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Sahlem GL, Dowdle LT, Baker NL, Sherman BJ, Gray KM, McRae-Clark AL, Froeliger B, Squeglia LM. Exploring the Utility of a Functional Magnetic Resonance Imaging (fMRI) Cannabis Cue-Reactivity Paradigm in Treatment Seeking Adults with Cannabis Use Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00274-X. [PMID: 39326740 DOI: 10.1016/j.bpsc.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/21/2024] [Accepted: 09/10/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) studies examining cue-reactivity in cannabis use disorder (CUD) have either had small sample sizes or involved non-treatment-seeking participants. As a secondary analysis, we administered an fMRI cue-reactivity task to CUD participants entering two separate clinical trials (varenicline or repetitive Transcranial Magnetic Stimulation-rTMS) to determine the task activation patterns for treatment-seeking participants with CUD. We aimed to determine the activation patterns for the total sample and determined behavioral correlates. We additionally compared studies to determine if patterns were consistent. METHODS Treatment-seeking participants with moderate or severe CUD had behavioral craving measured at baseline via the short form of the Marijuana Craving Questionnaire (MCQ-SF) and completed a visual cannabis cue-reactivity task during fMRI (measuring the Blood-Oxygen-Level-Dependent-BOLD response) following 24-hours of cannabis-abstinence. RESULTS Sixty-five participants were included (37-varenicline, 28-rTMS; 32% female; mean-age 30.4±9.9SD). When contrasting cannabis-images vs. matched-neutral-images, participants showed greater BOLD response in bilateral ventromedial-prefrontal, dorsolateral-prefrontal, anterior cingulate, and visual cortices, as well as the striatum. There was stronger task-based functional-connectivity (tbFC) between the medial prefrontal cortex and both the amygdala and the visual cortex. Craving negatively correlated with BOLD response in the left ventral striatum (R2=-0.32; p=0.01) in the full sample. There were no significant differences in either activation or tbFC between studies. DISCUSSION Among two separate treatment-seeking groups with CUD, there was increased cannabis cue-reactivity and tbFC in regions related to executive function and reward processing. Cannabis-craving was negatively associated with cue-reactivity in the left ventral striatum.
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Affiliation(s)
- Gregory L Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University.
| | - Logan T Dowdle
- Department of Radiology University of Minnesota, Minneapolis, MN
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina
| | - Brian J Sherman
- Department of Psychiatry, Medical University of South Carolina; Department of Psychology, The Citadel, Charleston, SC
| | - Kevin M Gray
- Department of Psychiatry, Medical University of South Carolina
| | - Aimee L McRae-Clark
- Department of Psychiatry, Medical University of South Carolina; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC
| | - Brett Froeliger
- Department of Psychiatry, Department of Psychological Sciences, University of Missouri, Columbia, MO
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Sahlem GL, Dowdle LT, Baker NL, Sherman BJ, Gray KM, McRae-Clark AL, Froeliger B, Squeglia LM. Exploring the Utility of a Functional Magnetic Resonance Imaging (fMRI) Cannabis Cue-Reactivity Paradigm in Treatment Seeking Adults with Cannabis Use Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.14.23298485. [PMID: 38014250 PMCID: PMC10680897 DOI: 10.1101/2023.11.14.23298485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Introduction Functional magnetic resonance imaging (fMRI) studies examining cue-reactivity in cannabis use disorder (CUD) to date have either involved non-treatment seeking participants or been small. We addressed this gap by administering an fMRI cue-reactivity task to CUD participants entering two separate clinical trials. Methods Treatment-seeking participants with moderate or severe CUD had behavioral craving measured at baseline via the Marijuana Craving Questionnaire (MCQ-SF). They additionally completed a visual cannabis cue-reactivity paradigm during fMRI following 24-hours of abstinence from cannabis. During fMRI, the Blood Oxygen Level Dependent (BOLD) signal was acquired while participants viewed cannabis-images or matched-neutral-images. BOLD responses were correlated with the MCQ-SF using a General Linear Model. Results N=65 participants (32% female; mean age 30.4±9.9SD) averaged 46.3±15.5SD on the MCQ-SF. When contrasting cannabis-images vs. matched-neutral-images, participants showed greater BOLD response in bilateral ventromedial prefrontal, dorsolateral prefrontal, anterior cingulate, and visual cortices, as well as the striatum. Similarly, there was stronger task-based functional-connectivity (tbFC) between the medial prefrontal cortex and both the amygdala and the visual cortex. There were no significant differences in either activation or tbFC between studies or between sexes. Craving negatively correlated with BOLD response in the left ventral striatum (R 2 =-0.25; p =0.01). Conclusions We found that, among two separate treatment-seeking CUD groups, cannabis cue-reactivity was evidenced by greater activation and tbFC in regions related to executive function and reward processing, and craving was negatively associated with cue-reactivity in the ventral striatum. Future directions include examining if pharmacological, neuromodulatory, or psychosocial interventions can alter corticostriatal cue-reactivity.
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Spencer CN, Elton A, Dove S, Faulkner ML, Robinson DL, Boettiger CA. Naltrexone engages a brain reward network in the presence of reward-predictive distractor stimuli in males. ADDICTION NEUROSCIENCE 2023; 7:100085. [PMID: 37424633 PMCID: PMC10328541 DOI: 10.1016/j.addicn.2023.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The non-selective opioid receptor antagonist, naltrexone is one of the most prescribed medications for treating alcohol and opioid addiction. Despite decades of clinical use, the mechanism(s) by which naltrexone reduces addictive behavior remains unclear. Pharmaco-fMRI studies to date have largely focused on naltrexone's impact on brain and behavioral responses to drug or alcohol cues or on decision-making circuitry. We hypothesized that naltrexone's effects on reward-associated brain regions would associate with reduced attentional bias (AB) to non-drug, reward-conditioned cues. Twenty-three adult males, including heavy and light drinkers, completed a two-session, placebo-controlled, double-blind study testing the effects of acute naltrexone (50 mg) on AB to reward-conditioned cues and neural correlates of such bias measured via fMRI during a reward-driven AB task. While we detected significant AB to reward-conditioned cues, naltrexone did not reduce this bias in all participants. A whole-brain analysis found that naltrexone significantly altered activity in regions associated with visuomotor control regardless of whether a reward-conditioned distractor was present. A region-of-interest analysis of reward-associated areas found that acute naltrexone increased BOLD signal in the striatum and pallidum. Moreover, naltrexone effects in the pallidum and putamen predicted individual reduction in AB to reward-conditioned distractors. These findings suggest that naltrexone's effects on AB primarily reflect not reward processing per se, but rather top-down control of attention. Our results suggest that the therapeutic actions of endogenous opioid blockade may reflect changes in basal ganglia function enabling resistance to distraction by attractive environmental cues, which could explain some variance in naltrexone's therapeutic efficacy.
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Affiliation(s)
- Cory N. Spencer
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda Elton
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
- Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samantha Dove
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Monica L. Faulkner
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Donita L. Robinson
- Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charlotte A. Boettiger
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
- Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Grodin EN, Meredith LR, Burnette EM, Miotto K, Irwin MR, Ray LA. Baseline C-reactive protein levels are predictive of treatment response to a neuroimmune modulator in individuals with an alcohol use disorder: a preliminary study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:333-344. [PMID: 36282988 PMCID: PMC10840759 DOI: 10.1080/00952990.2022.2124918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023]
Abstract
Background: Inflammation is implicated in alcohol use disorder (AUD). Ibudilast, a neuroimmune modulator, shows promise for the treatment of AUD. Elevated inflammation, indicated by high levels of C-reactive protein (CRP), represents a possible subtype of AUD, which may be associated with treatment response to ibudilast.Objectives: The current study evaluated CRP as a predictor of treatment response to ibudilast; hypothesizing that ibudilast would be more effective at reducing drinking and alcohol cue-reactivity in individuals with higher CRP levels.Methods: This is a secondary analysis of a clinical trial of ibudilast for AUD, which found that ibudilast reduced heavy drinking in individuals with AUD. Fifty-one individuals were randomized to receive ibudilast (n = 24 [16 M/8F]) or placebo (n = 27 [18 M/9F]) for two weeks. Participants provided blood samples at baseline to assess CRP levels, completed daily assessments of alcohol use, and an fMRI alcohol cue-reactivity task at study mid-point. Models tested the effects of medication, CRP levels, and their interaction on drinks per drinking day and alcohol cue-reactivity.Results: There was a significant interaction between medication and CRP (F = 3.80, p = .03), such that the ibudilast high CRP group had fewer drinks per drinking day compared to the ibudilast low CRP group. CRP moderated the effect of medication on brain activation in a cluster extending from the left inferior frontal gyrus to the right-dorsal striatum (Z = 4.55, p < .001). This interaction was driven by attenuated cue-reactivity in the ibudilast high CRP group relative to the ibudilast low CRP and placebo high CRP groups.Conclusions: This study serves as an initial investigation into predictors of clinical response to ibudilast treatment and suggests that a baseline proinflammatory profile may enhance clinical efficacy.
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Affiliation(s)
- Erica N. Grodin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Lindsay R. Meredith
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Elizabeth M. Burnette
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Neuroscience Interdepartmental Program, University of California at Los Angeles, Los Angeles, CA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
| | - Michael R. Irwin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
- Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, CA
| | - Lara A. Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
- Brain Research Institute, University of California, Los Angeles, CA
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Deep brain stimulation of the nucleus accumbens in treatment-resistant alcohol use disorder: a double-blind randomized controlled multi-center trial. Transl Psychiatry 2023; 13:49. [PMID: 36755017 PMCID: PMC9908935 DOI: 10.1038/s41398-023-02337-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
Treatment resistance in alcohol use disorders (AUD) is a major problem for affected individuals and for society. In the search of new treatment options, few case studies using deep brain stimulation (DBS) of the nucleus accumbens have indicated positive effects in AUD. Here we report a double-blind randomized controlled trial comparing active DBS ("DBS-EARLY ON") against sham stimulation ("DBS-LATE ON") over 6 months in n = 12 AUD inpatients. This 6-month blind phase was followed by a 12-month unblinded period in which all patients received active DBS. Continuous abstinence (primary outcome), alcohol use, alcohol craving, depressiveness, anxiety, anhedonia and quality of life served as outcome parameters. The primary intention-to-treat analysis, comparing continuous abstinence between treatment groups, did not yield statistically significant results, most likely due to the restricted number of participants. In light of the resulting limited statistical power, there is the question of whether DBS effects on secondary outcomes can nonetheless be interpreted as indicative of an therapeutic effect. Analyses of secondary outcomes provide evidence for this, demonstrating a significantly higher proportion of abstinent days, lower alcohol craving and anhedonia in the DBS-EARLY ON group 6 months after randomization. Exploratory responder analyses indicated that patients with high baseline alcohol craving, depressiveness and anhedonia responded to DBS. The results of this first randomized controlled trial are suggestive of beneficial effects of DBS in treatment-resistant AUD and encourage a replication in larger samples.
