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Raff H, Glaeser BL, Szabo A, Olsen CM, Everson CA. Sleep restriction during opioid abstinence affects the hypothalamic-pituitary-adrenal (HPA) axis in male and female rats. Stress 2023; 26:2185864. [PMID: 36856367 PMCID: PMC10339708 DOI: 10.1080/10253890.2023.2185864] [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: 12/13/2022] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Hypothalamic-pituitary-adrenal (HPA) axis dynamics are disrupted by opioids and may be involved in substance abuse; this persists during withdrawal and abstinence and is associated with co-morbid sleep disruption leading to vulnerability to relapse. We hypothesized that chronic sleep restriction (SR) alters the HPA axis diurnal rhythm and the sexually dimorphic response to acute stressor during opioid abstinence. We developed a rat model to evaluate the effect of persistent sleep loss during opioid abstinence on HPA axis dynamics in male and female rats. Plasma ACTH and corticosterone were measured diurnally and in response to acute restraint stress in rats Before (control) compared to During subsequent opioid abstinence without or with SR. Abstinence, regardless of sleep state, led to an increase in plasma ACTH and corticosterone in the morning in males. There was a tendency for higher PM plasma ACTH during abstinence in SR males (p = 0.076). ACTH and corticosterone responses to restraint were reduced in male SR rats whereas there was a failure to achieve the post-restraint nadir in female SR rats. There was no effect of the treatments or interventions on adrenal weight normalized to body weight. SR resulted in a dramatic increase in hypothalamic PVN AVP mRNA and plasma copeptin in male but not female rats. This corresponded to the attenuation of the HPA axis stress response in SR males during opioid abstinence. We have identified a potentially unique, sexually dimorphic role for magnocellular vasopressin in the control of the HPA axis during opioid abstinence and sleep restriction.
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Affiliation(s)
- Hershel Raff
- Department of Medicine (Endocrinology and Molecular Medicine), Surgery, and Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Endocrine Research Laboratory, Aurora St. Luke’s Medical Center, Advocate Aurora Research Institute, Milwaukee, Wisconsin, USA
| | - Breanna L. Glaeser
- Department of Pharmacology & Toxicology and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher M. Olsen
- Departments of Pharmacology & Toxicology and Neurosurgery, Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Carol A. Everson
- Department of Medicine (Endocrinology and Molecular Medicine) and Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Abstract
Sleep health is an important factor across several physical and mental health disorders, and a growing scientific consensus has identified sleep as a critical component of opioid use disorder (OUD), both in the active disease state and during OUD recovery. The goal of this narrative review is to collate the literature on sleep, opioid use, and OUD as a means of identifying therapeutic targets to improve OUD treatment outcomes. Sleep disturbance is common and often severe in persons with OUD, especially during opioid withdrawal, but also in persons on opioid maintenance therapies. There is ample evidence that sleep disturbances including reduced total sleep time, disrupted sleep continuity, and poor sleep quality often accompany negative OUD treatment outcomes. Sleep disturbances are bidirectionally associated with several other factors related to negative treatment outcomes, including chronic stress, stress reactivity, low positive affect, high negative affect, chronic pain, and drug craving. This constellation of outcome variables represents a more comprehensive appraisal of the quality of life and quality of recovery than is typically assessed in OUD clinical trials. To date, there are very few clinical trials or experimental studies aimed at improving sleep health in OUD patients, either as a means of improving stress, affect, and craving outcomes, or as a potential mechanistic target to reduce opioid withdrawal and drug use behaviors. As such, the direct impact of sleep improvement in OUD patients is largely unknown, yet mechanistic and clinical research suggests that therapeutic interventions that target sleep are a promising avenue to improve OUD treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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3
