1
|
Chmiel J, Malinowska A, Rybakowski F, Leszek J. The Effectiveness of Mindfulness in the Treatment of Methamphetamine Addiction Symptoms: Does Neuroplasticity Play a Role? Brain Sci 2024; 14:320. [PMID: 38671972 PMCID: PMC11047954 DOI: 10.3390/brainsci14040320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Methamphetamine is a highly stimulating psychoactive drug that causes life-threatening addictions and affects millions of people around the world. Its effects on the brain are complex and include disturbances in the neurotransmitter systems and neurotoxicity. There are several known treatment methods, but their effectiveness is moderate. It must be emphasised that no drugs have been approved for treatment. For this reason, there is an urgent need to develop new, effective, and safe treatments for methamphetamine. One of the potential treatments is mindfulness meditation. In recent years, this technique has been researched extensively in the context of many neurological and psychiatric disorders. METHODS This review explores the use of mindfulness in the treatment of methamphetamine addiction. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. RESULTS Ten studies were identified that used mindfulness-based interventions in the treatment of methamphetamine addiction. The results show that mindfulness is an effective form of reducing hunger, risk of relapses, stress indicators, depression, and aggression, alone or in combination with transcranial direct current stimulation (tDCS). Mindfulness also improved the cognitive function in addicts. The included studies used only behavioural measures. The potential mechanisms of mindfulness in addiction were explained, and it was proposed that it can induce neuroplasticity, alleviating the symptoms of addiction. CONCLUSIONS Evidence from the studies suggest that mindfulness may be an effective treatment option for methamphetamine addiction, used alone or in combination with tDCS. However, further high-quality research is required to establish the role of this treatment option in this field. The use of neuroimaging and neurophysiological measures is fundamental to understand the mechanisms of mindfulness.
Collapse
Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | | | - Filip Rybakowski
- Department and Clinic of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
| |
Collapse
|
2
|
Gancz NN, Forster SE. Threats to external validity in the neuroprediction of substance use treatment outcomes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:5-20. [PMID: 36099534 PMCID: PMC9974755 DOI: 10.1080/00952990.2022.2116712] [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: 03/20/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
Background: Tools predicting individual relapse risk would invaluably inform clinical decision-making (e.g. level-of-care) in substance use treatment. Studies of neuroprediction - use of neuromarkers to predict individual outcomes - have the dual potential to create such tools and inform etiological models leading to new treatments. However, financial limitations, statistical power demands, and related factors encourage restrictive selection criteria, yielding samples that do not fully represent the target population. This problem may be further compounded by a lack of statistical optimism correction in neuroprediction research, resulting in predictive models that are overfit to already-restricted samples.Objectives: This systematic review aims to identify potential threats to external validity related to restrictive selection criteria and underutilization of optimism correction in the existing neuroprediction literature targeting substance use treatment outcomes.Methods: Sixty-seven studies of neuroprediction in substance use treatment were identified and details of sample selection criteria and statistical optimism correction were extracted.Results: Most publications were found to report restrictive selection criteria (e.g. excluding psychiatric (94% of publications) and substance use comorbidities (69% of publications)) that would rule-out a considerable portion of the treatment population. Furthermore, only 21% of publications reported optimism correction.Conclusion: Restrictive selection criteria and underutilization of optimism correction are common in the existing literature and may limit the generalizability of identified neural predictors to the target population whose treatment they would ultimately inform. Greater attention to the inclusivity and generalizability of addiction neuroprediction research, as well as new opportunities provided through open science initiatives, have the potential to address this issue.
