokes (14 right, 23 left) were administered questionnaires to assess urge (Questionnaire on Smoking Urges) before (retrospectively) and during hospitalization and 3 months post-stroke, withdrawal during hospitalization (Wisconsin Smoking Withdrawal Scale), and prolonged abstinence at 3 months post-stroke. Crude and adjusted linear regression models were performed controlling for baseline covariates. RESULTS Right and left insular-damaged smokers experienced a significant decrease in urge from baseline to hospitalization and three-month follow-up (p < 0.01). Smokers with left-sided insular infarcts relative to right-sided experienced a larger decrease in acute urge (adjusted β=-1.16, 95% CI: -2.59, 0.27, p = 0.11) but not chronically (adjusted β=-0.06, 95% CI: -1.53, 1.40, p = 0.93). Left-sided insular damage was also associated with significantly fewer and less severe withdrawal symptoms during hospitalization (adjusted β=-3.52, 95% CI: -7.01, -0.04, p = 0.05). No differences were noted between groups for prolonged abstinence (p = 0.50). CONCLUSIONS Left insular adaptations are suggestive to have an impact on acute changes in urge and withdrawal more so than the right insula, however lateral asymmetries did not exist for long-term changes.
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Affiliation(s)
- Amir Abdolahi
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420644 Rochester, NY 14642, USA.
| | - Geoffrey C. Williams
- Departments of Medicine, Psychiatry, and Clinical and Social Sciences in Psychology, University of Rochester Medical Center, 601 Elmwood Ave. Rochester, NY 14642, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420644 Rochester, NY 14642, USA.
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25
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Janes AC, Datko M, Roy A, Barton B, Druker S, Neal C, Ohashi K, Benoit H, van Lutterveld R, Brewer JA. Quitting starts in the brain: a randomized controlled trial of app-based mindfulness shows decreases in neural responses to smoking cues that predict reductions in smoking. Neuropsychopharmacology 2019; 44:1631-1638. [PMID: 31039580 PMCID: PMC6785102 DOI: 10.1038/s41386-019-0403-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
Current treatments for smoking yield suboptimal outcomes, partly because of an inability to reduce cue-induced smoking. Mindfulness training (MT) has shown preliminary efficacy for smoking cessation, yet its neurobiological target remains unknown. Our prior work with nonsmokers indicates that MT reduces posterior cingulate cortex (PCC) activity. In individuals who smoke, the PCC, consistently a main hub of the "default mode network," activates in response to smoking cues. In this randomized controlled trial, we tested the effects of app-delivered MT on PCC reactivity to smoking cues and whether individual differences in MT-mediated PCC changes predicted smoking outcomes. Smoking cue-induced PCC reactivity was measured using functional magnetic resonance imaging at baseline and 1 month after receiving smartphone app-based MT (n = 33) vs. an active control (National Cancer Institute's QuitGuide, n = 34). Whether individual differences in treatment-related changes in PCC activity predicted smoking behavior was assessed. The MT group demonstrated a significant correlation between a reduction in PCC reactivity to smoking cues and a decline in cigarette consumption (r = 0.39, p = 0.02). No association was found in the control group (r = 0.08, p = 0.65). No effects of group alone were found in PCC or cigarette reduction. Post hoc analysis revealed this association is sex specific (women, r = 0.49, p = 0.03; men: r = -0.08, p = 0.79). This initial report indicates that MT specifically reduces smoking cue-induced PCC activity in a subject-specific manner, and the reduction in PCC activity predicts a concurrent decline in smoking. These findings link the hypothesized behavioral effects of MT for smoking to neural mechanisms particularly in women. This lays the groundwork for identifying individuals who may benefit from targeted digital therapeutic treatments such as smartphone-based MT, yielding improved clinical outcomes.