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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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Florence L, Lassi DLS, Kortas GT, Lima DR, de Azevedo-Marques Périco C, Andrade AG, Torales J, Ventriglio A, De Berardis D, De Aquino JP, Castaldelli-Maia JM. Brain Correlates of the Alcohol Use Disorder Pharmacotherapy Response: A Systematic Review of Neuroimaging Studies. Brain Sci 2022; 12:brainsci12030386. [PMID: 35326342 PMCID: PMC8946664 DOI: 10.3390/brainsci12030386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 01/17/2023] Open
Abstract
Background: Although Alcohol Use Disorder (AUD) is highly prevalent worldwide, treating this condition remains challenging. Further, potential treatments for AUD do not fully address alcohol-induced neuroadaptive changes. Understanding the effects of pharmacotherapies for AUD on the human brain may lead to tailored, more effective treatments, and improved individual clinical outcomes. Objectives: We systematically reviewed the literature for studies investigating pharmacotherapies for AUD that included neuroimaging-based treatment outcomes. We searched the PubMed, Scielo, and PsycINFO databases up to January 2021. Study eligibility criteria, participants, and interventions: Eligible studies included those investigating pharmacotherapies for AUD and employing functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and/or proton magnetic resonance spectroscopy (H-MRS). Study appraisal and synthesis methods: Two independent reviewers screened studies’ titles and abstracts for inclusion. Data extraction forms were shared among all the authors to standardize data collection. We gathered information on the following variables: sample size; mean age; sociodemographic and clinical characteristics; alcohol use status; study design and methodology; main neuroimaging findings and brain-regions of interest (i.e., brain areas activated by alcohol use and possible pharmacological interactions); and limitations of each study. Results: Out of 177 studies selected, 20 studies provided relevant data for the research topic. Findings indicate that: (1) Acamprosate and gabapentin may selectively modulate limbic regions and the anterior cingulate cortex; (2) Naltrexone and disulfiram effects may involve prefrontal, premotor, and cerebellar regions; (3) Pharmacotherapies acting on glutamate and GABA neurotransmission involve primarily areas underpinning reward and negative affective states, and; (4) Pharmacotherapies acting on opioid and dopamine systems may affect areas responsible for the cognitive and motor factors of AUD. Limitations: Most of the studies were focused on naltrexone. A small number of studies investigated the action of disulfiram and gabapentin, and no neuroimaging studies investigated topiramate. In addition, the time between medication and neuroimaging scans varied widely across studies. Conclusions: We identified key-brain regions modulated by treatments available for AUD. Some of the regions modulated by naltrexone are not specific to the brain reward system, such as the parahippocampal gyrus (temporal lobe), parietal and occipital lobes. Other treatments also modulate not specific regions of the reward system, but play a role in the addictive behaviors, including the insula and dorsolateral prefrontal cortex. The role of these brain regions in mediating the AUD pharmacotherapy response warrants investigation in future research studies.
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Affiliation(s)
- Luiza Florence
- Department of Neuroscience, FMABC University Center, Santo André 09060-870, SP, Brazil; (L.F.); (C.d.A.-M.P.); (A.G.A.)
| | - Dângela Layne Silva Lassi
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
| | - Guilherme T. Kortas
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
| | - Danielle R. Lima
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
| | | | - Arthur G. Andrade
- Department of Neuroscience, FMABC University Center, Santo André 09060-870, SP, Brazil; (L.F.); (C.d.A.-M.P.); (A.G.A.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
| | - Julio Torales
- Department of Psychiatry, National University of Asunción, San Lorenzo 2064, Paraguay;
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Domenico De Berardis
- Mental Health Center of Giulianova, Asl Teramo, 64021 Giulianova, Italy;
- Department of Neurosciences and Imaging, University “G. D’Annunzio” Chieti, 66100 Chieti, Italy
- International Centre for Education and Research in Neuropsychiatry, University of Samara, 443100 Samara, Russia
| | - João P. De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA;
| | - João M. Castaldelli-Maia
- Department of Neuroscience, FMABC University Center, Santo André 09060-870, SP, Brazil; (L.F.); (C.d.A.-M.P.); (A.G.A.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
- Correspondence:
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Abstract
Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. Given that AUD is a very heterogeneous disorder, it is unlikely that one single medication will be effective for all individuals with an AUD. As such, there is a need to develop new, more effective, and diverse pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. In this qualitative literature review, we discuss the efficacy, mechanism of action, and tolerability of approved, repurposed, and novel pharmacotherapies for the treatment of AUD with a clinical perspective. Pharmacotherapies discussed include: disulfiram, acamprosate, naltrexone, nalmefene, topiramate, gabapentin, varenicline, baclofen, sodium oxybate, aripiprazole, ondansetron, mifepristone, ibudilast, suvorexant, prazosin, doxazosin, N-acetylcysteine, GET73, ASP8062, ABT-436, PF-5190457, and cannabidiol. Overall, many repurposed and novel agents discussed in this review demonstrate clinical effectiveness and promise for the future of AUD treatment. Importantly, these medications also offer potential improvements towards the advancement of precision medicine and personalized treatment for the heterogeneous AUD population. However, there remains a great need to improve access to treatment, increase the menu of approved pharmacological treatments, and de-stigmatize and increase treatment-seeking for AUD.
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Le TM, Malone T, Li CSR. Positive alcohol expectancy and resting-state functional connectivity of the insula in problem drinking. Drug Alcohol Depend 2022; 231:109248. [PMID: 34998254 PMCID: PMC8881788 DOI: 10.1016/j.drugalcdep.2021.109248] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
Positive alcohol expectancy (AE), a significant predictor of excessive alcohol consumption, is associated with heightened drinking motivation and reduced control. As the insula interacts with the limbic and prefrontal structures to integrate stimulus saliency, interoception, and cognitive control, the region may play a unique role in modulating AE. Here, we examined resting-state functional connectivity of the right and left insula in relation to AE in 180 adult drinkers. Whole-brain multiple regressions and path analysis were performed to delineate the inter-relationship between AE, insular connectivity, and drinking severity. We found that heightened AE was associated with diminished right insular connectivity with regions involved in negative emotion processing and self-control, including the amygdala, putamen, and ventromedial prefrontal cortex. In contrast, there was a positive relationship between AE and right insular connectivity with regions implicated in motivated responses to alcohol stimuli, including the superior parietal lobule, postcentral and superior frontal gyri. Path analysis showed that the two sets of right insular connectivity exhibited opposing associations with AE and that their net strength (i.e., "control minus motivation") was negatively correlated with AE and drinking severity. Analyses of the left insula seed, in contrast, did not yield regional connectivity in significant correlation with AE. These findings highlight the roles of right insula connectivity in motivational and regulatory processes that may differentially modulate drinking behavior. Recruitment of the motivational circuit and/or disengagement of the affective control circuit would be associated with heightened AE and heavier alcohol consumption.
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Affiliation(s)
- Thang M. Le
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA,Correspondence: Thang M. Le, Ph.D., Connecticut Mental Health Center, S105, 34 Park Street, New Haven, CT 06519-1109, USA, , Phone: 203-974-7360
| | - Tessa Malone
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Chiang-Shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520, USA,Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT 06520, USA,Wu Tsai Institute, Yale University, New Haven, CT, USA
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Bach P, Reinhard I, Koopmann A, Bumb JM, Sommer WH, Vollstädt‐Klein S, Kiefer F. Test-retest reliability of neural alcohol cue-reactivity: Is there light at the end of the magnetic resonance imaging tube? Addict Biol 2022; 27:e13069. [PMID: 34132011 DOI: 10.1111/adb.13069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/25/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
Over the last decades, the assessment of alcohol cue-reactivity gained popularity in addiction research, and efforts were undertaken to establish neural biomarkers. This attempt however depends on the reliability of cue-induced brain activation. Thus, we assessed test-retest reliability of alcohol cue-reactivity and its implications for imaging studies in addiction. We investigated test-retest reliability of alcohol cue-induced brain activation in 144 alcohol-dependent patients over 2 weeks. We computed established reliability estimates, such as intraclass correlation (ICC), Dice and Jaccard coefficients, for the three contrast conditions of interest: 'alcohol', 'neutral' and the 'alcohol versus neutral' difference contrast. We also investigated how test-retest reliability of the different contrasts affected the capacity to establishing associations with clinical data and determining effect size estimates. Whereas brain activation, indexed by the constituting contrast conditions 'alcohol' and 'neutral' separately, displayed overall moderate (ICC > 0.4) to good (ICC > 0.75) test-retest reliability in areas of the mesocorticolimbic system, the difference contrast 'alcohol versus neutral' showed poor overall reliability (ICC < 0.40), which was related to the intercorrelation between the constituting conditions. Data simulations and analyses of craving data confirmed that the low reliability of the difference contrast substantially limited the capacity to establish associations with clinical data and precisely estimate effect sizes. Future research on alcohol cue-reactivity should be cautioned by the low reliability of the common 'alcohol versus neutral' difference contrast. We propose that this limitation can be overcome by using the constituent task conditions as an individual difference measure, when intending to longitudinally monitor brain responses.
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Affiliation(s)
- Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS) University of Heidelberg Heidelberg Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University Mannheim Germany
| | - Anne Koopmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS) University of Heidelberg Heidelberg Germany
| | - Jan M. Bumb
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS) University of Heidelberg Heidelberg Germany
| | - Wolfgang H. Sommer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University Mannheim Germany
- Institute of Psychopharmacology, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University Mannheim Germany
| | - Sabine Vollstädt‐Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University Mannheim Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS) University of Heidelberg Heidelberg Germany
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Hill-Bowen LD, Riedel MC, Poudel R, Salo T, Flannery JS, Camilleri JA, Eickhoff SB, Laird AR, Sutherland MT. The cue-reactivity paradigm: An ensemble of networks driving attention and cognition when viewing drug and natural reward-related stimuli. Neurosci Biobehav Rev 2021; 130:201-213. [PMID: 34400176 PMCID: PMC8511211 DOI: 10.1016/j.neubiorev.2021.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
The cue-reactivity paradigm is a widely adopted neuroimaging probe engendering brain activity linked with attentional, affective, and reward processes following presentation of appetitive stimuli. Given the multiple mental operations invoked, we sought to decompose cue-related brain activity into constituent components employing emergent meta-analytic techniques when considering drug and natural reward-related cues. We conducted coordinate-based meta-analyses delineating common and distinct brain activity convergence across cue-reactivity studies (N = 196 articles) involving drug (n = 133) or natural (n = 63) visual stimuli. Across all studies, convergence was observed in limbic, cingulate, insula, and fronto-parieto-occipital regions. Drug-distinct convergence was observed in posterior cingulate, dorsolateral prefrontal, and temporo-parietal regions, whereas distinct-natural convergence was observed in thalamic, insular, orbitofrontal, and occipital regions. We characterized connectivity profiles of identified regions by leveraging task-independent and task-dependent MRI datasets, grouped these profiles into subnetworks, and linked each with putative mental operations. Outcomes suggest multifaceted brain activity during cue-reactivity can be decomposed into elemental processes and indicate that while drugs of abuse usurp the brain's natural-reward-processing system, some regions appear distinct to drug cue-reactivity.
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Affiliation(s)
- Lauren D Hill-Bowen
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Michael C Riedel
- Department of Physics, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Ranjita Poudel
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Taylor Salo
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Jessica S Flannery
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Julia A Camilleri
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, 52425, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, 52425, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Angela R Laird
- Department of Physics, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States
| | - Matthew T Sutherland
- Department of Psychology, Florida International University, 11200 SW 8(th)Street, Miami, FL, 33199, United States.
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12
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Roos CR, Bold KW, Witkiewitz K, Leeman RF, DeMartini KS, Fucito LM, Corbin WR, Mann K, Kranzler HR, O’Malley SS. Reward drinking and naltrexone treatment response among young adult heavy drinkers. Addiction 2021; 116:2360-2371. [PMID: 33620746 PMCID: PMC8328878 DOI: 10.1111/add.15453] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/11/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022]
Abstract
AIMS Theory-driven, exploratory study to: (i) identify a reward drinking phenotype in young adults; (ii) evaluate this phenotype as a predictor of naltrexone response; and (iii) examine mechanisms of naltrexone in reward drinkers. DESIGN Secondary analysis of a randomized controlled trial. SETTING USA. PARTICIPANTS A total of 128 young adult (ages 18-25) heavy drinkers. INTERVENTIONS Naltrexone versus placebo. MEASUREMENTS Daily surveys assessed affect, urge, drinking, and context. The Drinking Motives Questionnaire was used to identify phenotypes based on reward (enhancement motives) and relief (coping motives) drinking. FINDINGS We identified three profiles: "Low reward/Low relief" (14.1%; low enhancement/low coping motives); "Reward drinkers" (62.2%; high enhancement/low coping motives); and "High reward/High relief" (22.7%; high enhancement/high coping motives). Among reward drinkers (versus low profile), naltrexone significantly reduced percent days drinking to intoxication (blood alcohol concentration [BAC] ≥0.08) (PDI) (d = 0.56; 95% CI [0.17, 0.96]) and percent high intensity drinking days (PHID) (8/10 drinks for women/men) (d = 0.32; 95% CI [0.01, 0.68]). Among the high reward/high relief profile drinkers (versus low profile), naltrexone reduced PHID (d = 0.69; 95% CI [0.02, 1.50]). Using profile-informed cutoffs and observed scores (for clinical applicability): (i) among cutoff-derived reward drinkers, we found a medium-to-large (d = 0.66; 95% CI [0.24, 1.16]) and small effect (d = 0.28; 95% CI [0.04, 0.72]) of naltrexone in reducing PDI and PHID, respectively; and (ii) among the cutoff-derived high reward/high relief subgroup, we found a medium-to-large effect (d = 0.63; 95% CI [0.05, 1.1]) of naltrexone in reducing PHID. Among reward drinkers (not other profiles), naltrexone reduced drinking on days a drinking event occurred by weakening the within-day association between positive affect and urges (P < 0.05). CONCLUSIONS Naltrexone has pronounced effects in reducing risky drinking among young adult reward drinkers (high reward/low relief) by reducing urges on days when individuals have higher positive affect and are exposed to a drinking event. Naltrexone also appears to reduce risky drinking among young adult high reward/high relief drinkers, but not via the same mechanism.