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Petrie DJ, Knapp KS, Freet CS, Deneke E, Brick TR, Cleveland HH, Bunce SC. Prefrontal cortical response to natural rewards and self-reported anhedonia are associated with greater craving among recently withdrawn patients in residential treatment for opioid use disorder. Brain Res Bull 2022; 190:32-41. [PMID: 36122801 PMCID: PMC10161509 DOI: 10.1016/j.brainresbull.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022]
Abstract
Both anhedonia and craving are common among patients with opioid use disorder (OUD), and are associated with vulnerability to relapse. Although these constructs are theoretically linked relatively few studies have examined them together. In the current study, recently withdrawn patients (N = 71) in residential treatment for prescription OUD underwent a cue reactivity paradigm while being monitored with functional near-infrared spectroscopy (fNIRS). Patients also self-reported symptoms of anhedonia via the Snaith-Hamilton Pleasure Scale (SHAPS), while smartphone-based ecological momentary assessments (EMA) were used to measure craving levels. On average, lower right prefrontal cortex (PFC) activity in response to positive social stimuli was associated with higher craving (β = - 2.87; S.E. = 1.23; p = 0.02). Self-reported anhedonia moderated the association between PFC activity and craving (β = - 1.02; S.E. = 0.48; p = 0.04), such that patients with two or more anhedonic symptoms had a significant and stronger negative association between PFC activation to hedonically positive images and craving, compared to patients with fewer than two anhedonic symptoms, among whom the association was not significant. This finding provides evidence that higher levels of anhedonia among patients in residential treatment for OUD are associated with a stronger link between lower PFC response to positive social experiences and higher levels of craving, potentially increasing overall vulnerability to relapse.
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Affiliation(s)
- Daniel J Petrie
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - Kyler S Knapp
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States; Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, United States
| | - Christopher S Freet
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Erin Deneke
- Caron Treatment Centers, Wernersville, PA, United States
| | - Timothy R Brick
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States; Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, United States
| | - H Harrington Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - Scott C Bunce
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States.
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4
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Hazani HM, Naina Mohamed I, Muzaimi M, Mohamed W, Yahaya MF, Teoh SL, Pakri Mohamed RM, Mohamad Isa MF, Abdulrahman SM, Ramadah R, Kamaluddin MR, Kumar J. Goofballing of Opioid and Methamphetamine: The Science Behind the Deadly Cocktail. Front Pharmacol 2022; 13:859563. [PMID: 35462918 PMCID: PMC9021401 DOI: 10.3389/fphar.2022.859563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Globally, millions of people suffer from various substance use disorders (SUD), including mono-and polydrug use of opioids and methamphetamine. Brain regions such as the cingulate cortex, infralimbic cortex, dorsal striatum, nucleus accumbens, basolateral and central amygdala have been shown to play important roles in addiction-related behavioral changes. Clinical and pre-clinical studies have characterized these brain regions and their corresponding neurochemical changes in numerous phases of drug dependence such as acute drug use, intoxication, craving, withdrawal, and relapse. At present, many studies have reported the individual effects of opioids and methamphetamine. However, little is known about their combined effects. Co-use of these drugs produces effects greater than either drug alone, where one decreases the side effects of the other, and the combination produces a prolonged intoxication period or a more desirable intoxication effect. An increasing number of studies have associated polydrug abuse with poorer treatment outcomes, drug-related deaths, and more severe psychopathologies. To date, the pharmacological treatment efficacy for polydrug abuse is vague, and still at the experimental stage. This present review discusses the human and animal behavioral, neuroanatomical, and neurochemical changes underlying both morphine and methamphetamine dependence separately, as well as its combination. This narrative review also delineates the recent advances in the pharmacotherapy of mono- and poly drug-use of opioids and methamphetamine at clinical and preclinical stages.
