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Martucci KT. Neuroimaging of opioid effects in humans across conditions of acute administration, chronic pain therapy, and opioid use disorder. Trends Neurosci 2024; 47:418-431. [PMID: 38762362 PMCID: PMC11168870 DOI: 10.1016/j.tins.2024.04.005] [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: 10/30/2023] [Revised: 04/01/2024] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
Evidence of central nervous system (CNS) exogenous opioid effects in humans has been primarily gained through neuroimaging of three participant populations: individuals after acute opioid administration, those with opioid use disorder (OUD), and those with chronic pain receiving opioid therapy. In both the brain and spinal cord, opioids alter processes of pain, cognition, and reward. Opioid-related CNS effects may persist and accumulate with longer opioid use duration. Meanwhile, opioid-induced benefits versus risks to brain health remain unclear. This review article highlights recent accumulating evidence for how exogenous opioids impact the CNS in humans. While investigation of CNS opioid effects has remained largely disparate across contexts of opioid acute administration, OUD, and chronic pain opioid therapy, integration across these contexts may enable advancement toward effective interventions.
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Affiliation(s)
- Katherine T Martucci
- Human Affect and Pain Neuroscience Lab, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA; Center for Translational Pain Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Institute for Brain Sciences, Duke University, Durham, NC, USA.
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Taremian F, Eskandari Z, Dadashi M, Hosseini SR. Disrupted resting-state functional connectivity of frontal network in opium use disorder. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:297-305. [PMID: 34155942 DOI: 10.1080/23279095.2021.1938051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Opioid use disorder (OUD) as a chronic relapsing disorder is initially driven by dysfunction of brain reward networks and associated with several psychiatric disorders. Resting-state EEG was recorded in 24 healthy participants as well as 31 patients with OUD. Healthy participants do not meet OUD criteria. After pre-processing of the raw EEG, functional connectivity in the frontal network using eLORETA and all networks using graph analysis method were calculated. Patients with OUD had higher electrical neuronal activity compared to healthy participants in higher frequency bands. The statistical analysis revealed that patients with OUD had significantly decreased phase synchronization in β1 and β2 frequency bands compared with the healthy group in the frontal network. Regarding global network topology, we found a significant decrease in the characteristic path length and an increase in global efficiency, clustering coefficient, and transitivity in patients compared with the healthy group. These changes indicated that local specialization and global integration of the brain were disrupted in OUD and it suggests a tendency toward random network configuration of functional brain networks in patients with OUD. Disturbances in EEG-based brain network indices might reflect an altered cortical functional network in OUD. These findings might provide useful biomarkers to understand cortical brain pathology in opium use disorder.
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Affiliation(s)
- Farhad Taremian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zakaria Eskandari
- Department of Clinical Psychology and Addiction Studies, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohsen Dadashi
- Department of Clinical Psychology and Addiction Studies, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Seyed Ruhollah Hosseini
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
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Yazgeç E, Bora E, İngeç S, Çıray RO, Bağcı B, Alkın T. Social Cognition in Opioid Use Disorder. Subst Use Misuse 2023; 58:996-1003. [PMID: 37096303 DOI: 10.1080/10826084.2023.2201845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background: Opioid use disorder (OUD) is associated with significant functional impairment and neurocognitive dysfunction, but only a handful of studies have investigated social cognitive abilities in this condition. This study aimed to investigate facial emotion recognition accuracy/biases and two different aspects of theory of mind (ToM) (ToM-decoding vs ToM-reasoning) in people with recovered OUD. Methods: The participants included 32 people with recovered OUD who were on Buprenorphine + Naloxone (B/N) maintenance treatment and 32 healthy controls. In addition to neurocognitive tasks, both groups were assessed by a facial emotion recognition task, the faux pas recognition task, and the reading the mind from the eyes task. Results: In comparison to healthy controls, people on B/N maintenance treatment showed deficits in facial emotion recognition (d = 1.32) and both aspects of ToM (d = 0.87-1.21). In analyses of individual emotions, people on B/N maintenance treatment had decreased accuracy in recognition of anger and fear and had a bias to identify other emotions as sad. The duration of opioid use was robustly associated with difficulties in the recognition of anger. Conclusion: People in B/N maintenance treatment have significant difficulties in recognizing the emotions and mental states of others. Deficits in social cognition might be important for understanding the difficulties in interpersonal and social functioning in people with OUD.