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Affiliation(s)
- Amy C. Janes
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA 02478 USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA 02115 USA
| | - Michael Datko
- 0000 0004 0386 9924grid.32224.35Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, 149 Thirteenth St. #2301, Charlestown, MA 02129 USA ,0000 0000 9419 3149grid.239475.eCenter for Mindfulness and Compassion, Cambridge Health Alliance, 1035 Cambridge St. #21, Cambridge, MA 02141 USA
| | - Alexandra Roy
- 0000 0004 1936 9094grid.40263.33Mindfulness Center, Brown University School of Public Health and Warren Alpert School of Medicine, 121S Main St, Providence, RI 02903 USA
| | - Bruce Barton
- 0000 0001 0742 0364grid.168645.8Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655 USA
| | - Susan Druker
- 0000 0001 0742 0364grid.168645.8Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655 USA
| | - Carolyn Neal
- 0000 0004 0447 0018grid.266900.bUniversity of Oklahoma-Tulsa School of Community Medicine, Tulsa, OK 74135 USA
| | - Kyoko Ohashi
- 0000 0000 8795 072Xgrid.240206.2McLean Imaging Center, McLean Hospital, Belmont, MA 02478 USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA 02115 USA
| | - Hanif Benoit
- 0000 0001 0742 0364grid.168645.8Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655 USA
| | - Remko van Lutterveld
- 0000 0004 1936 9094grid.40263.33Mindfulness Center, Brown University School of Public Health and Warren Alpert School of Medicine, 121S Main St, Providence, RI 02903 USA
| | - Judson A. Brewer
- 0000 0004 1936 9094grid.40263.33Mindfulness Center, Brown University School of Public Health and Warren Alpert School of Medicine, 121S Main St, Providence, RI 02903 USA
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26
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Lin F, Wu G, Zhu L, Lei H. Region-Specific Changes of Insular Cortical Thickness in Heavy Smokers. Front Hum Neurosci 2019; 13:265. [PMID: 31417384 PMCID: PMC6685069 DOI: 10.3389/fnhum.2019.00265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
Insula plays an essential role in maintaining the addiction to cigarette smoking and smoking-related alterations on the insular volume and density have been reported in smokers. However, less is known about the effects of chronic cigarette smoking on the insular cortical thickness. In this study, we explored the region-specific changes of insular cortical thickness in heavy smokers and their relations with smoking-related variables. 37 heavy smokers (29 males, mean age 47.19 ± 7.22 years) and 37 non-smoking healthy controls (29 males, mean age 46.95 ± 8.45 years) participated in the study. Subregional insular cortical thickness was evaluated and compared between the two groups. Correlation analysis was performed to investigate relationships between the insular cortical thickness and clinical characteristics in heavy smokers. There was no statistical difference on the cortical thickness in the left insula (p = 0.536) between the two groups while heavy smokers had a slightly thinner cortical thickness in the right insula (p = 0.048). In addition, heavy smokers showed a greater cortical thinning in the anterior (p = 0.0084) and superior (p = 0.0054) segment of the circular sulcus of the right insula as well as the inferior (p = 0.012) segment of the circular sulcus of the left insula. Moreover, the cortical thickness of the superior segment of the circular sulcus of the left insula was correlated negatively with nicotine severity (r = −0.423; p = 0.009) and the longer cigarette exposure was associated with the cortical thinning in the long insular gyrus and central sulcus of the right insula (r = −0.475; p = 0.003). Our findings indicate that chronic cigarette use is associated with region-specific insular thinning, which has the potential to improve our understanding of the specific roles of insular subregions in nicotine addiction.
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Affiliation(s)
- Fuchun Lin
- National Center for Magnetic Resonance in Wuhan, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Guangyao Wu
- Department of Radiology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Department of Medical Imaging, Shenzhen University General Hospital, Medical College of Shenzhen University, Shenzhen, China
| | - Ling Zhu
- Department of Radiology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Hao Lei
- National Center for Magnetic Resonance in Wuhan, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
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27
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Ibrahim C, Rubin-Kahana DS, Pushparaj A, Musiol M, Blumberger DM, Daskalakis ZJ, Zangen A, Le Foll B. The Insula: A Brain Stimulation Target for the Treatment of Addiction. Front Pharmacol 2019; 10:720. [PMID: 31312138 PMCID: PMC6614510 DOI: 10.3389/fphar.2019.00720] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
Substance use disorders (SUDs) are a growing public health concern with only a limited number of approved treatments. However, even approved treatments are subject to limited efficacy with high long-term relapse rates. Current treatment approaches are typically a combination of pharmacotherapies and behavioral counselling. Growing evidence and technological advances suggest the potential of brain stimulation techniques for the treatment of SUDs. There are three main brain stimulation techniques that are outlined in this review: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The insula, a region of the cerebral cortex, is known to be involved in critical aspects underlying SUDs, such as interoception, decision making, anxiety, pain perception, cognition, mood, threat recognition, and conscious urges. This review focuses on both the preclinical and clinical evidence demonstrating the role of the insula in addiction, thereby demonstrating its promise as a target for brain stimulation. Future research should evaluate the optimal parameters for brain stimulation of the insula, through the use of relevant biomarkers and clinical outcomes for SUDs.