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Affiliation(s)
- Hanis Mohammad Hazani
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
| | - Mustapha Muzaimi
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Wael Mohamed
- Basic Medical Science Department, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
- Faculty of Medicine, Department of Clinical Pharmacology, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamad Fairuz Yahaya
- Department of Anatomy, Faculty of Medicine, National University of Malaysia, Cheras, Malaysia
| | - Seong Lin Teoh
- Department of Anatomy, Faculty of Medicine, National University of Malaysia, Cheras, Malaysia
| | | | | | | | - Ravi Ramadah
- National Anti-Drugs Agency Malaysia, Selangor, Malaysia
| | - Mohammad Rahim Kamaluddin
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, The National University of Malaysia, Bangi, Malaysia
| | - Jaya Kumar
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Cheras, Malaysia
- *Correspondence: Jaya Kumar,
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Huhn AS, Brooner RK, Sweeney MM, Antoine D, Hammond AS, Ayaz H, Dunn KE. The association of prefrontal cortex response during a natural reward cue-reactivity paradigm, anhedonia, and demoralization in persons maintained on methadone. Addict Behav 2021; 113:106673. [PMID: 33022538 PMCID: PMC7736228 DOI: 10.1016/j.addbeh.2020.106673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 12/23/2022]
Abstract
Persons with opioid use disorder (OUD) often experience anhedonia and demoralization, yet there is relatively little research on the pathophysiology of anhedonia and demoralization in OUD treatment and recovery. In the current study, persons maintained on methadone (N = 29) underwent a natural reward-cue paradigm during functional near-infrared spectroscopy (fNIRS) imaging. Natural reward cues included highly palatable food, positive social interactions (e.g., a happy family at the dinner table), and emotional intimacy (e.g. couples embracing or kissing, but no erotic images). Participants also self-reported symptoms of anhedonia on the Snaith-Hamilton Pleasure Scale (SHPS) and demoralization on the Demoralization Scale II (DS-II). Participants who reported clinically-significant anhedonia on the SHPS displayed decreased neural activity in the right prefrontal cortex (PFC) in response to natural reward cues (F(1,25) = 3.612, p = 0.027, ηp2 = 0.302). In linear regression models of positive social cues, decreased neural activity in the right VMPFC was associated with increased SHPS total score (F(1,27) = 7.131, R2 = 0.209, p = .013), and decreased neural activity in an area encompassing the right lateral VMPFC and DLPFC was associated with increased DS-II total score (F(1,27) = 10.641, R2 = 0.283, p = 0.003). This study provides initial evidence that the prefrontal cortex is involved in the pathophysiology of anhedonia and demoralization in persons in recovery from OUD. Anhedonia and demoralization are important treatment outcomes that should be queried along with a constellation of physical and mental health outcomes, to assess areas of needed improvement in methadone maintenance and other OUD treatment modalities.
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Affiliation(s)
- Andrew S Huhn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Mary M Sweeney
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Denis Antoine
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Alexis S Hammond
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, United States; Drexel University, College of Arts and Sciences, Department of Psychology, United States; University of Pennsylvania, Department of Family and Community Health, United States; Children's Hospital of Philadelphia, Center for Injury Research and Prevention, United States
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
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6
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Pregnane steroidogenesis is altered by HIV-1 Tat and morphine: Physiological allopregnanolone is protective against neurotoxic and psychomotor effects. Neurobiol Stress 2020; 12:100211. [PMID: 32258256 PMCID: PMC7109513 DOI: 10.1016/j.ynstr.2020.100211] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/08/2020] [Accepted: 01/20/2020] [Indexed: 02/07/2023] Open
Abstract
Pregnane steroids, particularly allopregnanolone (AlloP), are neuroprotective in response to central insult. While unexplored in vivo, AlloP may confer protection against the neurological dysfunction associated with human immunodeficiency virus type 1 (HIV-1). The HIV-1 regulatory protein, trans-activator of transcription (Tat), is neurotoxic and its expression in mice increases anxiety-like behavior; an effect that can be ameliorated by progesterone, but not when 5α-reduction is blocked. Given that Tat's neurotoxic effects involve mitochondrial dysfunction and can be worsened with opioid exposure, we hypothesized that Tat and/or combined morphine would perturb steroidogenesis in mice, promoting neuronal death, and that exogenous AlloP would rescue these effects. Like other models of neural injury, conditionally inducing HIV-1 Tat in transgenic mice significantly increased the central synthesis of pregnenolone and progesterone's 5α-reduced metabolites, including AlloP, while decreasing central deoxycorticosterone (independent of changes in plasma). Morphine significantly increased brain and plasma concentrations of several steroids (including progesterone, deoxycorticosterone, corticosterone, and their metabolites) likely via activation of the hypothalamic-pituitary-adrenal stress axis. Tat, but not morphine, caused glucocorticoid resistance in primary splenocytes. In neurons, Tat depolarized mitochondrial membrane potential and increased cell death. Physiological concentrations of AlloP (0.1, 1, or 10 nM) reversed these effects. High-concentration AlloP (100 nM) was neurotoxic in combination with morphine. Tat induction in transgenic mice potentiated the psychomotor effects of acute morphine, while exogenous AlloP (1.0 mg/kg, but not 0.5 mg/kg) was ameliorative. Data demonstrate that steroidogenesis is altered by HIV-1 Tat or morphine and that physiological AlloP attenuates resulting neurotoxic and psychomotor effects.