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Affiliation(s)
- Emre Yazgeç
- Department of Psychiatry, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey
- Department of Neuroscience Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Seda İngeç
- Department of Psychiatry, Balıkesir State Hospital, Balikesir, Turkey
| | - R Oğulcan Çıray
- Department of Child and Adolescent Psychiatry, Mardin StateHospital, Mardin, Turkey
| | - Başak Bağcı
- Department of Psychiatry, Ataturk Education and Research Hospital, Izmır Kâtip Çelebi University, Izmir, Turkey
| | - Tunç Alkın
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey
- Department of Neuroscience Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
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Chen J, Li Y, Wang S, Li W, Liu Y, Jin L, Li Z, Zhu J, Wang F, Liu W, Xue J, Shi H, Wang W, Jin C, Li Q. Methadone maintenance treatment alters couplings of default mode and salience networks in individuals with heroin use disorder: A longitudinal self-controlled resting-state fMRI study. Front Psychiatry 2023; 14:1132407. [PMID: 37139328 PMCID: PMC10149709 DOI: 10.3389/fpsyt.2023.1132407] [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: 12/27/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Methadone maintenance treatment (MMT) is a common treatment for heroin use disorder (HUD). Although individuals with HUD have been reported to show impaired coupling among the salience network (SN), executive control network (ECN), and default mode network (DMN), the effects of MMT on the coupling among three large-scale networks in individuals with HUD remains unclear. Methods Thirty-seven individuals with HUD undergoing MMT and 57 healthy controls were recruited. The longitudinal one-year follow-up study aimed to evaluate the effects of methadone on anxiety, depression, withdrawal symptoms and craving and number of relapse, and brain function (SN, DMN and bilateral ECN) in relation to heroin dependence. The changes in psychological characteristics and the coupling among large-scale networks after 1 year of MMT were analyzed. The associations between the changes in coupling among large-scale networks and psychological characteristics and the methadone dose were also examined. Results After 1 year of MMT, individuals with HUD showed a reduction in the withdrawal symptom score. The number of relapses was negatively correlated with the methadone dose over 1 year. The functional connectivity between the medial prefrontal cortex (mPFC) and the left middle temporal gyrus (MTG; both key nodes of the DMN) was increased, and the connectivities between the mPFC and the anterior insular and middle frontal gyrus (key nodes of the SN) were also increased. The mPFC-left MTG connectivity was negatively correlated with the withdrawal symptom score. Conclusion Long-term MMT enhanced the connectivity within the DMN which might be related to reduced withdrawal symptoms, and that between the DMN and SN which might be related to increase in salience values of heroin cues in individuals with HUD. Long-term MMT may be a double-edged sword in treatment for HUD.
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Affiliation(s)
- Jiajie Chen
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yongbin Li
- Department of Radiology, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
| | - Shu Wang
- Biomedical Engineering, School of Life Science and Technology, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yan Liu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Long Jin
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhe Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Liu
- Department of Radiology, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
| | - Jiuhua Xue
- Department of Radiology, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
| | - Hong Shi
- Department of Radiology, Xi'an No. 1 Hospital, Xi'an, Shaanxi, China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- Wei Wang,
| | - Chenwang Jin
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Chenwang Jin,
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- *Correspondence: Qiang Li,
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Luo J, Yang R, Yang W, Duan C, Deng Y, Zhang J, Chen J, Liu J. Increased Amplitude of Low-Frequency Fluctuation in Right Angular Gyrus and Left Superior Occipital Gyrus Negatively Correlated With Heroin Use. Front Psychiatry 2020; 11:492. [PMID: 32719620 PMCID: PMC7350776 DOI: 10.3389/fpsyt.2020.00492] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/14/2020] [Indexed: 12/01/2022] Open
Abstract
Abnormal amplitude of low-frequency fluctuation has been implicated in heroin addiction. However, previous studies lacked consistency and didn't consider the impact of confounding factors such as methadone and alcohol. Fifty-one heroin-dependent (HD) individuals and 40 healthy controls underwent resting-state functional magnetic resonance imaging. The 'amplitude of low-frequency fluctuation' (ALFF) value was calculated and support vector machine (SVM) classification analysis was applied to analyze the data. Compared with healthy controls, heroin addicts exhibited increased ALFF in the right angular gyrus (AG) and left superior occipital gyrus (SOG). A negative correlation was observed between increased ALFF in the right angular gyrus and left superior occipital gyrus and the duration of heroin use (p 1=0.004, r 1=-0.426; p 2=0.009, r 2=-0.361). Moreover, the ALFF in the right AG and left SOG could discriminate the HD subjects from the controls with acceptable accuracy (Acc1=64.85%, p 1=0.004; Acc2=63.80%, p 2=0.005). HD patients showed abnormal ALFF in the brain areas involved in semantic memory and visual networks. The longer HD individuals abused heroin, the less the ALFF of associated brain regions increased. These observed patterns suggested that the accumulative effect of heroin's neurotoxicity overpowered self-recovery of the brain and may be applied as a potential biomarker to identify HD individuals from the controls.