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Affiliation(s)
- Corey R. Roos
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Krysten W. Bold
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Katie Witkiewitz
- University of New Mexico, Department of Psychology, Albuquerque, NM
| | - Robert F. Leeman
- Yale School of Medicine, Department of Psychiatry, New Haven, CT,University of Florida, Department of Health Education and Behavior, Gainesville, FL
| | | | - Lisa M. Fucito
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | | | - Karl Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim Germany
| | - Henry R. Kranzler
- Perelman School of Medicine, University of Pennsylvania and Crescenz VAMC, Philadelphia, PA
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13
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Bach P, Weil G, Pompili E, Hoffmann S, Hermann D, Vollstädt-Klein S, Kiefer F, Mann K, Sommer WH. FMRI-based prediction of naltrexone response in alcohol use disorder: a replication study. Eur Arch Psychiatry Clin Neurosci 2021; 271:915-927. [PMID: 33884495 PMCID: PMC8236024 DOI: 10.1007/s00406-021-01259-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/30/2021] [Indexed: 12/20/2022]
Abstract
Pharmacological treatment in alcohol use disorder suffers from modest effect sizes. Efforts have been undertaken to identify patient characteristics that help to select individuals that benefit from pharmacological treatment. Previous studies indicated that neural alcohol cue-reactivity (CR) might provide a marker that identifies patients, which benefit from naltrexone treatment.We investigated the reproducibility of the association between ventral striatum (VS) activation and naltrexone (NTX) treatment response by analyzing data from a recent longitudinal clinical trial in N = 44 abstinent treatment-seeking alcohol-dependent patients. A follow-up was conducted over 3 months. We computed the percentage of significant voxels in VS and tested main effects and interactions with NTX treatment on relapse risk using Cox Regression models.We found a significant interaction effect between pre-treatment cue reactivity in the VS and NTX treatment on time to first heavy relapse (Hazard Ratio = 7.406, 95% CI 1.17-46.56, p = 0.033), such that the patient group with high VS activation (defined by a mean split) showed a significant medication effect (Hazard Ratio = 0.140, 95% CI 0.02-0.75, p = 0.022) with a number needed to treat of 3.4 [95% CI 2.413.5], while there was no significant effect in the group with low VS activation (Hazard Ratio = 0.726, p = 0.454).Thus, using an independent sample we replicated the previously described positive association between VS activation and NTX efficacy. Although our results should be considered cautiously in light of the small sample size, our results support the potential of neural alcohol CR as a tool for precision medicine approaches in alcohol dependence.
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Affiliation(s)
- Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany.
- Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany.
| | - Georg Weil
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
| | - Enrico Pompili
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
- Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Derik Hermann
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
- Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
- Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
| | - Wolfgang H Sommer
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159, Mannheim, Germany
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
- Bethanien Hospital for Psychiatry, Greifswald, Germany
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14
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Karl D, Bumb JM, Bach P, Dinter C, Koopmann A, Hermann D, Mann K, Kiefer F, Vollstädt-Klein S. Nalmefene attenuates neural alcohol cue-reactivity in the ventral striatum and subjective alcohol craving in patients with alcohol use disorder. Psychopharmacology (Berl) 2021; 238:2179-2189. [PMID: 33846866 PMCID: PMC8292278 DOI: 10.1007/s00213-021-05842-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/29/2021] [Indexed: 12/31/2022]
Abstract
RATIONALE Alcohol use disorder is a common and devastating mental illness for which satisfactory treatments are still lacking. Nalmefene, as an opioid receptor modulator, could pharmacologically support the reduction of drinking by reducing the (anticipated) rewarding effects of alcohol and expanding the range of treatment options. It has been hypothesized that nalmefene acts via an indirect modulation of the mesolimbic reward system. So far, only a few imaging findings on the neuronal response to nalmefene are available. OBJECTIVES We tested the effect of a single dose of 18 mg nalmefene on neuronal cue-reactivity in the ventral and dorsal striatum and subjective craving. METHODS Eighteen non-treatment-seeking participants with alcohol use disorder (67% male, M = 50.3 ± 13.9 years) with a current high-risk drinking level (M = 76.9 ± 52 g of pure alcohol per day) were investigated using a cue-reactivity task during functional magnetic resonance imaging (fMRI) in a double-blind, placebo-controlled, cross-over study/design. In addition, self-reported craving was assessed before and after exposure to alcohol cues. RESULTS An a priori defined region of interest (ROI) analysis of fMRI data from 15 participants revealed that nalmefene reduced alcohol cue-reactivity in the ventral, but not the dorsal striatum. Additionally, the subjective craving was significantly reduced after the cue-reactivity task under nalmefene compared to placebo. CONCLUSION In the present study, reduced craving and cue-reactivity to alcohol stimuli in the ventral striatum by nalmefene indicates a potential anti-craving effect of this drug via attenuation of neural alcohol cue-reactivity.
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Affiliation(s)
- Damian Karl
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - J Malte Bumb
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Patrick Bach
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Christina Dinter
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Anne Koopmann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Derik Hermann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
| | - Karl Mann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany
- Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany.
- Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany.
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15
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Zeng J, Yu S, Cao H, Su Y, Dong Z, Yang X. Neurobiological correlates of cue-reactivity in alcohol-use disorders: A voxel-wise meta-analysis of fMRI studies. Neurosci Biobehav Rev 2021; 128:294-310. [PMID: 34171325 DOI: 10.1016/j.neubiorev.2021.06.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/31/2021] [Accepted: 06/19/2021] [Indexed: 02/08/2023]
Abstract
Altered brain responses to alcohol-associated stimuli are a neural hallmark of alcohol-use disorder (AUD) and a promising target for pharmacotherapy. However, findings in cue-reactivity based functional MRI (fMRI) studies are inconclusive. To investigate the neural substrates of cue-reactivity and their relevance to treatment outcomes, alcohol craving and relapse in AUD patients, we performed five meta-analyses using signed differential mapping software. Our meta-analysis revealed that alcohol cues evoke greater cue-reactivity than neutral cues in the mesocorticolimbic circuit and lower reactivity in the parietal and temporal regions in AUD patients. Compared to controls, AUD individuals displayed hyperactivations in the medial prefrontal cortex and anterior/middle part of the cingulate cortex. After receiving AUD treatment, AUD patients exhibited greater activations in the precentral gyrus but reduced activations in the bilateral caudate nucleus, insula, right DLPFC, and left superior frontal gyrus. No significant results were found in cue-reactivity correlates of alcohol craving and relapse. Our results implicate cue-induced abnormalities in corticostriatal-limbic circuits may underline the pathophysiology of AUD, and have translational value for treatment development.
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Affiliation(s)
- Jianguang Zeng
- School of Economics and Business Administration, Chongqing University, Chongqing, 400044, China
| | - Shuxian Yu
- School of Economics and Business Administration, Chongqing University, Chongqing, 400044, China
| | - Hengyi Cao
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Hempstead, NY, USA; Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Yueyue Su
- School of Public Policy and Administration, Chongqing University, Chongqing, 400044, China
| | - Zaiquan Dong
- Department of Psychiatry, State Key Lab of Biotherapy, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xun Yang
- School of Public Policy and Administration, Chongqing University, Chongqing, 400044, China.
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16
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It is never as good the second time around: Brain areas involved in salience processing habituate during repeated drug cue exposure in treatment engaged abstinent methamphetamine and opioid users. Neuroimage 2021; 238:118180. [PMID: 34020015 DOI: 10.1016/j.neuroimage.2021.118180] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022] Open
Abstract
The brain response to drug-related cues is an important marker in addiction-medicine. However, the temporal dynamics of this response in repeated exposure to cues are not well known. In an fMRI drug cue-reactivity task, the presence of rapid habituation or sensitization was investigated by modeling time and its interaction with condition (drug>neutral) using an initial discovery-sample. Replication of this temporal response was tested in two other clinical populations all abstinent during their early recovery (treatment). Sixty-five male participants (35.8 ± 8.4 years-old) with methamphetamine use disorder (MUD) were recruited as the discovery-sample from an abstinence-based residential treatment program. A linear mixed effects model was used to identify areas with a time-by-condition interaction in the discovery-sample. Replication of these effects was tested in two other samples (29 female with MUD from a different residential program and 22 male with opioid use disorder from the same residential program as the discovery sample). The second replication sample was re-tested within two weeks. In the discovery-sample, clusters within the VMPFC, amygdala and ventral striatum showed both a main effect of condition and a condition-by-time interaction, indicating a habituating response to drug-related but not neutral cues. The estimates for the main effects and interactions were generally consistent between the discovery and replication-samples across all clusters. The re-test data showed a consistent lack of drug > neutral and habituation response within all selected clusters in the second cue-exposure session. The VMPFC, amygdala and ventral striatum show habituation in response to drug-related cues which is consistent among different clinical populations. This habituated response in the first session of cue-exposure and lack of reactivity in the second session of exposure may be important for informing the development of cue-desensitization interventions.
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17
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Logge WB, Morris RW, Baillie AJ, Haber PS, Morley KC. Baclofen attenuates fMRI alcohol cue reactivity in treatment-seeking alcohol dependent individuals. Psychopharmacology (Berl) 2021; 238:1291-1302. [PMID: 30788529 DOI: 10.1007/s00213-019-05192-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/04/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE Baclofen has been shown to effect fMRI alcohol cue reactivity in alcohol dependence, but potential varying effects related to baclofen dose levels have not been examined. OBJECTIVE This study investigated whether baclofen attenuates craving and alcohol cue-elicited activation in alcohol-dependent treatment seekers, and the relationship between this response and clinical outcomes (Morley et al. 2018; Morley et al. 2013). METHODS Participants included 30 alcohol-dependent individuals who had received daily baclofen 30 mg (n = 11), 75 mg (n = 8) or placebo (n = 11) for at least 2 weeks. Using functional magnetic resonance imaging (fMRI), we examined alcohol cue-elicited neural activation during a visual alcohol cue reactivity task 120 min following treatment administration, and alcohol cue reactivity and percentage of heavy drinking days (% HDD) associations were assessed. RESULTS Both baclofen-treated groups reported fewer post-scan % HDD when compared to the placebo-treated group, but no subjective craving group differences were found. Increased alcohol cue-elicited activation was seen in placebo compared to the 75 mg/day baclofen participants in two clusters spanning prefrontal regions implicated in cue reactivity, chiefly frontal regions (i.e., frontal and precentral gyri, anterior cingulate cortex), but no observed alcohol cue reactivity differences between placebo and 30 mg/day baclofen groups. Post-scan % HDD was positively correlated with increased alcohol cue-elicited activation in a cluster encompassing the bilateral caudate nucleus and dorsal anterior cingulate cortex when comparing placebo versus 75 mg/day baclofen groups, and several clusters including prefrontal and mesolimbic regions when comparing placebo versus 30 mg/day baclofen groups. CONCLUSIONS Baclofen administration attenuates alcohol cue-elicited activation and reduced the association in baclofen-treated participants between increased activity in key drug cue reactivity regions and higher post-scan % HDD observed in placebo-treated participants, suggesting a dose-specific response effect that may lead to reduced heavy drinking in chronic alcohol-dependent individuals. TRIAL REGISTRATION ClinicalTrials.gov , NCT01711125, https://clinicaltrials.gov/ct2/show /NCT01711125.