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7
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Coccurello R. Anhedonia in depression symptomatology: Appetite dysregulation and defective brain reward processing. Behav Brain Res 2019; 372:112041. [DOI: 10.1016/j.bbr.2019.112041] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/22/2022]
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Abstract
Opioid use disorder (OUD) is a disorder that can lead to several negative outcomes, including overdose and death. A variety of opioids can be abused by individuals including both prescribed and non-prescribed opioids. Continued opioid use can be driven by negative affective states associated with opioid withdrawal. Several treatments exist in the field including medication assisted treatments such as methadone, buprenorphine, and naltrexone. Treatments such as clonidine and lofexidine can also be used to assist with decreasing withdrawal symptoms. Increasing adherence to treatment can further improve patient outcomes and promote continuation with treatment. A variety of methods to reduce relapse can also be utilized such as opioid agonists and maintenance therapy. According to the Centers for Disease Control, opioid overdoses contributed to 67.8% of overdose deaths in 2017.
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9
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Huhn AS, Sweeney MM, Brooner RK, Kidorf MS, Tompkins DA, Ayaz H, Dunn KE. Prefrontal cortex response to drug cues, craving, and current depressive symptoms are associated with treatment outcomes in methadone-maintained patients. Neuropsychopharmacology 2019; 44:826-833. [PMID: 30375498 PMCID: PMC6372589 DOI: 10.1038/s41386-018-0252-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 12/31/2022]
Abstract
Methadone maintenance is an effective treatment for opioid use disorder, yet many methadone-maintained patients (MMPs) continue to struggle with chronic relapse. The current study evaluated whether functional near-infrared spectroscopy (fNIRS) could identify prefrontal cortex (PFC) markers of ongoing opioid use in MMPs, and whether clinical measures of depression and self-report measures of craving would also be associated with opioid use. MMPs (n = 29) underwent a drug cue reactivity paradigm during fNIRS measurements of PFC reactivity. Self-reported opioid craving (measured by a visual analog scale; 0-100) was collected before and after drug cue reactivity, and depressive symptoms were assessed via the 17-item Hamilton Depression Rating Scale (HAM-D). Hierarchical regression and partial correlations were used to evaluate associations between weekly urine drug screens over a 90-day follow-up period and fNIRS, craving, and HAM-D assessments. Neural response to drug cues in the left lateral PFC, controlling for age, sex, and days in treatment was significantly associated with percent opioid-negative urine screens during follow-up (∆F1, 24 = 13.19, p = 0.001, ∆R2 = 0.30), and correctly classified 86% of MMPs as either using opioids, or abstaining from opioids (χ2(4) = 16.28, p = 0.003). Baseline craving (p < 0.001) and HAM-D assessment (p < 0.01) were also associated with percent opioid-negative urine screens. Combining fNIRS results, baseline craving scores, and HAM-D scores created a robust predictive model (∆F3, 22 = 16.75, p < 0.001, ∆R2 = 0.59). These data provide preliminary evidence that the fNIRS technology may have value as an objective measure of treatment outcomes within outpatient methadone clinics. Depressive symptoms and drug craving were also correlated with opioid use in MMPs.