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Affiliation(s)
- Jing Luo
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ru Yang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenhan Yang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | | | - Yuan Deng
- Yunnan Institute for Drug Abuse, Kunming, China
| | - Jun Zhang
- Hunan Judicial Police Academy, Changsha, China
| | - Jiyuan Chen
- Hunan Drug Rehabilitation Administration, Changsha, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
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McConnell PA, Garland EL, Zubieta J, Newman‐Norlund R, Powers S, Froeliger B. Impaired frontostriatal functional connectivity among chronic opioid using pain patients is associated with dysregulated affect. Addict Biol 2020; 25:e12743. [PMID: 30945801 DOI: 10.1111/adb.12743] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/21/2019] [Accepted: 02/10/2019] [Indexed: 12/11/2022]
Abstract
Preclinical studies have shown effects of chronic exposure to addictive drugs on glutamatergic-mediated neuroplasticity in frontostriatal circuitry. These initial findings have been paralleled by human functional magnetic resonance imaging (fMRI) research demonstrating weaker frontostriatal resting-state functional connectivity (rsFC) among individuals with psychostimulant use disorders. However, there is a dearth of human imaging literature describing associations between long-term prescription opioid use, frontostriatal rsFC, and brain morphology among chronic pain patients. We hypothesized that prescription opioid users with chronic pain, as compared with healthy control subjects, would evidence weaker frontostriatal rsFC coupled with less frontostriatal gray matter volume (GMV). Further, those opioid use-related deficits in frontostriatal circuitry would be associated with negative affect and drug misuse. Prescription opioid users with chronic pain (n = 31) and drug-free healthy controls (n = 30) underwent a high-resolution anatomical and an eyes-closed resting-state functional scan. The opioid group, relative to controls, exhibited weaker frontostriatal rsFC, and less frontostriatal GMV in both L.NAc and L.vmPFC. Frontostriatal rsFC partially mediated group differences in negative affect. Within opioid users, L.NAc GMV predicted opioid misuse severity. The current study revealed that prescription opioid use in the context of chronic pain is associated with functional and structural abnormalities in frontostriatal circuitry. These results suggest that opioid use-related abnormalities in frontostriatal circuitry may undergird disturbances in affect that may contribute to the ongoing maintenance of opioid use and misuse. These findings warrant further examination of interventions to treat opioid pathophysiology in frontostriatal circuitry over the course of treatment.