Collapse
Affiliation(s)
- Naomi N. Gancz
- VA Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC)
- University of California, Los Angeles, Department of Psychology
| | - Sarah E. Forster
- VA Pittsburgh Healthcare System, VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC)
| |
Collapse
|
3
|
Dacosta-Sánchez D, González-Ponce BM, Fernández-Calderón F, Sánchez-García M, Lozano OM. Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real-world data. Int J Methods Psychiatr Res 2022; 31:e1929. [PMID: 35765238 PMCID: PMC9720222 DOI: 10.1002/mpr.1929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Treatment retention and adherence are used as outcomes in numerous randomized clinical trials and observational studies conducted in the addiction field. Although usual criteria are 3/6 months of treatment retention or number of sessions attended, there is not a methodological support for conclusions using these criteria. This study analyzed the usefulness of retention and adherence to predict therapeutic success. METHODS Retrospective observational study using real-world data from electronic health records of 11,907 patients in treatment diagnosed with cocaine, alcohol, cannabis and opiate use disorders or harmful use. RESULTS Moderate effect size relations were found between the different type of clinical discharge and months in retention (η2 = 0.12) and proportion of attendance (η2 = 0.10). No relationship was found with the number of sessions attended. Using cut-off points (i.e., 3 or 6 months in treatment or attending 6 therapy sessions) worsens the ability to predict the type of discharge. DISCUSSIONS/CONCLUSION Treatment retention and adherence are indicators moderately related to therapeutic success. Research using these indicators to assess the effectiveness of therapies should complement their results with other clinical indicators and quality of life measures.
Collapse
Affiliation(s)
| | | | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Manuel Sánchez-García
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Oscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| |
Collapse
|
4
|
Abstract
Diffusion tractography allows identification and measurement of structural tracts in the human brain previously associated with motivated behavior in animal models. Recent findings indicate that the structural properties of a tract connecting the midbrain to nucleus accumbens (NAcc) are associated with a diagnosis of stimulant use disorder (SUD), but not relapse. In this preregistered study, we used diffusion tractography in a sample of patients treated for SUD (n = 60) to determine whether qualities of tracts projecting from medial prefrontal, anterior insular, and amygdalar cortices to NAcc might instead foreshadow relapse. As predicted, reduced diffusion metrics of a tract projecting from the right anterior insula to the NAcc were associated with subsequent relapse to stimulant use, but not with previous diagnosis. These findings highlight a structural target for predicting relapse to stimulant use and further suggest that distinct connections to the NAcc may confer risk for relapse versus diagnosis.
Collapse
|
5
|
Rezapour T, Hatami J, Farhoudian A, Noroozi A, Daneshmand R, Sofuoglu M, Baldacchino A, Ekhtiari H. Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder. J Subst Abuse Treat 2021; 131:108558. [PMID: 34366202 DOI: 10.1016/j.jsat.2021.108558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Impaired cognitive functions, particularly executive function, predicts poor treatment success in people with substance use disorders. The current study investigated the effect of receiving adjunct cognitive rehabilitation and baseline executive function (EF) measures on treatment response among people with opioid use disorder (OUD). METHOD The analysis sample consisted of 113 participants with OUD who were discharged from a compulsory court-mandated methadone maintenance treatment (MMT) and followed for 3 months. We used the Backward digit span/Auditory verbal learning, Stroop, and Trail making tests to assess the three measures of EF, including working memory, inhibition, and shifting, respectively. Treatment response was operationalized as (1) treatment retention and (2) the number of positive urine tests for morphine during 3-month follow-up periods. The study used Cox's proportional hazards model and linear mixed model to identify predictive factors. RESULTS Lower Stroop interference scores predicted increased length of stay in treatment (χ2 = 33.15, P < 0.001). The linear mixed model showed that scores on auditory verbal learning test and group intervention predicted the number of positive urine tests during a 3-month follow-up. CONCLUSION Working memory and inhibitory control, as well as receiving cognitive rehabilitation, could be potentially considered as predictors of treatment response for newly MMT admitted patients with OUD. Assessment of EF before treatment initiation may inform treatment providers about patient's cognitive deficits that may interfere with therapeutic interventions.