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Affiliation(s)
- Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Robert K Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Michael S Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - D Andrew Tompkins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
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10
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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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11
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The relationship between childhood trauma, early-life stress, and alcohol and drug use, abuse, and addiction: An integrative review. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-9973-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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12
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Gruber SA, Sagar KA, Dahlgren MK, Gonenc A, Smith RT, Lambros AM, Cabrera KB, Lukas SE. The Grass Might Be Greener: Medical Marijuana Patients Exhibit Altered Brain Activity and Improved Executive Function after 3 Months of Treatment. Front Pharmacol 2018; 8:983. [PMID: 29387010 PMCID: PMC5776082 DOI: 10.3389/fphar.2017.00983] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/22/2017] [Indexed: 11/22/2022] Open
Abstract
The vast majority of states have enacted full or partial medical marijuana (MMJ) programs, causing the number of patients seeking certification for MMJ use to increase dramatically in recent years. Despite increased use of MMJ across the nation, no studies thus far have examined the specific impact of MMJ on cognitive function and related brain activation. In the present study, MMJ patients seeking treatment for a variety of documented medical conditions were assessed prior to initiating MMJ treatment and after 3 months of treatment as part of a larger longitudinal study. In order to examine the effect of MMJ treatment on task-related brain activation, MMJ patients completed the Multi-Source Interference Test (MSIT) while undergoing functional magnetic resonance imaging (fMRI). We also collected data regarding conventional medication use, clinical state, and health-related measures at each visit. Following 3 months of treatment, MMJ patients demonstrated improved task performance accompanied by changes in brain activation patterns within the cingulate cortex and frontal regions. Interestingly, after MMJ treatment, brain activation patterns appeared more similar to those exhibited by healthy controls from previous studies than at pre-treatment, suggestive of a potential normalization of brain function relative to baseline. These findings suggest that MMJ use may result in different effects relative to recreational marijuana (MJ) use, as recreational consumers have been shown to exhibit decrements in task performance accompanied by altered brain activation. Moreover, patients in the current study also reported improvements in clinical state and health-related measures as well as notable decreases in prescription medication use, particularly opioids and benzodiapezines after 3 months of treatment. Further research is needed to clarify the specific neurobiologic impact, clinical efficacy, and unique effects of MMJ for a range of indications and how it compares to recreational MJ use.
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Affiliation(s)
- Staci A Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Marijuana Investigations for Neuroscientific Discovery Program, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kelly A Sagar
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Marijuana Investigations for Neuroscientific Discovery Program, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Mary K Dahlgren
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Marijuana Investigations for Neuroscientific Discovery Program, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychology, Tufts University, Medford, MA, United States
| | - Atilla Gonenc
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Marijuana Investigations for Neuroscientific Discovery Program, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Rosemary T Smith
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Marijuana Investigations for Neuroscientific Discovery Program, McLean Imaging Center, McLean Hospital, Belmont, MA, United States
| | - Ashley M Lambros
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Marijuana Investigations for Neuroscientific Discovery Program, McLean Imaging Center, McLean Hospital, Belmont, MA, United States
| | - Korine B Cabrera
- Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, Belmont, MA, United States.,Marijuana Investigations for Neuroscientific Discovery Program, McLean Imaging Center, McLean Hospital, Belmont, MA, United States
| | - Scott E Lukas
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Behavioral Psychopharmacology Research Laboratory, McLean Imaging Center, McLean Hospital, Belmont, MA, United States
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13
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Kroczek AM, Haeussinger FB, Fallgatter AJ, Batra A, Ehlis AC. Prefrontal functional connectivity measured with near-infrared spectroscopy during smoking cue exposure. Addict Biol 2017; 22:513-522. [PMID: 26687485 DOI: 10.1111/adb.12344] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/27/2015] [Accepted: 11/05/2015] [Indexed: 12/11/2022]
Abstract
Cue reactivity (CR) is an important concept for relapse in substance use disorders (SUD). Although cue exposure (CE) therapy is discussed as relapse prevention, current approaches still need improvement considering its efficacy. From a neurobiological perspective, CR is related to an over-activation in sensitized subcortical structures, their projections to motivationally relevant cortical structures (e.g. orbitofrontal cortex, OFC) and deficient prefrontal inhibitory control. Therefore, we analyzed prefrontal cortical activation and its relation to craving during smoking CE. We focused on the OFC-as a projection area of sensitized subcortical structures-due its importance in the processing of reinforcement value and the dorsolateral prefrontal cortex (dlPFC) based on its importance for behavioral inhibition. Functional near-infrared spectroscopy (fNIRS) was used to assess hemodynamics in prefrontal regions during smoking CE in 24 subjects (n = 12 occasional smokers, n = 12 controls). Subjective craving intensity (minimum craving as marker of baseline inhibition, range as marker of inhibition time course) was additionally assessed. Craving ratings indicated that CR was elicited solely in smokers, not controls. Those subjective ratings correlated with hemodynamic activity in OFC (craving range) and dlPFC (minimum craving). OFC activation was found earlier throughout the CE in smokers compared to controls. Connectivity (seed-based correlation) between OFC and dlPFC was increased in smokers. fNIRS can capture prefrontal hemodynamic activity involved in CR elicited during CE and is therefore a promising method to investigate CR and its implications for relapse prevention in SUD.