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Affiliation(s)
- Patrick A. McConnell
- Department of NeuroscienceMedical University of South Carolina Charleston South Carolina USA
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention DevelopmentUniversity of Utah Salt Lake City Utah USA
- College of Social WorkUniversity of Utah Salt Lake City Utah USA
| | - Jon‐Kar Zubieta
- Department of PsychiatryUniversity of Utah Salt Lake City Utah USA
- University Neuropsychiatric InstituteUniversity of Utah Salt Lake City Utah USA
| | - Roger Newman‐Norlund
- Department of PsychologyUniversity of South Carolina Columbia South Carolina USA
| | - Shannon Powers
- Department of NeuroscienceMedical University of South Carolina Charleston South Carolina USA
| | - Brett Froeliger
- Department of NeuroscienceMedical University of South Carolina Charleston South Carolina USA
- Hollings Cancer CenterMedical University of South Carolina Charleston South Carolina USA
- Center for Biomedical ImagingMedical University of South Carolina Charleston South Carolina USA
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7
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Terrett G, Mercuri K, Pizarro-Campagna E, Hugrass L, Curran HV, Henry JD, Rendell PG. Social cognition impairments in long-term opiate users in treatment. J Psychopharmacol 2020; 34:254-263. [PMID: 31556782 DOI: 10.1177/0269881119875981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Long-term opiate users experience pervasive social difficulties, but there has been surprisingly limited research focused on social-cognitive functioning in this population. AIM The aim of this study was to investigate whether three important aspects of social cognition (facial emotion recognition, theory of mind (ToM) and rapid facial mimicry) differ between long-term opiate users and healthy controls. METHODS The participants were 25 long-term opiate users who were enrolled in opiate substitution programmes, and 25 healthy controls. Facial emotion recognition accuracy was indexed by responses to 60 photographs of faces depicting the six basic emotions (happiness, sadness, anger, fear, surprise and disgust). ToM was assessed using the Reading the Mind in the Eyes task, which requires participants to infer mental states of others from partial facial cues. Rapid facial mimicry was assessed by recording activity in the zygomaticus major and corrugator supercilii muscle regions while participants passively viewed images of happy and angry facial expressions. RESULTS Relative to the control group, the opiate user group exhibited deficits in both facial emotion recognition and ToM. Moreover, only control participants exhibited typical rapid facial mimicry responses to happy facial expressions. CONCLUSIONS These data indicate that long-term opiate users exhibit abnormalities in three distinct areas of social-cognitive processing, pointing to the need for additional work to establish how social-cognitive functioning relates to functional outcomes in this group. Such work may ultimately inform the development of interventions aimed at improving treatment outcomes for long-term opiate users.
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Affiliation(s)
- Gill Terrett
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Fitzroy, VIC, Australia
| | - Kimberly Mercuri
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Fitzroy, VIC, Australia
| | - Elizabeth Pizarro-Campagna
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Fitzroy, VIC, Australia
| | - Laila Hugrass
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Fitzroy, VIC, Australia
| | - H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Julie D Henry
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Peter G Rendell
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Fitzroy, VIC, Australia
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Moningka H, Lichenstein S, Yip SW. Current understanding of the neurobiology of opioid use disorder: An overview. Curr Behav Neurosci Rep 2019; 6:1-11. [PMID: 34485022 PMCID: PMC8412234 DOI: 10.1007/s40473-019-0170-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This review provides an overview of the neurobiological mechanisms underlying opioid use disorder (OUD) drawing from genetic, functional and structural magnetic resonance imaging (MRI) research. RECENT FINDINGS Preliminary evidence suggests an association between OUD and specific variants of the DRD2, δ-opioid receptor 1 (OPRD1) and μ-opioid receptor 1 (OPRM1) genes. Additionally, MRI research indicates functional and structural alterations in striatal and corticolimbic brain regions and pathways underlying reward, emotion/stress and cognitive control processes among individuals with OUD. SUMMARY Individual differences in genetic and functional and structural brain-based features are correlated with differences in OUD severity and treatment outcomes, and therefore may potentially one day be used to inform OUD treatment selection. However, given the heterogeneous findings reported, further longitudinal research across different stages of opioid addiction is needed to yield a convergent characterization of OUD and improve treatment and prevention.