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Affiliation(s)
- Warren B Logge
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Lv 6, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Richard W Morris
- Central Clinical School, Faculty of Medicine and Health, & Centre for Translational Data Science, University of Sydney, Sydney, NSW, Australia
| | - Andrew J Baillie
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Paul S Haber
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Lv 6, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Lv 6, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia
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Ray LA, Grodin EN, Leggio L, Bechtholt AJ, Becker H, Ewing SWF, Jentsch JD, King AC, Mason BJ, O’Malley S, MacKillop J, Heilig M, Koob GF. The future of translational research on alcohol use disorder. Addict Biol 2021; 26:e12903. [PMID: 32286721 PMCID: PMC7554164 DOI: 10.1111/adb.12903] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
In March 2019, a scientific meeting was held at the University of California, Los Angeles (UCLA) Luskin Center to discuss approaches to expedite the translation of neurobiological insights to advances in the treatment of alcohol use disorder (AUD). A guiding theme that emerged was that while translational research in AUD is clearly a challenge, it is also a field ripe with opportunities. Herein, we seek to summarize and disseminate the recommendations for the future of translational AUD research using four sections. First, we briefly review the current landscape of AUD treatment including the available evidence-based treatments and their uptake in clinical settings. Second, we discuss AUD treatment development efforts from a translational science viewpoint. We review current hurdles to treatment development as well as opportunities for mechanism-informed treatment. Third, we consider models of translational science and public health impact. Together, these critical insights serve as the bases for a series of recommendations and future directions. Towards the goal of improving clinical care and population health for AUD, scientists are tasked with bolstering the clinical applicability of their research findings so as to expedite the translation of knowledge into patient care.
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Affiliation(s)
- Lara A. Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Erica N. Grodin
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD; Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Anita J. Bechtholt
- National Institute on Alcohol Abuse and Alcoholism, Division of Treatment and Recovery Research, National Institutes of Health, Bethesda, MD, USA
| | - Howard Becker
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Science; Department of Neuroscience, Medical University of South Carolina; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Sarah W. Feldstein Ewing
- Oregon Health and Science University, Department of Child and Adolescent Psychiatry, Portland, Oregon, USA
| | - J. David Jentsch
- Binghamton University, Department of Psychology, Binghamton, NY, USA
| | - Andrea C. King
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, USA
| | - Barbara J. Mason
- The Scripps Research Institute, Pearson Center for Alcoholism and Addiction Research, La Jolla, CA, USA
| | | | - James MacKillop
- McMaster University and St. Joseph’s Healthcare Hamilton, Peter Boris Center for Addictions Research, Hamilton, ON, CAN
| | - Markus Heilig
- Linkoping University, Center for Social and Affective Neuroscience, Linkoping, Sweden
| | - George F. Koob
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA; National Institute on Drug Abuse, Baltimore, MD, USA
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19
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Strosche A, Zhang X, Kirsch M, Hermann D, Ende G, Kiefer F, Vollstädt‐Klein S. Investigation of brain functional connectivity to assess cognitive control over cue-processing in Alcohol Use Disorder. Addict Biol 2021; 26:e12863. [PMID: 31908107 DOI: 10.1111/adb.12863] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/19/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022]
Abstract
Alcohol Use Disorder has been associated with impairments of functional connectivity between neural networks underlying reward processing and cognitive control. Evidence for aberrant functional connectivity between the striatum, insula, and frontal cortex in alcohol users exists at rest, but not during cue-exposure. In this study, we investigated functional connectivity changes during a cue-reactivity task across different subgroups of alcohol consumers. Ninety-six participants (ranging from light social to heavy social drinkers and nonabstinent dependent to abstinent dependent drinkers) were examined. A functional magnetic resonance imaging cue-reactivity paradigm was administered, during which alcohol-related and neutral stimuli were presented. Applying psychophysiological interaction analyses, we found: (a) Abstinent alcohol-dependent patients compared with non-abstinent dependent drinkers showed a greater increase of functional connectivity of the ventral striatum and anterior insula with the anterior cingulate cortex and dorsolateral prefrontal cortex during the presentation of alcohol cues compared with neutral cues. (b) Subjective craving correlated positively with functional connectivity change between the posterior insula and the medial orbitofrontal cortex and negatively with functional connectivity change between the ventral striatum and the anterior cingulate cortex, dorsolateral prefrontal cortex, and lateral orbitofrontal cortex. (c) Compulsivity of alcohol use correlated positively with functional connectivity change between the dorsolateral prefrontal cortex and the ventral striatum, anterior insula, and posterior insula. Results suggest increased cognitive control over cue-processing in abstinent alcohol-dependent patients, compensating high levels of cue-provoked craving and compulsive use. Clinical trial registration details: ClinicalTrials.gov ID: NCT00926900.
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Affiliation(s)
- Alicia Strosche
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Xiaochu Zhang
- CAS Key Laboratory of Brain Function and Disease and School of Life Sciences University of Science and Technology of China Hefei Anhui China
- Hefei Medical Research Center on Alcohol Addiction Anhui Mental Health Center Hefei China
- Academy of Psychology and Behavior Tianjin Normal University Tianjin China
| | - Martina Kirsch
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Derik Hermann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
| | - Sabine Vollstädt‐Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim University of Heidelberg Heidelberg Germany
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20
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Garrison KA, DeMartini KS, Corlett PR, Worhunsky PD, Krystal JH, O’Malley SS. Drinking and responses to antidrinking messages among young adults: An fMRI study. Addict Biol 2021; 26:e12882. [PMID: 32068323 PMCID: PMC7431375 DOI: 10.1111/adb.12882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/10/2019] [Accepted: 01/21/2020] [Indexed: 01/21/2023]
Abstract
Young adults consume most of their alcohol by binge drinking, and more than one-third report binge drinking in the past month. Some will transition out of excessive drinking, while others will maintain or increase alcohol use into adulthood. Public health campaigns depicting negative consequences of drinking have shown some efficacy at reducing this behavior. However, substance use in dependent individuals is governed in part by automatic or habitual responses to drug cues rather than the consequences. This study used functional magnetic resonance imaging to measure neural responses to drinking cues and drinking cues paired with antidrinking messages among young adults who binge drink (N = 30). This study also explored responses to smoking cues and antismoking messages. Neural responses were also compared between drinking/smoking and neutral cues. Self-reported drinking and smoking were collected at baseline, postscan, and 1 month. Results indicate that activity in the ventral striatum-implicated in reward processing-was lower for drinking cues paired with antidrinking messages than drinking cues. This difference was less pronounced in young adults who reported greater baseline past month drinking quantity. Past month drinking quantity decreased from baseline to 1 month. Further, young adults who showed higher activity during antidrinking messages in the medial prefrontal cortex-implicated in processing message self-relevance- reported a greater decrease in past month drinking frequency from baseline to 1 month. Findings may help to identify young adults who are at risk for continued heavy drinking in adulthood and inform interventions aimed to reduce drinking and reward in young adults.
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Affiliation(s)
| | - Kelly S DeMartini
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA
| | - Philip R Corlett
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA
| | | | - John H Krystal
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA
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21
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Hayes A, Herlinger K, Paterson L, Lingford-Hughes A. The neurobiology of substance use and addiction: evidence from neuroimaging and relevance to treatment. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
SUMMARYAddiction is a global health problem with a chronic relapsing nature for which there are few treatment options. In the past few decades, neuroimaging has allowed us to better understand the neurobiology of addiction. Functional neuroimaging paradigms have been developed to probe the neural circuits underlying addiction, including reward, inhibitory control, stress, emotional processing and learning/memory networks. Functional neuroimaging has also been used to provide biological support for the benefits of psychosocial and pharmacological interventions, although evidence remains limited and often inconclusive in this area, which may contribute to the variability in treatment efficacy. In this article, we discuss the changing definitions and clinical criteria that describe and classify addictive disorders. Using examples from functional neuroimaging studies we summarise the neurobiological mechanisms that underpin drug use, dependence, tolerance, withdrawal and relapse. We discuss the links between functional neuroimaging and treatment, outline clinical management in the UK and give an overview of future directions in research and addiction services.
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22
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Miranda R, O'Malley SS, Treloar Padovano H, Wu R, Falk DE, Ryan ML, Fertig JB, Chun TH, Muvvala SB, Litten RZ. Effects of Alcohol Cue Reactivity on Subsequent Treatment Outcomes Among Treatment-Seeking Individuals with Alcohol Use Disorder: A Multisite Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Varenicline. Alcohol Clin Exp Res 2020; 44:1431-1443. [PMID: 32363592 PMCID: PMC7572549 DOI: 10.1111/acer.14352] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The alcohol cue reactivity paradigm is increasingly used to screen medications for the treatment of alcohol use disorder (AUD) and other substance use disorders. Yet, its prospective association with craving and naturalistic drinking outcomes in clinical trials remains unknown. This study embedded repeated human laboratory assessments of alcohol cue reactivity within the context of a randomized controlled trial to examine the effects of varenicline tartrate (Chantix® ), a partial agonist of α4β2 nicotinic acetylcholine receptors, on alcohol craving among treatment-seeking heavy drinkers with AUD. Our main objectives were to test whether varenicline, as compared to placebo, blunts alcohol cue-elicited craving and test whether alcohol cue reactivity observed in the human laboratory predicts subsequent alcohol craving and use during the remainder of the trial. DESIGN AND METHODS This double-blind, randomized, 2-site study compared the effects of varenicline (up to 2 mg/d) and placebo on responses to in vivo alcohol cue and affective picture cue exposure in the human laboratory. Forty-seven volunteers (18 females, 29 males), ages 23 to 67 years (M = 43.7, SD = 11.5), were recruited from the community via advertisements to participate in a clinical trial designed to study the effects of varenicline on alcohol use. Participants were randomized to either varenicline or placebo for 6 weeks. RESULTS Varenicline did not attenuate cue-induced alcohol craving relative to placebo, but craving captured during the cue reactivity paradigm significantly predicted subsequent alcohol use in real-world settings during the clinical trial. Higher craving predicted heavier alcohol use. CONCLUSIONS Our results are among the first to show alcohol cue-induced craving captured during a human laboratory paradigm predicts drinking outcomes in the context of a clinical trial.
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Affiliation(s)
- Robert Miranda
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Stephanie S O'Malley
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Hayley Treloar Padovano
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Ran Wu
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Daniel E Falk
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Megan L Ryan
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Joanne B Fertig
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Thomas H Chun
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Srinivas B Muvvala
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Raye Z Litten
- From the, Department of Psychiatry and Human Behavior, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), Yale School of Medicine, New Haven, Connecticut, USA
- Division of Medications Development, (RMJ, SSO, HTP, RW, DEF, MLR, JBF, THC, SBM, RZL), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
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Lim AC, Green R, Grodin EN, Venegas A, Meredith LR, Donato S, Burnette E, Ray LA. Alcohol Cue-Induced Ventral Striatum Activity Predicts Subsequent Alcohol Self-Administration. Alcohol Clin Exp Res 2020; 44:1224-1233. [PMID: 32406553 PMCID: PMC7336863 DOI: 10.1111/acer.14342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Human laboratory paradigms are a pillar in medication development for alcohol use disorders (AUD). Neuroimaging paradigms, in which individuals are exposed to cues that elicit neural correlates of alcohol craving (e.g., mesocorticolimbic activation), are increasingly utilized to test the effects of AUD medications. Elucidation of the translational effects of these neuroimaging paradigms on human laboratory paradigms, such as self-administration, is warranted. The current study is a secondary analysis examining whether alcohol cue-induced activation in the ventral striatum is predictive of subsequent alcohol self-administration in the laboratory. METHODS Non-treatment-seeking heavy drinkers of East Asian descent (n = 41) completed a randomized, placebo-controlled, double-blind, crossover experiment on the effects of naltrexone on neuroimaging and human laboratory paradigms. Participants completed 5 days of study medication (or placebo); on day 4, they completed a neuroimaging alcohol taste cue-reactivity task. On the following day (day 5), participants completed a 60-minute alcohol self-administration paradigm. RESULTS Multilevel Cox regressions indicated a significant effect of taste cue-elicited ventral striatum activation on latency to first drink, Wald χ2 = 2.88, p = 0.05, such that those with higher ventral striatum activation exhibited shorter latencies to consume their first drink. Similarly, ventral striatum activation was positively associated with total number of drinks consumed, F(1, 38) = 5.90, p = 0.02. These effects were significant after controlling for alcohol use severity, OPRM1 genotype, and medication. Other potential regions of interest (anterior cingulate, thalamus) were not predictive of self-administration outcomes. CONCLUSIONS Neuroimaging alcohol taste cue paradigms may be predictive of laboratory paradigms such as self-administration. Elucidation of the relationships among different paradigms will inform how these paradigms may be used synergistically in experimental medicine and medication development.