Collapse
Affiliation(s)
- Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Javad Hatami
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Daneshmand
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA
| | - Alex Baldacchino
- University of St Andrews, School of Medicine, Division of Population and Behavioral Sciences, St Andrews, Scotland, UK
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA.
| |
Collapse
|
6
|
Dacosta-Sánchez D, Díaz-Batanero C, Fernandez-Calderon F, Lozano ÓM. Impact of Cluster B Personality Disorders in Drugs Therapeutic Community Treatment Outcomes: A Study Based on Real World Data. J Clin Med 2021; 10:jcm10122572. [PMID: 34200750 PMCID: PMC8230360 DOI: 10.3390/jcm10122572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The impact of dual pathology on treatment outcomes is unclear, with the literature reporting both favorable and unfavorable evidence. The main aim of this study was to determine how dual pathology affects treatment outcomes using real world data obtained from inpatients that began treatment in therapeutic communities. METHOD The data of 2458 inpatients were used. Clinical information was obtained from electronic medical records. Reliability of diagnosis was checked and revealed a mean kappa value of 0.88. RESULTS Of the sample, 41.8% were discharged after achieving the therapeutic objectives. Patients diagnosed with Cluster B personality disorders were found to have a higher risk of dropping out of treatment (HR = 1.320; z = 2.61; p = 0.009). CONCLUSIONS Personality traits exhibited by Cluster B patients can interfere with treatment in therapeutic communities. There is a need to develop specific interventions for these inpatient groups, which could be implemented in therapeutic communities.
Collapse
Affiliation(s)
- Daniel Dacosta-Sánchez
- Department of Experimental and Clinical Psychology, University of Huelva, 21071 Huelva, Spain; (D.D.-S.); (C.D.-B.); (F.F.-C.)
- Research Center for Natural Resources, Health and Environment, University of Huelva, 21071 Huelva, Spain
| | - Carmen Díaz-Batanero
- Department of Experimental and Clinical Psychology, University of Huelva, 21071 Huelva, Spain; (D.D.-S.); (C.D.-B.); (F.F.-C.)
- Research Center for Natural Resources, Health and Environment, University of Huelva, 21071 Huelva, Spain
| | - Fermin Fernandez-Calderon
- Department of Experimental and Clinical Psychology, University of Huelva, 21071 Huelva, Spain; (D.D.-S.); (C.D.-B.); (F.F.-C.)
- Research Center for Natural Resources, Health and Environment, University of Huelva, 21071 Huelva, Spain
| | - Óscar M. Lozano
- Department of Experimental and Clinical Psychology, University of Huelva, 21071 Huelva, Spain; (D.D.-S.); (C.D.-B.); (F.F.-C.)
- Research Center for Natural Resources, Health and Environment, University of Huelva, 21071 Huelva, Spain
- Correspondence:
| |
Collapse
|
7
|
Caspani G, Sebők V, Sultana N, Swann JR, Bailey A. Metabolic phenotyping of opioid and psychostimulant addiction: A novel approach for biomarker discovery and biochemical understanding of the disorder. Br J Pharmacol 2021; 179:1578-1606. [PMID: 33817774 DOI: 10.1111/bph.15475] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/21/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
Despite the progress in characterising the pharmacological profile of drugs of abuse, their precise biochemical impact remains unclear. The metabolome reflects the multifaceted biochemical processes occurring within a biological system. This includes those encoded in the genome but also those arising from environmental/exogenous exposures and interactions between the two. Using metabolomics, the biochemical derangements associated with substance abuse can be determined as the individual transitions from recreational drug to chronic use (dependence). By understanding the biomolecular perturbations along this time course and how they vary across individuals, metabolomics can elucidate biochemical mechanisms of the addiction cycle (dependence/withdrawal/relapse) and predict prognosis (recovery/relapse). In this review, we summarise human and animal metabolomic studies in the field of opioid and psychostimulant addiction. We highlight the importance of metabolomics as a powerful approach for biomarker discovery and its potential to guide personalised pharmacotherapeutic strategies for addiction targeted towards the individual's metabolome.