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Affiliation(s)
- Hestia Moningka
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
- University College London, Division of Psychology and Language Sciences, London WC1H 0AP
| | - Sarah Lichenstein
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
| | - Sarah W. Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510
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9
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Stewart JL, May AC, Aupperle RL, Bodurka J. Forging Neuroimaging Targets for Recovery in Opioid Use Disorder. Front Psychiatry 2019; 10:117. [PMID: 30899231 PMCID: PMC6417368 DOI: 10.3389/fpsyt.2019.00117] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/15/2019] [Indexed: 01/01/2023] Open
Abstract
The United States is in the midst of an opioid epidemic and lacks a range of successful interventions to reduce this public health burden. Many individuals with opioid use disorder (OUD) consume drugs to relieve physical and/or emotional pain, a pattern that may increasingly result in death. The field of addiction research lacks a comprehensive understanding of physiological and neural mechanisms instantiating this cycle of Negative Reinforcement in OUD, resulting in limited interventions that successfully promote abstinence and recovery. Given the urgency of the opioid crisis, the present review highlights faulty brain circuitry and processes associated with OUD within the context of the Three-Stage Model of Addiction (1). This model underscores Negative Reinforcement processes as crucial to the maintenance and exacerbation of chronic substance use together with Binge/Intoxication and Preoccupation/Anticipation processes. This review focuses on cross-sectional as well as longitudinal studies of relapse and treatment outcome that employ magnetic resonance imaging (MRI), functional near-infrared spectroscopy (fNIRs), brain stimulation methods, and/or electroencephalography (EEG) explored in frequency and time domains (the latter measured by event-related potentials, or ERPs). We discuss strengths and limitations of this neuroimaging work with respect to study design and individual differences that may influence interpretation of findings (e.g., opioid use chronicity/recency, comorbid symptoms, and biological sex). Lastly, we translate gaps in the OUD literature, particularly with respect to Negative Reinforcement processes, into future research directions involving operant and classical conditioning involving aversion/stress. Overall, opioid-related stimuli may lessen their hold on frontocingulate mechanisms implicated in Preoccupation/Anticipation as a function of prolonged abstinence and that degree of frontocingulate impairment may predict treatment outcome. In addition, longitudinal studies suggest that brain stimulation/drug treatments and prolonged abstinence can change brain responses during Negative Reinforcement and Preoccupation/Anticipation to reduce salience of drug cues, which may attenuate further craving and relapse. Incorporating this neuroscience-derived knowledge with the Three-Stage Model of Addiction may offer a useful plan for delineating specific neurobiological targets for OUD treatment.
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Affiliation(s)
- Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - April C May
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, San Diego, CA, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, United States
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10
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Moningka H, Lichenstein S, Worhunsky PD, DeVito EE, Scheinost D, Yip SW. Can neuroimaging help combat the opioid epidemic? A systematic review of clinical and pharmacological challenge fMRI studies with recommendations for future research. Neuropsychopharmacology 2019; 44:259-273. [PMID: 30283002 PMCID: PMC6300537 DOI: 10.1038/s41386-018-0232-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 02/04/2023]
Abstract
The current opioid epidemic is an urgent public health problem, with enormous individual, societal, and healthcare costs. Despite effective, evidence-based treatments, there is significant individual variability in treatment responses and relapse rates are high. In addition, the neurobiology of opioid-use disorder (OUD) and its treatment is not well understood. This review synthesizes published fMRI literature relevant to OUD, with an emphasis on findings related to opioid medications and treatment, and proposes areas for further research. We conducted a systematic literature review of Medline and Psychinfo to identify (i) fMRI studies comparing OUD and control participants; (ii) studies related to medication, treatment, abstinence or withdrawal effects in OUD; and (iii) studies involving manipulation of the opioid system in healthy individuals. Following application of exclusionary criteria (e.g., insufficient sample size), 45 studies were retained comprising data from ~1400 individuals. We found convergent evidence that individuals with OUD display widespread heightened neural activation to heroin cues. This pattern is potentiated by heroin, attenuated by medication-assisted treatments for opioids, predicts treatment response, and is reduced following extended abstinence. Nonetheless, there is a paucity of literature examining neural characteristics of OUD and its treatment. We discuss limitations of extant research and identify critical areas for future neuroimaging studies, including the urgent need for studies examining prescription opioid users, assessing sex differences and utilizing a wider range of clinically relevant task-based fMRI paradigms across different stages of addiction.
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Affiliation(s)
- Hestia Moningka
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Sarah Lichenstein
- Yale School of Medicine, Radiology and Bioimaging Sciences, New Haven, CT, 06510, USA
| | - Patrick D Worhunsky
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Elise E DeVito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Dustin Scheinost
- Yale School of Medicine, Radiology and Bioimaging Sciences, New Haven, CT, 06510, USA
| | - Sarah W Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA.