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Affiliation(s)
- Christine Ibrahim
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Dafna S. Rubin-Kahana
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abhiram Pushparaj
- Qunuba Sciences, Toronto, ON, Canada
- Ironstone Product Development, Toronto, ON, Canada
| | | | - Daniel M. Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J. Daskalakis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abraham Zangen
- Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Addictions Division, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Alcohol Research and Treatment Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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28
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Regner MF, Tregellas J, Kluger B, Wylie K, Gowin JL, Tanabe J. The insula in nicotine use disorder: Functional neuroimaging and implications for neuromodulation. Neurosci Biobehav Rev 2019; 103:414-424. [PMID: 31207255 DOI: 10.1016/j.neubiorev.2019.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/18/2019] [Accepted: 06/03/2019] [Indexed: 12/30/2022]
Abstract
Insula dysfunction contributes to nicotine use disorders. Yet, much remains unknown about how insular functions promote nicotine use. We review current models of brain networks in smoking and propose an extension to those models that emphasizes the role of the insula in craving. During acute withdrawal, the insula provides the sensation of craving to the cerebrum and is thought to negotiate craving sensations with cognitive control to guide behavior - either to smoke or abstain. Recent studies have shown that insula processing is saturable, such that different insular functions compete for limited resources. We propose that this saturability explains how craving during withdrawal can overload insular processing to the exclusion of other functions, such as saliency and network homeostasis. A novel signal flow model illustrates how limited insular capacity leads to breakdown of normal function. Finally, we discuss suitability of insula as a neuromodulation target to promote cessation. Given the limited efficacy of standard-of-care treatments for nicotine use disorder, insular neuromodulation offers an innovative, potentially therapeutic target for improving smoking cessation.
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Affiliation(s)
- Michael F Regner
- Department of Radiology, University of Colorado School of Medicine, United States; Department of Bioengineering, University of Colorado School of Medicine, United States.
| | - Jason Tregellas
- Department of Radiology, University of Colorado School of Medicine, United States; Department of Psychiatry, University of Colorado School of Medicine, United States; Research Service, Rocky Mountain Regional VA Medical Center, United States
| | - Benzi Kluger
- Department of Psychiatry, University of Colorado School of Medicine, United States; Department of Neurology, University of Colorado School of Medicine, United States
| | - Korey Wylie
- Department of Psychiatry, University of Colorado School of Medicine, United States
| | - Joshua L Gowin
- Department of Radiology, University of Colorado School of Medicine, United States
| | - Jody Tanabe
- Department of Radiology, University of Colorado School of Medicine, United States; Department of Psychiatry, University of Colorado School of Medicine, United States; Department of Neurology, University of Colorado School of Medicine, United States
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29
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Maynard OM, McClernon FJ, Oliver JA, Munafò MR. Using Neuroscience to Inform Tobacco Control Policy. Nicotine Tob Res 2019; 21:739-746. [PMID: 29590482 PMCID: PMC6528159 DOI: 10.1093/ntr/nty057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/23/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Techniques employed in the field of neuroscience, such as eye tracking, electroencephalography, and functional magnetic resonance imaging, have been important in informing our understanding of the cognitive mechanisms underlying tobacco smoking. These techniques are now increasingly being used to investigate the likely impact of tobacco control policies. AIMS AND METHODS In this narrative review, we outline the value of these methodological approaches in answering policy-relevant tobacco control research questions, with a particular focus on their use in examining the impact of standardized cigarette packaging and health warnings. We also examine the limitations of these methodologies and provide examples of how they can be used to answer other policy-relevant questions. RESULTS We argue that neuroscience techniques can provide more objective evidence of the impacts of policy measures, allow investigation where it is not possible to conduct behavioral manipulations, and facilitate a deeper understanding of the cognitive mechanisms underlying the impacts of tobacco control policies such as standardized packaging, health warnings, point-of-sale displays, and mass media campaigns. CONCLUSIONS Rather than replacing more traditional methods of examining tobacco control measures, such as observational experiments, surveys, and questionnaires, neuroscience techniques can complement and extend these methods. IMPLICATIONS Neuroscience techniques facilitate objective examination of the mechanisms underlying the impacts of tobacco control measures. These techniques can therefore complement and extend other methodologies typically used in this field, such as observational experiments, surveys, and questionnaires.