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Affiliation(s)
- Agnes M. Kroczek
- Department of Psychiatry and Psychotherapy Tuebingen; University of Tuebingen; Germany
- Graduate School of Neural and Behavioural Sciences Tuebingen; Germany
| | - Florian B. Haeussinger
- Department of Psychiatry and Psychotherapy Tuebingen; University of Tuebingen; Germany
- Graduate School of Neural and Behavioural Sciences Tuebingen; Germany
| | - Andreas J. Fallgatter
- Department of Psychiatry and Psychotherapy Tuebingen; University of Tuebingen; Germany
- LEAD Graduate School Tuebingen; Germany
- Werner Reichardt Centre for Integrative Neuroscience; Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy Tuebingen; University of Tuebingen; Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy Tuebingen; University of Tuebingen; Germany
- LEAD Graduate School Tuebingen; Germany
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Garland EL, Bryan CJ, Nakamura Y, Froeliger B, Howard MO. Deficits in autonomic indices of emotion regulation and reward processing associated with prescription opioid use and misuse. Psychopharmacology (Berl) 2017; 234:621-629. [PMID: 27933366 PMCID: PMC5266620 DOI: 10.1007/s00213-016-4494-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/27/2016] [Indexed: 12/16/2022]
Abstract
RATIONALE Prescription opioid misuse and high-dose opioid use may result in allostatic dysregulation of hedonic brain circuitry, leading to reduced emotion regulation capacity. In particular, opioid misuse may blunt the ability to experience and upregulate positive affect from natural rewards. OBJECTIVES The purpose of this study was to examine associations between opioid use/misuse and autonomic indices of emotion regulation capability in a sample of chronic pain patients receiving prescription opioid pharmacotherapy. METHODS Chronic pain patients taking long-term opioid analgesics (N = 40) completed an emotion regulation task while heart rate variability (HRV) was recorded, and also completed self-report measures of opioid misuse, craving, pain severity, and emotional distress. Based on a validated cut-point on the Current Opioid Misuse Measure, participants were grouped as opioid misusers or non-misusers. Opioid misuse status and morphine equivalent daily dose (MEDD) were examined as predictors of HRV and self-reports of emotion regulation. RESULTS Opioid misusers exhibited significantly less HRV during positive and negative emotion regulation, and significantly less positive effect, than non-misusers, after controlling for confounders including pain severity and emotional distress. MEDD was inversely associated with positive emotion regulation efficacy. CONCLUSION Findings implicate the presence of reward processing deficits among chronic pain patients with opioid-misusing behaviors, and opioid dosage was associated with deficient emotion regulation, suggesting the presence of compromised top-down cognitive control over bottom-up hedonic processes. Emotion regulation among opioid misusers may represent an important treatment target.