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Affiliation(s)
- Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lindsay R. Meredith
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Suzanna Donato
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Burnette
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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24
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Oberlin BG, Shen YI, Kareken DA. Alcohol Use Disorder Interventions Targeting Brain Sites for Both Conditioned Reward and Delayed Gratification. Neurotherapeutics 2020; 17:70-86. [PMID: 31863407 PMCID: PMC7007465 DOI: 10.1007/s13311-019-00817-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Alcohol use disorder is a destructive compulsion characterized by chronic relapse and poor recovery outcomes. Heightened reactivity to alcohol-associated stimuli and compromised executive function are hallmarks of alcohol use disorder. Interventions targeting these two interacting domains are thought to ameliorate these altered states, but the mutual brain sites of action are yet unknown. Although interventions on alcohol cue reactivity affect reward area responses, how treatments alter brain responses when subjects exert executive effort to delay gratification is not as well-characterized. Focusing on interventions that could be developed into effective clinical treatments, we review and identify brain sites of action for these two categories of potential therapies. Using activation likelihood estimation (ALE) meta-analysis, we find that interventions on alcohol cue reactivity localize to ventral prefrontal cortex, dorsal anterior cingulate, and temporal, striatal, and thalamic regions. Interventions for increasing delayed reward preference elicit changes mostly in midline default mode network regions, including posterior cingulate, precuneus, and ventromedial prefrontal cortex-in addition to temporal and parietal regions. Anatomical co-localization of effects appears in the ventromedial prefrontal cortex, whereas effects specific to delay-of-gratification appear in the posterior cingulate and precuneus. Thus, the current available literature suggests that interventions in the domains of cue reactivity and delay discounting alter brain activity along midline default mode regions, specifically in the ventromedial prefrontal cortex for both domains, and the posterior cingulate/precuneus for delay-of-gratification. We believe that these findings could facilitate targeting and development of new interventions, and ultimately treatments of this challenging disorder.
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Affiliation(s)
- Brandon G Oberlin
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA.
- Department of Neurology, Indiana University School of Medicine, Indianapolis,, USA.
- Addiction Neuroscience Program, Department of Psychology, Indiana University Purdue University at Indianapolis, School of Science, Indianapolis, USA.
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, USA.
| | - Yitong I Shen
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis,, USA
| | - David A Kareken
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis,, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, USA
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25
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Bach P, Weil G, Pompili E, Hoffmann S, Hermann D, Vollstädt‐Klein S, Mann K, Perez‐Ramirez U, Moratal D, Canals S, Dursun SM, Greenshaw AJ, Kirsch P, Kiefer F, Sommer WH. Incubation of neural alcohol cue reactivity after withdrawal and its blockade by naltrexone. Addict Biol 2020; 25:e12717. [PMID: 30748046 DOI: 10.1111/adb.12717] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/15/2018] [Accepted: 01/08/2019] [Indexed: 12/25/2022]
Abstract
During the first weeks of abstinence, alcohol craving in patients may increase or "incubate." We hypothesize that Naltrexone (NTX) blocks this incubation effect. Here, we compared NTX effects on neural alcohol cue reactivity (CR) over the first weeks of abstinence and on long-term clinical outcomes to standard treatment. Male alcohol-dependent patients (n = 55) and healthy controls (n = 35) were enrolled. Participants underwent baseline psychometric testing and functional magnetic resonance imaging (fMRI) assessment of mesolimbic alcohol CR. Patients participated in a standard treatment program with the option of adjuvant NTX. They received another scan after 2 weeks of treatment. We found higher CR in several brain regions in patients versus healthy controls. CR significantly increased over 2 weeks in the standard treatment group (n = 13) but not in the NTX group (n = 22). NTX significantly attenuated CR in the left putamen and reduced relapse risk to heavy drinking within 3 months of treatment. Additionally, increased CR in the left putamen and its course over time predicted both NTX response and relapse risk. Carrier status for the functional OPRM1 variant rs1799971:A > G was considered but had no effect on NTX efficacy. In conclusion, NTX was most effective in patients with high CR in the left putamen. While the results from our naturalistic study await further confirmation from prospective randomized trials, they support a potential role of neural CR as a biomarker in the development of precision medicine approaches with NTX.
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Affiliation(s)
- Patrick Bach
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS)University of Heidelberg Heidelberg Germany
| | - Georg Weil
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
| | - Enrico Pompili
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS)University of Heidelberg Heidelberg Germany
| | - Derik Hermann
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS)University of Heidelberg Heidelberg Germany
| | - Sabine Vollstädt‐Klein
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
| | - Karl Mann
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
| | - Ursula Perez‐Ramirez
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València Valencia Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València Valencia Spain
| | - Santiago Canals
- Instituto de Neurociencias, Consejo Superior de Investigaciones Científicas and Universidad Miguel Hernández San Juan de Alicante Spain
| | | | | | - Peter Kirsch
- Department for Clinical PsychologyCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS)University of Heidelberg Heidelberg Germany
| | - Wolfgang H. Sommer
- Department of Addictive Behavior and Addiction MedicineCentral Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim Mannheim Germany
- Institute of Psychopharmacology, Central Institute of Mental HealthUniversity of Heidelberg, Medical Faculty Mannheim Mannheim Germany
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26
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Regier PS, Kampman KM, Childress AR. Clinical Trials for Stimulant Use Disorders: Addressing Heterogeneities That May Undermine Treatment Outcomes. Handb Exp Pharmacol 2020; 258:299-322. [PMID: 32193666 DOI: 10.1007/164_2019_303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In recent years, use of cocaine and amphetamines and deaths associated with stimulants have been on the rise, and there are still no FDA-approved medications for stimulant use disorders. One contributing factor may involve heterogeneity. At the neurobiological level, dual dopamine dysfunction may be undermining medication efficacy, suggesting a need for combination pharmacotherapies. At the population level, individual variability is expressed in a number of ways and, if left unaddressed, may interfere with medication efficacy. This chapter reviews studies investigating medications to address dopamine dysfunction, and it also identifies several prominent heterogeneities associated with stimulant (and other substance) use disorders. The chapter has implications for improving interventions to treat stimulant use disorders, and the theme of individual heterogeneity may have broader application across substance use disorders.
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Affiliation(s)
- Paul S Regier
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kyle M Kampman
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Rose Childress
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, PA, USA
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27
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Interaction between behavioral inhibition and neural alcohol cue-reactivity in ADHD and alcohol use disorder. Psychopharmacology (Berl) 2020; 237:1691-1707. [PMID: 32285159 PMCID: PMC7239811 DOI: 10.1007/s00213-020-05492-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 02/14/2020] [Indexed: 12/18/2022]
Abstract
RATIONALE Compared to the general population, adult Attention-Deficit / Hyperactivity Disorder (ADHD) is more prevalent in patients with Alcohol Use Disorder (AUD). Impaired behavioral inhibition is a common characteristic in both ADHD and AUD. Relapse risk is increased in patients with AUD and comorbid, untreated ADHD and in AUD patients with increased neural cue-reactivity. OBJECTIVES In this study, we examined the interaction between neural correlates of behavioral inhibition and alcohol cue-reactivity with a hybrid imaging task. METHODS Out of 69 adult study participants, we included n = 49 in our final analyses: Individuals had a diagnosis of either AUD (n = 13), ADHD (n = 14) or both (n = 5), or were healthy controls (HC; n = 17). The functional magnetic resonance imaging paradigm aimed to examine the combined effects of both an interference-inhibition task ("Simon-task") and an alcohol cue-reactivity task. Instead of segregating by diagnostic group, we pursued a dimensional approach in which we compared measures of AUD and ADHD severity, as well as the interaction of both, using multiple regression analyses. RESULTS The four groups did not differ on the behavioral level on either the inhibition task or the alcohol cue-reactivity task. However, brain activation in frontal control and reward-related regions during completion of the combined tasks were related to ADHD and AUD severity (symptom load). During presentation of both alcohol cues and the inhibition task, participants with higher AUD and ADHD symptom load exhibited greater BOLD (blood oxygen level dependent) responses in subcortical reward-related regions. CONCLUSIONS Our findings support the hypothesis that ADHD additionally diminishes inhibition ability in individuals with AUD. This may increase relapse risk when confronted with alcohol cues. Further, it is crucial for patients with comorbid AUD and ADHD to take into account not only reduced cognitive control over behavioral inhibition but also simultaneously heightened alcohol cue-reactivity.
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28
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Litten RZ, Falk DE, Ryan ML, Fertig J, Leggio L. Five Priority Areas for Improving Medications Development for Alcohol Use Disorder and Promoting Their Routine Use in Clinical Practice. Alcohol Clin Exp Res 2019; 44:23-35. [PMID: 31803968 DOI: 10.1111/acer.14233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/02/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Megan L Ryan
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Joanne Fertig
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland.,Medication Development Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland.,Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
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29
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Wilcox CE, Brett ME, Calhoun VD. Objective markers for psychiatric decision-making: How to move imaging into clinical practice. NEUROIMAGE-CLINICAL 2019; 26:102084. [PMID: 31784372 PMCID: PMC7229341 DOI: 10.1016/j.nicl.2019.102084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Megan E Brett
- Department of Internal Medicine, Division of Infectious Diseases, University of New Mexico, Albuquerque NM
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Hansson AC, Gründer G, Hirth N, Noori HR, Spanagel R, Sommer WH. Dopamine and opioid systems adaptation in alcoholism revisited: Convergent evidence from positron emission tomography and postmortem studies. Neurosci Biobehav Rev 2019; 106:141-164. [DOI: 10.1016/j.neubiorev.2018.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/08/2018] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
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Bach P, Reinhard I, Bühler S, Vollstädt-Klein S, Kiefer F, Koopmann A. Oxytocin modulates alcohol-cue induced functional connectivity in the nucleus accumbens of social drinkers. Psychoneuroendocrinology 2019; 109:104385. [PMID: 31362183 DOI: 10.1016/j.psyneuen.2019.104385] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/17/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023]
Abstract
The brain oxytocin system is involved in a wide range of addictive behaviors, inhibiting prime- and cue-induced relapse in preclinical models of substance use disorders. Especially the ability of oxytocin to modulate connectivity between the nucleus accumbens (NAc) and cortical regions has been identified as a factor likely to be critical to its effects on relapse. We thus investigated the effect of oxytocin on NAc functional connectivity during an alcohol cue-reactivity task. Thirteen male social drinkers participated in a randomized double-blind placebo-controlled cross-over functional magnetic resonance imaging (fMRI) alcohol cue-reactivity task with and without prior intranasal application of 24 IU oxytocin. Effects of oxytocin and functional connectivity during presentation of alcohol cues were assessed using ROI-to-ROI generalized psychophysiological interaction analyses. Oxytocin application significantly reduced NAc connectivity with the cuneus and thalamo-occipital connectivity, while enhancing connectivity between the paracingulate gyrus and precentral gyrus. This effect was specific to the alcohol presentation and was not found during processing of neutral pictures. In addition, the NAc-cuneus connectivity significantly correlated with alcohol cue-induced craving during the scanning session. For the first time, we could show that oxytocin selectively attenuates NAc connectivity during an alcohol cue-reactivity task which was related to changes in subjective craving for alcohol. This might reflect an attenuation of alcohol-cue saliency by oxytocin, which improves inhibitory control over craving and cue reactivity.