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Affiliation(s)
- Olivia M Maynard
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit (IEU), School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Marcus R Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit (IEU), School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
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30
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Karch S, Paolini M, Gschwendtner S, Jeanty H, Reckenfelderbäumer A, Yaseen O, Maywald M, Fuchs C, Rauchmann BS, Chrobok A, Rabenstein A, Ertl-Wagner B, Pogarell O, Keeser D, Rüther T. Real-Time fMRI Neurofeedback in Patients With Tobacco Use Disorder During Smoking Cessation: Functional Differences and Implications of the First Training Session in Regard to Future Abstinence or Relapse. Front Hum Neurosci 2019; 13:65. [PMID: 30886575 PMCID: PMC6409331 DOI: 10.3389/fnhum.2019.00065] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/08/2019] [Indexed: 02/04/2023] Open
Abstract
One of the most prominent symptoms in addiction disorders is the strong desire to consume a particular substance or to show a certain behavior (craving). The strong association between craving and the probability of relapse emphasizes the importance of craving in the therapeutic process. Former studies have demonstrated that neuromodulation using real-time fMRI (rtfMRI) neurofeedback (NF) can be used as a treatment modality in patients with tobacco use disorder. The aim of the present project was to determine whether it is possible to predict the outcome of NF training plus group psychotherapy at the beginning of the treatment. For that purpose, neuronal responses during the first rtfMRI NF session of patients who remained abstinent for at least 3 months were compared to those of patients with relapse. All patients were included in a certified smoke-free course and took part in three NF sessions. During the rtfMRI NF sessions tobacco-associated and neutral pictures were presented. Subjects were instructed to reduce their neuronal responses during the presentation of smoking cues in an individualized region of interest for craving [anterior cingulate cortex (ACC), insula or dorsolateral prefrontal cortex]. Patients were stratified to different groups [abstinence (N = 10) vs. relapse (N = 12)] according to their individual smoking status 3 months after the rtfMRI NF training. A direct comparison of BOLD responses during the first NF-session of patients who had remained abstinent over 3 months after the NF training and patients who had relapsed after 3 months showed that patients of the relapse group demonstrated enhanced BOLD responses, especially in the ACC, the supplementary motor area as well as dorsolateral prefrontal areas, compared to abstinent patients. These results suggest that there is a probability of estimating a successful withdrawal in patients with tobacco use disorder by analyzing the first rtfMRI NF session: a pronounced reduction of frontal responses during NF training in patients might be the functional correlate of better therapeutic success. The results of the first NF sessions could be useful as predictor whether a patient will be able to achieve success after the behavioral group therapy and NF training in quitting smoking or not.