Collapse
Affiliation(s)
- Giorgia Caspani
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Viktoria Sebők
- Pharmacology Section, Institute of Medical and Biomedical Education, St George's, University of London, London, UK
| | - Nowshin Sultana
- Pharmacology Section, Institute of Medical and Biomedical Education, St George's, University of London, London, UK
| | - Jonathan R Swann
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.,School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alexis Bailey
- Pharmacology Section, Institute of Medical and Biomedical Education, St George's, University of London, London, UK
| |
Collapse
|
8
|
Sampedro-Piquero P, Ladrón de Guevara-Miranda D, Pavón FJ, Serrano A, Suárez J, Rodríguez de Fonseca F, Santín LJ, Castilla-Ortega E. Neuroplastic and cognitive impairment in substance use disorders: a therapeutic potential of cognitive stimulation. Neurosci Biobehav Rev 2019; 106:23-48. [DOI: 10.1016/j.neubiorev.2018.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/15/2018] [Accepted: 11/23/2018] [Indexed: 01/08/2023]
|
9
|
Kamp F, Proebstl L, Hager L, Schreiber A, Riebschläger M, Neumann S, Straif M, Schacht-Jablonowsky M, Manz K, Soyka M, Koller G. Effectiveness of methamphetamine abuse treatment: Predictors of treatment completion and comparison of two residential treatment programs. Drug Alcohol Depend 2019; 201:8-15. [PMID: 31154239 DOI: 10.1016/j.drugalcdep.2019.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is an increasing demand of evidence-based treatment options for methamphetamine users, but research in this field is limited. This study therefore evaluates the efficacy of two residential treatment programs for methamphetamine users. METHOD A total of 108 patients with a history of methamphetamine abuse from two inpatient rehabilitation centers were studied for psychiatric symptoms, craving, psychosocial resources, and cognitive functioning at the start and end of therapy. Patients from one center ("amphetamine type stimulant group") received conventional group therapy plus an additional 10 h of group therapy focusing on stimulant use. Patients from the other center ("treatment as usual") received conventional group therapy only. Predictors of drop-out were estimated. RESULTS A drop-out rate of 40.7% was observed without a significant difference between both centers. Patients remained significantly longer in treatment as usual compared to amphetamine type stimulant treatment. Irrespective of treatment program, craving and psychiatric symptoms significantly decreased while psychosocial resources, processing speed, and cognitive flexibility improved over time. Other cognitive measures yielded mixed results. History of injection drug use was a significant predictor for treatment drop-out. CONCLUSIONS Existing treatments are effective in reducing craving and psychiatric symptoms. Additional stimulant specific groups do not appear to influence treatment completion and secondary outcome measures. Institutions should therefore offer treatment for methamphetamine users, even if they do not provide a therapy content focusing on methamphetamine. History of injection drug use should receive attention in treatment to prevent drop-out. Changes in cognitive functioning need to be further explored.
Collapse
Affiliation(s)
- F Kamp
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany.
| | - L Proebstl
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - L Hager
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - A Schreiber
- District Hospital Hochstadt, Hauptstraße 13, 96272, Hochstadt am Main, Germany
| | - M Riebschläger
- MEDIAN Clinic Mecklenburg, Blumenstraße 3, Rehna OT Parber, 19217, Germany
| | - S Neumann
- MEDIAN Clinic Mecklenburg, Blumenstraße 3, Rehna OT Parber, 19217, Germany
| | - M Straif
- District Hospital Hochstadt, Hauptstraße 13, 96272, Hochstadt am Main, Germany
| | | | - K Manz
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany
| | - M Soyka
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany; Medical Parc Chiemseeblick, Rathausstraße 8, 83233, Bernau am Chiemsee, Germany
| | - G Koller
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| |
Collapse
|
10
|