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Affiliation(s)
- Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; Feuerlein Center on Translational Addiction Medicine (FCTS), Heidelberg University, Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Sina Bühler
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; Feuerlein Center on Translational Addiction Medicine (FCTS), Heidelberg University, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; Feuerlein Center on Translational Addiction Medicine (FCTS), Heidelberg University, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; Feuerlein Center on Translational Addiction Medicine (FCTS), Heidelberg University, Germany
| | - Anne Koopmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany; Feuerlein Center on Translational Addiction Medicine (FCTS), Heidelberg University, Germany
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A Randomized, Placebo-controlled, Clinical Trial of Prazosin for the Treatment of Alcohol Use Disorder. J Addict Med 2019; 12:339-345. [PMID: 29664896 DOI: 10.1097/adm.0000000000000413] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The noradrenergic system plays an important role in the pathophysiology of alcohol use disorder (AUD). Medications in this class may reduce drinking. Our aims were to investigate this in a unique sample of individuals with AUD. METHODS Thirty-six individuals with AUD were randomized to treatment with prazosin, an alpha-1 noradrenergic antagonist, or placebo, for 6 weeks (target daily dose 16 mg). Hierarchical linear modeling was used to examine the effect of treatment group on rate of change in primary (drinks per week [DPW]) and several secondary outcome measures. RESULTS Prazosin did not significantly affect rate of reduction in alcohol use in the intent to treat sample (n = 36) compared with placebo, but did significantly increase the rate of reduction in DPW in an optimal treatment exposure subgroup (beta = -0.3; P = 0.01; event rate ratio 0.74; confidence interval 0.59, 0.93; n = 27). Poor adherence and tolerability may have contributed to null effects. Diastolic blood pressure (DBP) moderated the effects of treatment group on rate of reduction in drinks per drinking day, supporting previous work in doxazosin, another alpha-1 antagonist. Specifically, prazosin was associated with greater rates of reduction in drinking compared with placebo in individuals with high but not low DBP. CONCLUSIONS Our findings do not support the clinical utility of prazosin for all treatment-seeking AUD, but post hoc analyses indicate that it might have some efficacy in individuals who can tolerate it. Further work exploring the clinical utility of DBP as a treatment matching variable, and defining optimal values using sensitivity and specificity analyses, is warranted.
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Grodin EN, Ray LA. The Use of Functional Magnetic Resonance Imaging to Test Pharmacotherapies for Alcohol Use Disorder: A Systematic Review. Alcohol Clin Exp Res 2019; 43:2038-2056. [PMID: 31386215 PMCID: PMC6779480 DOI: 10.1111/acer.14167] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022]
Abstract
Alcohol use disorder (AUD) is a chronic relapsing condition that represents a significant public health concern. Pharmacological treatment development for AUD is a top research priority, and many studies are being conducted to evaluate potential AUD treatments. Understanding the brain circuitry impacted by addiction is crucial for the development of efficacious pharmacological interventions. These neuroadaptations can be probed noninvasively using functional magnetic resonance neuroimaging (fMRI). fMRI may be an effective tool to identify biomarkers for AUD pharmacotherapies, evaluating changes associated with pharmacological treatment. Thus, the present qualitative review of the literature focuses on the role of fMRI as a tool for medication development for AUD. The aim of this review was to assemble research across a range of fMRI paradigms to study the effectiveness of pharmacological treatments of adult AUD. First, we present a qualitative review of fMRI AUD pharmacotherapy studies, differentiating studies based on their dosing regimen. Second, we provide recommendations for the field to improve the use of fMRI as a biomarker for AUD pharmacotherapy.
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Affiliation(s)
- Erica N. Grodin
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
| | - Lara A. Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
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Witkiewitz K, Roos CR, Mann K, Kranzler HR. Advancing Precision Medicine for Alcohol Use Disorder: Replication and Extension of Reward Drinking as a Predictor of Naltrexone Response. Alcohol Clin Exp Res 2019; 43:2395-2405. [PMID: 31436886 PMCID: PMC6824945 DOI: 10.1111/acer.14183] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/15/2019] [Indexed: 12/24/2022]
Abstract
Background Precision medicine aims to identify those patients who will benefit the most from specific treatments. Recent work found large effects of naltrexone among “reward drinkers,” defined as individuals who drink primarily for the rewarding effects of alcohol. This study sought to replicate and extend these recent findings by examining whether the desire to drink mediated the effect of naltrexone among reward drinkers. Methods We conducted a secondary analysis of a 12‐week randomized clinical trial of daily or targeted naltrexone among problem drinkers (n = 163), with a focus on 86 individuals (n = 45 naltrexone and n = 41 placebo) who received daily medication. Interactive voice response technology was used to collect daily reports of drinking and desire to drink. Factor mixture models were used to derive reward and relief phenotypes. Moderation analyses were used to evaluate naltrexone effects, with phenotype as a moderator variable. Multilevel mediation tested average desire to drink as a mediator. Results Results indicated 4 phenotypes: low reward/low relief; low reward/high relief; high reward/low relief; and high reward/high relief. There was an interaction between the high reward/low relief subgroup (n = 10) and daily naltrexone versus placebo on drinks per drinking day (DPDD; p = 0.03), percent heavy drinking days (p = 0.004), and daily drinking (p = 0.02). As compared to placebo, individuals in the high reward/low relief phenotype who received daily naltrexone had significantly fewer DPDD (Cohen's d = 2.05) and had a lower proportion of heavy drinking days (Cohen's d = 1.75). As hypothesized, reductions in average desire to drink mediated the effect of naltrexone on average daily drinking among the high reward/low relief drinkers (moderated mediation effect: p = 0.029). Conclusions This theory‐driven study replicates the empirical finding that naltrexone is particularly efficacious among high reward/low relief drinkers. Our study brings the field a step closer to the potential of using a precision medicine approach to treating alcohol use disorder.
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Affiliation(s)
- Katie Witkiewitz
- From the, Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Corey R Roos
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Karl Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine and Crescenz Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
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Bifone A, Gozzi A, Cippitelli A, Matzeu A, Domi E, Li H, Scuppa G, Cannella N, Ubaldi M, Weiss F, Ciccocioppo. phMRI, neurochemical and behavioral responses to psychostimulants distinguishing genetically selected alcohol-preferring from genetically heterogenous rats. Addict Biol 2019; 24:981-993. [PMID: 30328656 PMCID: PMC6697752 DOI: 10.1111/adb.12671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/27/2018] [Accepted: 07/23/2018] [Indexed: 01/01/2023]
Abstract
Alcoholism is often associated with other forms of drug abuse, suggesting that innate predisposing factors may confer vulnerability to addiction to diverse substances. However, the neurobiological bases of these factors remain unknown. Here, we have used a combination of imaging, neurochemistry and behavioral techniques to investigate responses to the psychostimulant amphetamine in Marchigian Sardinian (msP) alcohol-preferring rats, a model of vulnerability to alcoholism. Specifically, we employed pharmacological magnetic resonance imaging to investigate the neural circuits engaged by amphetamine challenge, and to relate functional reactivity to neurochemical and behavioral responses. Moreover, we studied self-administration of cocaine in the msP rats. We found stronger functional responses in the extended amygdala, alongside with increased release of dopamine in the nucleus accumbens shell and augmented vertical locomotor activity compared with controls. Wistar and msP rats did not differ in operant cocaine self-administration under short access (2 hours) conditions, but msP rats exhibited a higher propensity to escalate drug intake following long access (6 hours). Our findings suggest that neurobiological and genetic mechanisms that convey vulnerability to excessive alcohol drinking also facilitate the transition from psychostimulants use to abuse.
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Affiliation(s)
- A Bifone
- Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Corso Bettini 31, 38068 Rovereto, Italy
| | - A Gozzi
- Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Corso Bettini 31, 38068 Rovereto, Italy
| | - A Cippitelli
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri, Camerino 62032, Italy
| | - A Matzeu
- Department of Molecular and Cellular Neuroscience, The Scripps Research Institute, La Jolla, United States
| | - E Domi
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri, Camerino 62032, Italy
| | - H Li
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri, Camerino 62032, Italy
| | - G Scuppa
- Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Corso Bettini 31, 38068 Rovereto, Italy
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri, Camerino 62032, Italy
| | - N Cannella
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri, Camerino 62032, Italy
| | - M Ubaldi
- School of Pharmacy, Pharmacology Unit, University of Camerino, Via Madonna delle Carceri, Camerino 62032, Italy
| | - F Weiss
- Department of Molecular and Cellular Neuroscience, The Scripps Research Institute, La Jolla, United States
| | - Ciccocioppo
- Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Corso Bettini 31, 38068 Rovereto, Italy
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Kwako LE, Schwandt ML, Ramchandani VA, Diazgranados N, Koob GF, Volkow ND, Blanco C, Goldman D. Neurofunctional Domains Derived From Deep Behavioral Phenotyping in Alcohol Use Disorder. Am J Psychiatry 2019; 176:744-753. [PMID: 30606047 PMCID: PMC6609498 DOI: 10.1176/appi.ajp.2018.18030357] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The authors evaluated whether three neurofunctional domains proposed to be critical in the addiction cycle, namely, incentive salience, negative emotionality, and executive function, could be identified through factor analysis of a deeply phenotyped clinical sample. METHODS Clinical, behavioral, and self-report measures of addiction, personality, cognition, behavior, and exposure to early-life stress were collected as part of a screening and natural history study of alcohol use disorders in 454 individuals representing the spectrum of alcohol use and use disorders. The multiple indicators, multiple causes (MIMIC) approach was used to identify significant predictors of the latent factors identified by the analysis. RESULTS The results showed significant support for both three- and four-factor models to explain biobehavioral variation in this sample of participants with alcohol use disorder and control subjects, but the three-factor model had the best fit indices. With some nuances, including cross-correlation (lack of independence) between the three factors, the factors corresponded to incentive salience, negative emotionality, and executive function (executive control). The MIMIC model revealed that both exposure to early-life stress and sociodemographic variables predicted these factors. CONCLUSIONS These findings suggest that three correlated neurofunctional domains are relevant for alcohol use disorder. More work is required to validate and standardize measures of neurofunctional domains in alcohol use disorder, to extend these findings to other addictive disorders, and to relate variations in them to predisposition, clinical course, treatment response, neuroimaging data, and other psychophysical indicators.