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Affiliation(s)
- Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sarah Gschwendtner
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Hannah Jeanty
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Arne Reckenfelderbäumer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Omar Yaseen
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christina Fuchs
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Agnieszka Chrobok
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Andrea Rabenstein
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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31
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Conklin CA, McClernon FJ, Vella EJ, Joyce CJ, Salkeld RP, Parzynski CS, Bennett L. Combined Smoking Cues Enhance Reactivity and Predict Immediate Subsequent Smoking. Nicotine Tob Res 2019; 21:241-248. [PMID: 29370401 PMCID: PMC6329405 DOI: 10.1093/ntr/nty009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/17/2018] [Indexed: 11/13/2022]
Abstract
Introduction Cue reactivity (CR) research has reliably demonstrated robust cue-induced responding among smokers exposed to common proximal smoking cues (eg, cigarettes, lighter). More recent work demonstrates that distal stimuli, most notably the actual environments in which smoking previously occurred, can also gain associative control over craving. In the real world, proximal cues always occur within an environment; thus, a more informative test of how cues affect smokers might be to present these two cue types simultaneously. Methods Using a combined-cue counterbalanced CR paradigm, the present study tested the impact of proximal (smoking and neutral) + personal environment (smoking and nonsmoking places) pictorial cues, on smokers' subjective and behavioral CR; as well as the extent to which cue-induced craving predicts immediate subsequent smoking in a within-subjects design. Results As anticipated, the dual smoking cue combination (ProxS + EnvS) led to the greatest cue-induced craving relative to the other three cue combinations (ProxS + EnvN, ProxN + EnvS, and ProxN ± EnvN), ps < .004. Dual smoking cues also led to significantly shorter post-trial latencies to smoke, ps < .01. Overall CR difference score (post-trial craving minus baseline craving) was predictive of subsequent immediate smoking indexed by: post-trial latency to smoke [B = -2.69, SE = 9.02; t(143) = -2.98, p = .003]; total puff volume [B = 2.99, SE = 1.13; t(143) = 2.65, p = .009]; and total number of puffs [B = .053, SE = .027; t(143) = 1.95, p = .05]. Conclusions The implications of these findings for better understanding the impact of cues on smoking behavior and cessation are discussed. Implications This novel cue reactivity study examined smokers' reactivity to combined proximal and distal smoking cues. Exposure to a combination of two smoking cues (proximal and environment) led to the greatest increases in cue-induced craving and smoking behavior compared to all other cue combinations. Further, the overall magnitude of cue-induced craving was found to significantly predict immediate subsequent smoking. This work provides new insight on how exposure to various cues and cue combinations directly affect smokers' craving and actual smoking behavior, as well as the relationship between those two indices of reactivity.
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Affiliation(s)
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Elizabeth J Vella
- Department of Psychology, University of Southern Maine, Portland, ME
| | | | - Ronald P Salkeld
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Lee Bennett
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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32
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Harris NA, Winder DG. Synaptic Plasticity in the Bed Nucleus of the Stria Terminalis: Underlying Mechanisms and Potential Ramifications for Reinstatement of Drug- and Alcohol-Seeking Behaviors. ACS Chem Neurosci 2018; 9:2173-2187. [PMID: 29851347 PMCID: PMC6146063 DOI: 10.1021/acschemneuro.8b00169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The bed nucleus of the stria terminalis (BNST) is a component of the extended amygdala that shows significant changes in activity and plasticity through chronic exposure to drugs and stress. The region is critical for stress- and cue-induced reinstatement of drug-seeking behaviors and is thus a candidate region for the plastic changes that occur in abstinence that prime addicted patients for reinstatement behaviors. Here, we discuss the various forms of long-term potentiation (LTP) and long-term depression (LTD) in the rodent BNST and highlight the way that these changes in excitatory transmission interact with exposure to alcohol and other drugs of abuse, as well as other stressors. In addition, we highlight potential areas for future research in this area, including investigating input- and cell-specific bidirectional changes in activity. As we continue to accrue foundational knowledge in the mechanisms and effects of plasticity in the BNST, molecular targets and treatment strategies that are relevant to reinstatement behaviors will also begin to emerge. Here, we briefly discuss the effects of catecholamine receptor modulators on synaptic plasticity in the BNST due to the role of norepinephrine in LTD and dopamine on the short-term component of LTP as well as the role that signaling at these receptors plays in reinstatement of drug- and alcohol-seeking behaviors. We hope that insights gained on the specific changes in plasticity that occur within the BNST during abstinence from alcohol and other drugs of abuse will provide insight into the biological underpinnings of relapse behavior in human addicts and inform future treatment modalities for addiction that tackle this complex biological problem.