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11
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Hu B, Dong Q, Hao Y, Zhao Q, Shen J, Zheng F. Effective brain network analysis with resting-state EEG data: a comparison between heroin abstinent and non-addicted subjects. J Neural Eng 2018; 14:046002. [PMID: 28397708 DOI: 10.1088/1741-2552/aa6c6f] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Neuro-electrophysiological tools have been widely used in heroin addiction studies. Previous studies indicated that chronic heroin abuse would result in abnormal functional organization of the brain, while few heroin addiction studies have applied the effective connectivity tool to analyze the brain functional system (BFS) alterations induced by heroin abuse. The present study aims to identify the abnormality of resting-state heroin abstinent BFS using source decomposition and effective connectivity tools. APPROACH The resting-state electroencephalograph (EEG) signals were acquired from 15 male heroin abstinent (HA) subjects and 14 male non-addicted (NA) controls. Multivariate autoregressive models combined independent component analysis (MVARICA) was applied for blind source decomposition. Generalized partial directed coherence (GPDC) was applied for effective brain connectivity analysis. Effective brain networks of both HA and NA groups were constructed. The two groups of effective cortical networks were compared by the bootstrap method. Abnormal causal interactions between decomposed source regions were estimated in the 1-45 Hz frequency domain. MAIN RESULTS This work suggested: (a) there were clear effective network alterations in heroin abstinent subject groups; (b) the parietal region was a dominant hub of the abnormally weaker causal pathways, and the left occipital region was a dominant hub of the abnormally stronger causal pathways. SIGNIFICANCE These findings provide direct evidence that chronic heroin abuse induces brain functional abnormalities. The potential value of combining effective connectivity analysis and brain source decomposition methods in exploring brain alterations of heroin addicts is also implied.
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Affiliation(s)
- Bin Hu
- School of Information Science and Engineering, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
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12
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Ieong HFH, Yuan Z. Emotion recognition and its relation to prefrontal function and network in heroin plus nicotine dependence: a pilot study. NEUROPHOTONICS 2018; 5:025011. [PMID: 29901032 PMCID: PMC5993953 DOI: 10.1117/1.nph.5.2.025011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/11/2018] [Indexed: 05/28/2023]
Abstract
Many patients with substance use disorders (SUDs) live in a stressful environment, and comorbidity is not uncommon. Understanding the neural mechanisms underlying heroin and nicotine dependences and their relationships to social cognition could facilitate behavioral therapy efficacy. We aimed to provide a translational approach that leads to identifying potential biomarkers for opioid use disorder (OUD) susceptibility during recovery. We examined the clinical characters and the relationships between theory of mind (ToM) and executive functions in three groups: heroin plus nicotine-dependent (HND) patients who had remained heroin abstinent ( ≥ 3 months), nicotine-dependent (ND) subjects, and healthy controls (C). The domains included emotion recognition, inhibition, shifting, updating, access, and processing speed. Resting-state functional connectivity (rsFC), ToM task-induced functional connectivity, and brain networks were then explored among 21 matched subjects using functional near-infrared spectroscopy. HND enhanced the severities of anxiety, depression, and hyperactivity. Inhibition domain was impaired in both HND and ND. No impairment in domains of emotion recognition, access, and update was observed. HND demonstrated enhanced rsFC in the medial prefrontal cortex and orbitofrontal cortex (OFC) and decreased ToM-induced connectivity across the PFC. The right superior frontal gyrus in the OFC (oSFG; x = 22 , y = 77 , and z = 6 ) was associated with working memory and emotion recognition in HND. Using a neuroimaging tool, these results supported the prominent reward-deficit-and-stress-surfeit hypothesis in SUDs, especially OUD, after protracted withdrawal. This may provide an insight in identifying potential biomarkers related to a dynamic environment.