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Affiliation(s)
- Laura E. Kwako
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892,Corresponding author: 10 Center Drive, 1-5340, Bethesda, MD, 20892-1108
| | - Melanie L. Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892
| | - Vijay A. Ramchandani
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892
| | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892
| | - George F. Koob
- Office of the Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892
| | - Nora D. Volkow
- Office of the Director, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, 20892
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, 20892
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892,Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892
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Lim AC, Ghahremani DG, Grodin EN, Green R, Bujarski S, Hartwell EE, Courtney KE, Hutchison K, Miotto K, Ray LA. Neuroimaging findings from an experimental pharmacology trial of naltrexone in heavy drinkers of East Asian descent. Drug Alcohol Depend 2019; 200:181-190. [PMID: 31160146 PMCID: PMC6760244 DOI: 10.1016/j.drugalcdep.2019.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/01/2019] [Accepted: 02/22/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite known genetic variation across races, studies examining pharmacogenetics of a single nucleotide polymorphism (SNP) of the mu-opioid receptor gene (OPRM1) on clinical response to naltrexone have been conducted in predominantly Caucasian samples. Evidence is mixed for pharmacogenetic OPRM1 and naltrexone effects on neural responses to alcohol cues. The current study tests the pharmacogenetic effects of naltrexone and OPRM1 on neural responses to alcohol taste cues in heavy drinkers of East Asian descent. METHODS Participants (N = 41) completed two double-blinded and counterbalanced functional magnetic resonance imaging (fMRI) sessions: one after taking naltrexone (50 mg/day) for four days and one after taking placebo for four days. Following titration, participants completed an fMRI alcohol taste-cues task. Analyses tested effects of naltrexone, OPRM1, and their interaction in whole-brain and region of interest (ROI) analyses of functional activation and functional connectivity in response to alcohol versus water taste cues. RESULTS We found no effects of naltrexone orOPRM1 on neural activation in whole-brain and ROI analyses, which included left and right ventral striatum (VS), anterior cingulate cortex (ACC), and orbitofrontal cortex (OFC). Naltrexone increased functional connectivity between left VS and clusters in medial prefrontal cortex, posterior cingulate gyrus, as well as right VS and occipital cortex, compared to placebo. CONCLUSIONS Naltrexone treatment enhanced functional connectivity in a key reinforcement-related pathway during alcohol versus water taste cues, corroborating neuroimaging work with other substances. Null medication and pharmacogenetics effects on functional activation add to a mixed naltrexone literature and may underscore the modest size of these effects in East Asians.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dara G Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Emily E Hartwell
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kelly E Courtney
- Department of Psychology, University of California, San Diego, San Diego, CA, USA
| | - Kent Hutchison
- Department of Psychology, University of Colorado, Boulder, CO, USA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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Wilcox CE, Abbott CC, Calhoun VD. Alterations in resting-state functional connectivity in substance use disorders and treatment implications. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91:79-93. [PMID: 29953936 PMCID: PMC6309756 DOI: 10.1016/j.pnpbp.2018.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 02/06/2023]
Abstract
Substance use disorders (SUD) are diseases of the brain, characterized by aberrant functioning in the neural circuitry of the brain. Resting state functional connectivity (rsFC) can illuminate these functional changes by measuring the temporal coherence of low-frequency fluctuations of the blood oxygenation level-dependent magnetic resonance imaging signal in contiguous or non-contiguous regions of the brain. Because this data is easy to obtain and analyze, and therefore fairly inexpensive, it holds promise for defining biological treatment targets in SUD, which could help maximize the efficacy of existing clinical interventions and develop new ones. In an effort to identify the most likely "treatment targets" obtainable with rsFC we summarize existing research in SUD focused on 1) the relationships between rsFC and functionality within important psychological domains which are believed to underlie relapse vulnerability 2) changes in rsFC from satiety to deprived or abstinent states 3) baseline rsFC correlates of treatment outcome and 4) changes in rsFC induced by treatment interventions which improve clinical outcomes and reduce relapse risk. Converging evidence indicates that likely "treatment target" candidates, emerging consistently in all four sections, are reduced connectivity within executive control network (ECN) and between ECN and salience network (SN). Other potential treatment targets also show promise, but the literature is sparse and more research is needed. Future research directions include data-driven prediction analyses and rsFC analyses with longitudinal datasets that incorporate time since last use into analysis to account for drug withdrawal. Once the most reliable biological markers are identified, they can be used for treatment matching, during preliminary testing of new pharmacological compounds to establish clinical potential ("target engagement") prior to carrying out costly clinical trials, and for generating hypotheses for medication repurposing.
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Elton A, Dove S, Spencer CN, Robinson DL, Boettiger CA. Naltrexone Acutely Enhances Connectivity Between the Ventromedial Prefrontal Cortex and a Left Frontoparietal Network. Alcohol Clin Exp Res 2019; 43:965-978. [PMID: 30848494 DOI: 10.1111/acer.13999] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Naltrexone, an opioid receptor antagonist that is Food and Drug Administration approved for treating alcohol use disorder (AUD), reduces alcohol craving and intake. Despite known pharmacological properties, little is known regarding the effects of naltrexone on neural circuit function. Thus, a data-driven examination of the neural effects of naltrexone in human subjects may offer novel insight into its treatment mechanisms. METHODS Twenty-one alcohol using males (22 to 39) participated in a double-blind, placebo-controlled crossover study of the effects of naltrexone on brain voxel-wise functional connectivity (FC) using intersubject FC correlation mapping. We first cross-correlated the time series from each gray matter voxel to produce a 6,356 × 6,356 FC matrix for each subject and session. We then subtracted the placebo FC matrix from the naltrexone FC matrix. To identify brain regions demonstrating significant reconfiguration of whole-brain FC patterns following naltrexone treatment, we statistically quantified the consistency of patterns of voxel FC changes across subjects. Permutation testing identified significant clusters of voxels undergoing significant reconfiguration. Using the identified clusters in a seed-based FC analysis, we then compared the FC patterns of affected brain areas on placebo versus naltrexone in a paired t-test. Ridge regression analyses identified self-report measures, including substance use, that significantly predicted individual differences in FC among naltrexone-modulated regions. RESULTS Two clusters in the rostral anterior cingulate cortex (rACC)/ventromedial prefrontal cortex (vmPFC) demonstrated significant modulation of FC by naltrexone. Using these 2 proximal clusters as a single seed, specific FC changes were identified in regions associated with a left frontoparietal network (increasing), as well as visual and motor regions (decreasing). Stronger FC between the rACC/vmPFC and this set of regions on placebo was associated with more external locus of control, whereas weaker connectivity was associated with greater substance use problems. Naltrexone strengthened these connections most among individuals who reported greater drinking to cope. CONCLUSIONS Enhancing connectivity between the rACC/vmPFC, implicated in alcohol craving, and components of a left frontoparietal network involved in executive control may represent an effective strategy for the treatment of AUD.
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Affiliation(s)
- Amanda Elton
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina.,Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina
| | - Samantha Dove
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina
| | - Cory N Spencer
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina
| | - Donita L Robinson
- Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina.,Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Charlotte A Boettiger
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina.,Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina.,Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, North Carolina
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40
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Aubin HJ, Mann K. Medication Development: Reducing Casualties in the Valley of Death and Providing Support for Survivors. Alcohol Clin Exp Res 2019; 43:22-25. [DOI: 10.1111/acer.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Henri-Jean Aubin
- CESP; Faculté de médecine; University Paris-Sud, Faculté de médecine - UVSQ; INSERM; Université Paris- Saclay; AP-HP; Hôpitaux Universitaires Paris-Sud; Villejuif France
| | - Karl Mann
- Central Institute of Mental Health; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
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Li H, Scuppa G, Shen Q, Masi A, Nasuti C, Cannella N, Ciccocioppo R. NOP Receptor Agonist Ro 64-6198 Decreases Escalation of Cocaine Self-Administration in Rats Genetically Selected for Alcohol Preference. Front Psychiatry 2019; 10:176. [PMID: 30984046 PMCID: PMC6450143 DOI: 10.3389/fpsyt.2019.00176] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
Cocaine dependence is a psychiatric condition for which effective medications are still lacking. Published data indicate that an increase in nociceptin/orphanin FQ (N/OFQ) transmission by NOP receptor activation attenuates cocaine-induced place conditioning and the locomotor sensitization effects of cocaine. This suggests that the activation of the N/OFQ receptor (NOP) may attenuate the motivation for psychostimulants. To further explore this possibility, we investigated the effect of the potent and selective NOP receptor agonist Ro 64-6198 on cocaine intake under 1 h short access (ShA) and 6 h long access (LgA) operant self-administration conditions in rats. We used Marchigian Sardinian alcohol-preferring (msP) rats and Wistar control rats. msP rats were used because we recently found that this rat line, originally selected for excessive alcohol drinking and preference, exhibits a greater propensity to escalate cocaine self-administration following LgA training. msP rats are also characterized by innate overexpression of the N/OFQ-NOP system compared with Wistar rats. Wistar and msP rats both exhibited an increase in cocaine self-administration under LgA conditions, with a higher trend toward escalation in msP rats. In Wistar rats, the intraperitoneal administration of Ro 64-6198 (0. 1 and 3 mg/kg) significantly decreased ShA cocaine self-administration. In Wistar rats that underwent LgA cocaine self-administration training, Ro 64-6198 induced no significant effect either during the first hour of self-administration or after the entire 6 h session. In msP rats, Ro 64-6198 significantly reduced cocaine self-administration both under ShA conditions and in the first hour of the LgA session. At the end of the 6 h session, the effect of Ro 64-6198 was no longer observed in msP rats. The highest dose of Ro 64-6198 (3 mg/kg) did not affect saccharin self-administration in msP rats but reduced saccharin self-administration in Wistar rats. Altogether, these data suggest that NOP receptor activation attenuates cocaine self-administration, and this effect tends to be more pronounced in a rat line with innately higher NOP receptor expression and that more robustly escalates cocaine intake.
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Affiliation(s)
- Hongwu Li
- College of Chemical Engineering, Changchun University of Technology, Changchun, China.,Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Giulia Scuppa
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Qianwei Shen
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Alessio Masi
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Cinzia Nasuti
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Nazzareno Cannella
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
| | - Roberto Ciccocioppo
- Pharmacology Unit, School of Pharmacy, University of Camerino, Camerino, Italy
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Kohno M, Dennis LE, McCready H, Schwartz DL, Hoffman WF, Korthuis PT. A preliminary randomized clinical trial of naltrexone reduces striatal resting state functional connectivity in people with methamphetamine use disorder. Drug Alcohol Depend 2018; 192:186-192. [PMID: 30266003 PMCID: PMC6200637 DOI: 10.1016/j.drugalcdep.2018.07.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Naltrexone has been shown to attenuate craving and the subjective effects of methamphetamine. Although naltrexone has modulatory effects on neural activity at dopaminergic synapses, the effect on striatal connectivity is unclear. As methamphetamine use is associated with greater resting-state functional connectivity (RSFC) in the dopaminergic system, we examined whether extended-release naltrexone (XR-NTX) can normalize striatal connectivity and whether changes in RSFC are associated with changes in craving and methamphetamine use. METHODS Thirty-seven participants in or seeking treatment for methamphetamine use disorder took part in this clinical trial at a university-based research clinic between May 2013 and March 2015 (Clinicaltrials.gov NCT01822132). Participants were randomized by a random number generator to a single four-week injection of XR-NTX or placebo. Functional magnetic resonance imaging (fMRI) and self-reported measures of craving and methamphetamine use were conducted before and after double-blinded randomization. FINDINGS There was a significant reduction in methamphetamine use in the naltrexone group and a significant treatment-by-time interaction on RSFC between the ventral striatum, amygdala, hippocampus, and midbrain. Connectivity was significantly reduced over time in participants randomized to naltrexone but unchanged in those randomized to placebo (p < 0.05, whole-brain corrected). Interactions between treatment and changes in connectivity show that significant reductions in connectivity were associated with reductions in methamphetamine use. CONCLUSIONS Neurobiological deficits associated with methamphetamine use may undermine the efficacy of pharmacotherapies that directly target the dopamine reward system. Naltrexone, via antagonism of indirect mu-opioid effects on dopamine neurons, may attenuate reward system connectivity and aid in methamphetamine use treatment.
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Affiliation(s)
- Milky Kohno
- Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Department of Behavioral Neuroscience, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Research and Development Service, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA; Methamphetamine Abuse Research Center, Oregon Health and Science University and Veterans Affairs Portland Health Care System, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA.
| | - Laura E Dennis
- Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Research and Development Service, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | - Holly McCready
- Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Research and Development Service, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | - Daniel L Schwartz
- Department of Neurology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Advanced Imaging Research Center, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA
| | - William F Hoffman
- Department of Psychiatry, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Department of Behavioral Neuroscience, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA; Research and Development Service, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA; Mental Health Division, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA; Methamphetamine Abuse Research Center, Oregon Health and Science University and Veterans Affairs Portland Health Care System, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA
| | - P Todd Korthuis
- Section of Addiction Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA
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Ray LA, Bujarski S, Grodin E, Hartwell E, Green R, Venegas A, Lim AC, Gillis A, Miotto K. State-of-the-art behavioral and pharmacological treatments for alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:124-140. [PMID: 30373394 DOI: 10.1080/00952990.2018.1528265] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities. OBJECTIVE This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support. METHOD This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated. SCIENTIFIC SIGNIFICANCE One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, cognitive behavioral therapy has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so-called silver bullet for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field, although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.