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Affiliation(s)
- Nicholas A. Harris
- Vanderbilt Center for Addiction Research
- Department of Molecular Physiology & Biophysics
| | - Danny G. Winder
- Vanderbilt Center for Addiction Research
- Department of Molecular Physiology & Biophysics
- Vanderbilt J.F. Kennedy Center for Research on Human Development
- Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
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Gilman JM, Radoman M, Schuster RM, Pachas G, Azzouz N, Fava M, Evins AE. Anterior insula activation during inhibition to smoking cues is associated with ability to maintain tobacco abstinence. Addict Behav Rep 2018; 7:40-46. [PMID: 29450255 PMCID: PMC5805503 DOI: 10.1016/j.abrep.2018.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 11/04/2022] Open
Abstract
Relapse to smoking after initial abstinence is a major clinical challenge with significant public health consequences. At the brain and behavioral level, those who relapse to tobacco smoking have both greater cue-reactivity and lower inhibitory control than those who remain abstinent. Little is known about neural activation during inhibitory control tasks in the presence of drug-related cues. In the current study, tobacco smokers (SMK; n = 22) and non-smoking controls (CON; n = 19) completed a Go/NoGo task involving smoking cues during a functional magnetic resonance imaging (fMRI) scan. Following the scan session, smokers were required to quit smoking, and maintenance of abstinence was evaluated as part of a 12-week smoking cessation trial. We evaluated pre-cessation brain activity during NoGo trials in smokers who were versus were not able to quit smoking. We then compared fMRI and inhibitory control measures between smokers and non-smokers. We did not find differences between SMK and CON in performance or activation to smoking or neutral cues. However, compared to SMK who relapsed, SMK who attained biochemically-validated abstinence at the end of the smoking cessation trial had greater neural activation in the anterior insula during NoGo trials specifically with smoking-related cues. Results indicate that within SMK, decreased inhibitory control activation during direct exposure to drug-related stimuli may be a marker of difficulty quitting and relapse vulnerability. Smokers and controls showed no differences in performance or activation to smoking or neutral cues. Abstinent smokers compared to relapsers had greater activation in the insula during NoGo trials with smoking-related cues. Within smokers, decreased NoGo activation during exposure to drug-related cues may be a marker of relapse vulnerability.
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Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, MGH, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Milena Radoman
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Randi M Schuster
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gladys Pachas
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Nour Azzouz
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Maurizio Fava
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Janes AC, Gilman JM, Frederick BB, Radoman M, Pachas G, Fava M, Evins AE. Salience network coupling is linked to both tobacco smoking and symptoms of attention deficit hyperactivity disorder (ADHD). Drug Alcohol Depend 2018; 182:93-97. [PMID: 29175464 PMCID: PMC6585943 DOI: 10.1016/j.drugalcdep.2017.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) symptoms, even those below diagnostic threshold, enhance the likelihood of nicotine dependence, suggesting a neurobiological link between disorders. Of particular interest is the salience network (SN), which mediates attention to salient internal/external stimuli to guide behavior and is anchored by the dorsal anterior cingulate cortex (dACC) and bilateral anterior insula (AI). Disrupted interactions between the SN and the default mode (DMN) and central executive networks (CEN) have been noted in both ADHD and nicotine dependence. Further, enhanced intra-SN coupling between the dACC-AI influences aspects of nicotine dependence such as reactivity to smoking cues. METHODS To identify links between SN functional connectivity and ADHD symptoms in nicotine dependence, we compared 21 nicotine dependent individuals with 17 non-smokers on ADHD symptoms as measured by the ADHD self-report scale (ASRS) and resting state intra and inter-SN functional connectivity. RESULTS Relative to healthy controls, nicotine dependent individuals had significantly higher ASRS scores and greater dACC-AI coupling. No group differences were noted on inter-SN network coupling. A significant association was found between ASRS and dACC-AI coupling both in the entire cohort and specifically when evaluating nicotine dependent individuals alone. CONCLUSIONS The greater ASRS scores in nicotine dependent individuals is in line with existent literature and the stronger dACC-AI coupling in smokers further supports the role of this network in nicotine dependence. The significant association between dACC-AI coupling and ASRS suggests that intra-SN coupling strength may impact neurocognitive functioning associated with both ADHD symptoms and nicotine dependence.
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Affiliation(s)
- A C Janes
- McLean Imaging Center, McLean Hospital, Belmont, MA, 02478, USA; Harvard Medical School, Boston, MA, USA.
| | - J M Gilman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, MGH, Charlestown, MA, USA,; Harvard Medical School, Boston, MA, USA
| | - B B Frederick
- McLean Imaging Center, McLean Hospital, Belmont, MA, 02478, USA; Harvard Medical School, Boston, MA, USA
| | - M Radoman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
| | - G Pachas
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - M Fava
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - A E Evins
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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