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Affiliation(s)
- Hada Fong-ha Ieong
- University of Macau, Bioimaging Core, Faculty of Health Sciences, Macau SAR, China
| | - Zhen Yuan
- University of Macau, Bioimaging Core, Faculty of Health Sciences, Macau SAR, China
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Ieong HFH, Yuan Z. Resting-State Neuroimaging and Neuropsychological Findings in Opioid Use Disorder during Abstinence: A Review. Front Hum Neurosci 2017; 11:169. [PMID: 28428748 PMCID: PMC5382168 DOI: 10.3389/fnhum.2017.00169] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/22/2017] [Indexed: 01/07/2023] Open
Abstract
Dependence to opiates, including illicit heroin and prescription pain killers, and treatment of the opioid use disorder (OUD) have been longstanding problems over the world. Despite intense efforts to scientific investigation and public health care, treatment outcomes have not significantly improved for the past 50 years. One reason behind the continuing use of heroin worldwide despite such efforts is its highly addictive nature. Brain imaging studies over the past two decades have made significant contribution to the understanding of the addictive properties as to be due in part to biological processes, specifically those in the brain structure and function. Moreover, traditional clinical neuropsychology studies also contribute to the account in part for the treatment-refractory nature of the drug abuse. However, there is a gap between those studies, and the rates of relapse are still high. Thus, a multidisciplinary approach is needed to understand the fundamental neural mechanism of OUD. How does the brain of an OUD patient functionally and cognitively differ from others? This brief review is to compare and contrast the current literature on non-invasive resting state neuroimaging and clinical neuropsychological studies with the focus on the abstinence stage in OUD. The results show as follow:
Brain connectivity strength in the reward system, dysregulation of circuits associated with emotion and stress, enhanced beta and alpha power activity, and high impulsivity are induced by OUD. Some recovery signs in cognition are demonstrated in OUD subjects after prolonged abstinence, but not in the subjects undergoing methadone treatment. Normalization in the composition of brain oscillations especially in the temporal region is induced and restored by methadone treatment in roughly 6 months in mean duration for OUDs having a mean opioid-use history of 10 years.
We hope that the review provides valuable implications for clinical research and practice and paves a new insight into the future path to the identification of potential biomarkers and clinical outcome predictors in OUD in the domains of brain regions, functions, and behaviors.
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Affiliation(s)
- Hada Fong-Ha Ieong
- Bioimaging Core, Faculty of Health Sciences, University of MacauTaipa, Macau
| | - Zhen Yuan
- Bioimaging Core, Faculty of Health Sciences, University of MacauTaipa, Macau
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Myers CE, Rego J, Haber P, Morley K, Beck KD, Hogarth L, Moustafa AA. Learning and generalization from reward and punishment in opioid addiction. Behav Brain Res 2016; 317:122-131. [PMID: 27641323 DOI: 10.1016/j.bbr.2016.09.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
This study adapts a widely-used acquired equivalence paradigm to investigate how opioid-addicted individuals learn from positive and negative feedback, and how they generalize this learning. The opioid-addicted group consisted of 33 participants with a history of heroin dependency currently in a methadone maintenance program; the control group consisted of 32 healthy participants without a history of drug addiction. All participants performed a novel variant of the acquired equivalence task, where they learned to map some stimuli to correct outcomes in order to obtain reward, and to map other stimuli to correct outcomes in order to avoid punishment; some stimuli were implicitly "equivalent" in the sense of being paired with the same outcome. On the initial training phase, both groups performed similarly on learning to obtain reward, but as memory load grew, the control group outperformed the addicted group on learning to avoid punishment. On a subsequent testing phase, the addicted and control groups performed similarly on retention trials involving previously-trained stimulus-outcome pairs, as well as on generalization trials to assess acquired equivalence. Since prior work with acquired equivalence tasks has associated stimulus-outcome learning with the nigrostriatal dopamine system, and generalization with the hippocampal region, the current results are consistent with basal ganglia dysfunction in the opioid-addicted patients. Further, a selective deficit in learning from punishment could contribute to processes by which addicted individuals continue to pursue drug use even at the cost of negative consequences such as loss of income and the opportunity to engage in other life activities.
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Affiliation(s)
- Catherine E Myers
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA.
| | - Janice Rego
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia
| | - Paul Haber
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW, Australia
| | - Kirsten Morley
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW, Australia
| | - Kevin D Beck
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Lee Hogarth
- School of Psychology, University of New South Wales, Sydney, NSW, Australia; School of Psychology, University of Exeter, Exeter, UK
| | - Ahmed A Moustafa
- Department of Veterans Affairs, New Jersey Health Care System, East Orange, NJ, USA; Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, NSW, Australia
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