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Affiliation(s)
- Lara A Ray
- a Department of Psychology , University of California , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Spencer Bujarski
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Erica Grodin
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Emily Hartwell
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - ReJoyce Green
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Alexandra Venegas
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Aaron C Lim
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Artha Gillis
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Karen Miotto
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
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Holla B, Karthik S, Biswal J, Viswanath B, Jayarajan D, Bharath RD, Venkatasubramanian G, Benegal V. Brain Functional Magnetic Resonance Imaging Cue-reactivity Can Predict Baclofen Response in Alcohol Use Disorders. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:290-301. [PMID: 30121979 PMCID: PMC6124881 DOI: 10.9758/cpn.2018.16.3.290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 12/20/2022]
Abstract
Objective Baclofen is a promising treatment for alcohol use disorders (AUD), although its clinical response in humans is mixed. The present study aimed at investigating the impact of baclofen treatment on cue-induced brain activation pattern and its relationship with relapse outcomes. Methods Twenty-three inpatients with AUD underwent a functional magnetic resonance imaging cue-reactivity task before beginning medication with baclofen and 2 weeks later. Twelve additional inpatients with AUD, who did not receive any anticraving medications, formed the control group. All subjects were prospectively followed up for 90 days post-discharge or until lapse to first alcohol use. Results Whole-brain linear mixed effects analysis revealed a significant group-by-time interaction with greater activation of the bilateral dorsolateral pre-frontal cortex and right anterior cingulate cortex (ACC) following baclofen treatment in comparison with the control group. Further, cox regression analysis revealed that increased activation of ACC and deactivation of insular cortex (IC) was associated with longer time to first alcohol use only in the baclofen treatment group but not in the control group. Conclusion This study provides preliminary evidence for the neural predictors of baclofen treatment response in AUD. Baclofen treatment in AUD was associated with changes in cue-reactivity at critical brain regions within the incentive-salience network. Importantly, baclofen treatment-related specific activation of regions involved in cognitive control (ACC) and deactivation of regions involved in reward anticipation (IC) prolonged the time to first alcohol drink.
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Affiliation(s)
- Bharath Holla
- Departments of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sheshachala Karthik
- Departments of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Jitendriya Biswal
- Departments of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Biju Viswanath
- Departments of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Deepak Jayarajan
- Departments of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rose Dawn Bharath
- Departments of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- Departments of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Vivek Benegal
- Departments of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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45
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O'Malley SS, Todtenkopf MS, Du Y, Ehrich E, Silverman BL. Effects of the Opioid System Modulator, Samidorphan, on Measures of Alcohol Consumption and Patient-Reported Outcomes in Adults with Alcohol Dependence. Alcohol Clin Exp Res 2018; 42:2011-2021. [DOI: 10.1111/acer.13849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/24/2018] [Indexed: 01/25/2023]
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Mann K, Roos CR, Witkiewitz K. Response to Letter to Editor (Precision medicine in alcohol dependence: evidence of efficacy and initial support for comparative effectiveness). Neuropsychopharmacology 2018; 43:1801-1802. [PMID: 29930387 PMCID: PMC6046056 DOI: 10.1038/s41386-018-0113-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/15/2018] [Accepted: 05/18/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, D-68159, Mannheim, Germany.
| | - Corey R Roos
- 0000 0001 2188 8502grid.266832.bDepartment of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106 USA
| | - Katie Witkiewitz
- 0000 0001 2188 8502grid.266832.bDepartment of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106 USA
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Forster SE, Dickey MW, Forman SD. Regional cerebral blood flow predictors of relapse and resilience in substance use recovery: A coordinate-based meta-analysis of human neuroimaging studies. Drug Alcohol Depend 2018; 185:93-105. [PMID: 29428325 DOI: 10.1016/j.drugalcdep.2017.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Predicting relapse vulnerability can inform level-of-care and personalized substance use treatment. Few reliable predictors of relapse risk have been identified from traditional clinical, psychosocial, and demographic variables. However, recent neuroimaging findings highlight the potential prognostic import of brain-based signals, indexing the degree to which neural systems have been perturbed by addiction. These proposed "neuromarkers" forecast the likelihood, severity, and timing of relapse but the reliability and generalizability of such effects remains to be established. METHODS Activation likelihood estimation was used to conduct a preliminary quantitative, coordinate-based meta-analysis of the addiction neuroprediction literature; specifically, studies wherein baseline measures of regional cerebral blood flow were prospectively associated with substance use treatment outcomes. Consensus patterns of activation associated with relapse vulnerability (greater activation predicts poorer outcomes) versus resilience (greater activation predicts improved outcomes) were specifically investigated. RESULTS Twenty-four eligible studies yielded 134 foci, representing 923 subjects. Consensus activation was identified in right putamen and claustrum (p < .05, cluster-corrected) in relation to positive and negative treatment outcomes - likely reflecting variability in measurement context (e.g., task, sample characteristics) across datasets. A single cluster in rostral-ventral anterior cingulate cortex (rACC) was associated with relapse resilience, specifically (p < .05, cluster-corrected); no significant vulnerability-related clusters were identified. CONCLUSIONS Right putamen activation has been associated with relapse vulnerability and resilience, while increased baseline rACC activation has been consistently associated with improved treatment outcomes. Methodological heterogeneity within the existing literature, however, limits firm conclusions and future work will be necessary to confirm and clarify these results.
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Affiliation(s)
- Sarah E Forster
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychiatry, United States.
| | - Michael Walsh Dickey
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychology, United States; University of Pittsburgh, Department of Communication Science and Disorders, United States
| | - Steven D Forman
- VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychiatry, United States
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Mann K, Roos CR, Hoffmann S, Nakovics H, Leménager T, Heinz A, Witkiewitz K. Precision Medicine in Alcohol Dependence: A Controlled Trial Testing Pharmacotherapy Response Among Reward and Relief Drinking Phenotypes. Neuropsychopharmacology 2018; 43:891-899. [PMID: 29154368 PMCID: PMC5809801 DOI: 10.1038/npp.2017.282] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/02/2017] [Accepted: 11/12/2017] [Indexed: 12/20/2022]
Abstract
Randomized trials of medications for alcohol dependence (AD) often report no differences between active medications. Few studies in AD have tested hypotheses regarding which medication will work best for which patients (ie, precision medicine). The PREDICT study tested acamprosate and naltrexone vs placebo in 426 randomly assigned AD patients in a 3-month treatment. PREDICT proposed individuals whose drinking was driven by positive reinforcement (ie, reward drinkers) would have a better treatment response to naltrexone, whereas individuals whose drinking was driven by negative reinforcement (ie, relief drinkers) would have a better treatment response to acamprosate. The goal of the current analysis was to test this precision medicine hypothesis of the PREDICT study via analyses of subgroups. Results indicated that four phenotypes could be derived using the Inventory of Drinking Situations, a 30-item self-report questionnaire. These were high reward/high relief, high reward/low relief, low reward/high relief, and low reward/low relief phenotypes. Construct validation analyses provided strong support for the validity of these phenotypes. The subgroup of individuals who were predominantly reward drinkers and received naltrexone vs placebo had an 83% reduction in the likelihood of any heavy drinking (large effect size). Cutoff analyses were done for clinical applicability: individuals are reward drinkers and respond to naltrexone if their reward score was higher than their relief score AND their reward score was between 12 and 31. Using naltrexone with individuals who are predominantly reward drinkers produces significantly higher effect sizes than prescribing the medication to a more heterogeneous sample.
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Affiliation(s)
- Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Corey R Roos
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque NM, USA
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Helmut Nakovics
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tagrid Leménager
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katie Witkiewitz
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque NM, USA
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Toward biomarkers of the addicted human brain: Using neuroimaging to predict relapse and sustained abstinence in substance use disorder. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:143-154. [PMID: 28322982 PMCID: PMC5603350 DOI: 10.1016/j.pnpbp.2017.03.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/17/2017] [Accepted: 03/01/2017] [Indexed: 01/23/2023]
Abstract
The ability to predict relapse is a major goal of drug addiction research. Clinical and diagnostic measures are useful in this regard, but these measures do not fully and consistently identify who will relapse and who will remain abstinent. Neuroimaging approaches have the potential to complement these standard clinical measures to optimize relapse prediction. The goal of this review was to survey the existing drug addiction literature that either used a baseline functional or structural neuroimaging phenotype to longitudinally predict a clinical outcome, or that examined test-retest of a neuroimaging phenotype during a course of abstinence or treatment. Results broadly suggested that, relative to individuals who sustained abstinence, individuals who relapsed had (1) enhanced activation to drug-related cues and rewards, but reduced activation to non-drug-related cues and rewards, in multiple corticolimbic and corticostriatal brain regions; (2) weakened functional connectivity of these same corticolimbic and corticostriatal regions; and (3) reduced gray and white matter volume and connectivity in prefrontal regions. Thus, beyond these regions showing baseline group differences, reviewed evidence indicates that function and structure of these regions can prospectively predict - and normalization of these regions can longitudinally track - important clinical outcomes including relapse and adherence to treatment. Future clinical studies can leverage this information to develop novel treatment strategies, and to tailor scarce therapeutic resources toward individuals most susceptible to relapse.
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50
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Wilcox CE, Claus ED, Calhoun VD, Rachakonda S, Littlewood RA, Mickey J, Arenella PB, Goodreau N, Hutchison KE. Default mode network deactivation to smoking cue relative to food cue predicts treatment outcome in nicotine use disorder. Addict Biol 2018; 23:412-424. [PMID: 28231626 DOI: 10.1111/adb.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/16/2016] [Accepted: 02/02/2017] [Indexed: 11/28/2022]
Abstract
Identifying predictors of treatment outcome for nicotine use disorders (NUDs) may help improve efficacy of established treatments, like varenicline. Brain reactivity to drug stimuli predicts relapse risk in nicotine and other substance use disorders in some studies. Activity in the default mode network (DMN) is affected by drug cues and other palatable cues, but its clinical significance is unclear. In this study, 143 individuals with NUD (male n = 91, ages 18-55 years) received a functional magnetic resonance imaging scan during a visual cue task during which they were presented with a series of smoking-related or food-related video clips prior to randomization to treatment with varenicline (n = 80) or placebo. Group independent components analysis was utilized to isolate the DMN, and temporal sorting was used to calculate the difference between the DMN blood-oxygen-level dependent signal during smoke cues and that during food cues for each individual. Food cues were associated with greater deactivation compared with smoke cues in the DMN. In correcting for baseline smoking and other clinical variables, which have been shown to be related to treatment outcome in previous work, a less positive Smoke - Food difference score predicted greater smoking at 6 and 12 weeks when both treatment groups were combined (P = 0.005, β = -0.766). An exploratory analysis of executive control and salience networks demonstrated that a more positive Smoke - Food difference score for executive control network predicted a more robust response to varenicline relative to placebo. These findings provide further support to theories that brain reactivity to palatable cues, and in particular in DMN, may have a direct clinical relevance in NUD.
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Affiliation(s)
- Claire E. Wilcox
- Department of Psychiatry; University of New Mexico; Albuquerque NM USA
| | - Eric D. Claus
- Mind Research Network and Lovelace Biomedical and Environmental Research Institute; Albuquerque NM USA
| | - Vince D. Calhoun
- Mind Research Network and Lovelace Biomedical and Environmental Research Institute; Albuquerque NM USA
| | - Srinivas Rachakonda
- Mind Research Network and Lovelace Biomedical and Environmental Research Institute; Albuquerque NM USA
| | - Rae A. Littlewood
- Mind Research Network and Lovelace Biomedical and Environmental Research Institute; Albuquerque NM USA
| | - Jessica Mickey
- Mind Research Network and Lovelace Biomedical and Environmental Research Institute; Albuquerque NM USA
| | | | - Natalie Goodreau
- Mind Research Network and Lovelace Biomedical and Environmental Research Institute; Albuquerque NM USA
| | - Kent E. Hutchison
- Mind Research Network and Lovelace Biomedical and Environmental Research Institute; Albuquerque NM USA
- Department of Psychology; University of Colorado Boulder; Boulder CO USA
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