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15
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Lydon-Staley DM, Cleveland HH, Huhn AS, Cleveland MJ, Harris J, Stankoski D, Deneke E, Meyer RE, Bunce SC. Daily sleep quality affects drug craving, partially through indirect associations with positive affect, in patients in treatment for nonmedical use of prescription drugs. Addict Behav 2017; 65:275-282. [PMID: 27544697 DOI: 10.1016/j.addbeh.2016.08.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/28/2016] [Accepted: 08/13/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Sleep disturbance has been identified as a risk factor for relapse in addiction to a range of substances. The relationship between sleep quality and treatment outcome has received relatively little attention in research on nonmedical use of prescription drugs (NMUPD). This study examined the within-person association between sleep quality and craving in medically detoxified patients in residence for the treatment of NMUPD. METHOD Participants (n=68) provided daily reports of their sleep quality, negative affect (NA), positive affect (PA), and craving for an average of 9.36 (SD=2.99) days. Within-person associations of sleep quality and craving were examined using multilevel modeling. Within-person mediation analyses were used to evaluate the mediating roles of NA and PA in the relationship between sleep quality and craving. RESULTS Greater cravings were observed on days of lower than usual sleep quality (γ10=-0.10, p=0.003). Thirty-one percent of the overall association between sleep quality and craving was explained by PA, such that poorer sleep quality was associated with lower PA and, in turn, lower PA was associated with greater craving. No evidence emerged for an indirect association between sleep quality and craving through NA. CONCLUSIONS Daily fluctuations in sleep quality were associated with fluctuations in craving, an association partially explained by the association between sleep quality and daily PA. These data encourage further research on the relationship between sleep, affect, and craving in NMUPD patients, as well as in patients with other substance use disorders.
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Affiliation(s)
- David M Lydon-Staley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States.
| | - H Harrington Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - Andrew S Huhn
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Michael J Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - Jonathan Harris
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Dean Stankoski
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Erin Deneke
- Caron Treatment Centers, Wernersville, PA, United States
| | - Roger E Meyer
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Scott C Bunce
- Department of Psychiatry, The Pennsylvania State University College of Medicine, Hershey, PA, United States
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16
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Huhn AS, Meyer RE, Harris JD, Ayaz H, Deneke E, Stankoski DM, Bunce SC. Evidence of anhedonia and differential reward processing in prefrontal cortex among post-withdrawal patients with prescription opiate dependence. Brain Res Bull 2016; 123:102-9. [PMID: 26711857 PMCID: PMC4893930 DOI: 10.1016/j.brainresbull.2015.12.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022]
Abstract
Anhedonia is an important but understudied element of a neuroadaptive model underlying vulnerability to relapse in opioid dependence. Previous research using fMRI has shown reduced activation to pleasant stimuli in rostral prefrontal cortex among heroin-dependent patients in early recovery. This study evaluated the presence of anhedonia among recently withdrawn prescription opiate dependent patients (PODP) in residential treatment compared to control subjects. Anhedonia was assessed using self-report, affect-modulated startle response (AMSR), and a cue reactivity task during which participant's rostral prefrontal cortex (RPFC) and ventrolateral prefrontal cortex (VLPFC) was monitored with functional near infrared spectroscopy (fNIRS). The cue reactivity task included three distinct categories of natural reward stimuli: highly palatable food, positive social situations, and intimate (non-erotic) interactions. PODP reported greater anhedonia on self-report (Snaith-Hamilton Pleasure Scale), and showed reduced hedonic response to positive stimuli in the AMSR task relative to controls. PODP also exhibited reduced neural activation in bilateral RPFC and left VLPFC in response to food images and reduced left VLPFC in response to images depicting positive social situations relative to controls. No differences were found for emotionally intimate stimuli. When patients were divided into groups based on the Snaith-Hamilton criteria for the presence or absence of anhedonia, patients endorsing anhedonia showed reduced neural responses to images depicting positive social stimuli and food relative to patients who did not endorse anhedonia. Activations were in areas of RPFC that support the retrieval of episodic memories. The results suggest the presence of anhedonia in a subsample of PODP.
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Affiliation(s)
- A S Huhn
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - R E Meyer
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - J D Harris
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - H Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States
| | - E Deneke
- Caron Treatment Centers, Wernersville, PA, United States
| | - D M Stankoski
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - S C Bunce
- Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, United States; School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States.
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