MacNiven KH, Jensen ELS, Borg N, Padula CB, Humphreys K, Knutson B. Association of Neural Responses to Drug Cues With Subsequent Relapse to Stimulant Use. JAMA Netw Open 2018; 1:e186466. [PMID: 30646331 PMCID: PMC6324538 DOI: 10.1001/jamanetworkopen.2018.6466] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Although chronic relapse is a characteristic of addiction to stimulants, conventional measures (eg, clinical, demographic, and self-report) do not robustly identify which individuals are most vulnerable to relapse. OBJECTIVES To test whether drug cues are associated with increased mesolimbic neural activity in patients undergoing treatment for stimulant use disorder and whether this activity is associated with risk for subsequent relapse. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study of 76 participants included a control group for baseline group comparisons. Veteran patients (n = 36) with stimulant use disorders were recruited from a 28-day residential treatment program at the Veterans Affairs Palo Alto Health Care System. Healthy controls (n = 40) were recruited from the surrounding community. Baseline data were collected between September 21, 2015, and January 26, 2018, from patients and healthy controls using functional magnetic resonance imaging during a performance of a reward cue task. Patients' stimulant use was subsequently assessed after treatment discharge (at approximately 1, 3, and 6 months) to assess relapse outcomes. MAIN OUTCOMES AND MEASURES Primary measures included neural responses to drug and food cues in estimated mesolimbic volumes of interest, including the medial prefrontal cortex, nucleus accumbens (NAcc), and ventral tegmental area. The primary outcome variable was relapse (defined as any stimulant use), assessed both dichotomously (3 months after discharge) and continuously (days to relapse). Brain activity measures were contrasted between groups to validate neural measures of drug cue reactivity, which were then used to estimate relapse outcomes of patients. RESULTS Relative to controls (n = 40; 16 women and 24 men; mean [SD] age, 32.0 [11.6] years), patients (n = 36; 2 women and 34 men; mean [SD] age, 43.4 [13.3] years) showed increased mesolimbic activity in response to drug cues (medial prefrontal cortex, t74 = 2.90, P = .005, Cohen d = 0.66; NAcc, t74 = 2.39, P = .02, Cohen d = 0.54; and ventral tegmental area, t74 = 4.04, P < .001, Cohen d = 0.92). In patients, increased drug cue response in the NAcc (but not other volumes of interest) was associated with time to relapse months later (Cox proportional hazards regression hazard ratio, 2.30; 95% CI, 1.40-3.79). After controlling for age, NAcc response to drug cues classified relapsers (12 patients; 1 woman and 11 men; mean [SD] age, 49.3 [14.1] years) and abstainers (21 patients; 1 woman and 20 men; mean [SD] age, 39.3 [12.3] years) at 3 months with 75.8% classification accuracy. Model comparison further indicated that NAcc responses to drug cues were associated with relapse above and beyond estimations of relapse according to conventional measures. CONCLUSIONS AND RELEVANCE Responses in the NAcc to stimulant cues appear to be associated with relapse in humans. Identification of neural markers may eventually help target interventions to the most vulnerable individuals.
Collapse
Affiliation(s)
- Kelly H MacNiven
- Department of Psychology, Stanford University, Stanford, California
| | - Emily L S Jensen
- Department of Psychology, Stanford University, Stanford, California
| | - Nicholas Borg
- Department of Psychology, Stanford University, Stanford, California
| | - Claudia B Padula
- Veterans Affairs Palo Alto Health Care System, Palo Alto, Stanford, California
| | - Keith Humphreys
- Veterans Affairs Palo Alto Health Care System, Palo Alto, Stanford, California
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Brian Knutson
- Department of Psychology, Stanford University, Stanford, California
| |
Collapse
|
11
|
Rubenis AJ, Fitzpatrick RE, Lubman DI, Verdejo-Garcia A. Sustained attention but not effort-based decision-making predicts treatment motivation change in people with methamphetamine dependence. J Subst Abuse Treat 2018; 95:48-54. [PMID: 30352670 DOI: 10.1016/j.jsat.2018.09.007] [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: 01/28/2018] [Revised: 07/30/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early treatment motivation is a meaningful predictor of clinical outcomes in the context of methamphetamine dependence (MD). Cognitive deficits associated with MD can have a significant impact on motivational fluctuations during early treatment. We specifically examined if sustained attention and effort-based decision-making predict early treatment motivation change in individuals with MD. We hypothesised that both variables would be significant predictors of individual differences in treatment motivation change. METHODS We conducted a longitudinal, observational, cohort study on individuals with MD (N = 72, Age, M = 31.1, SD = 7.3, 29% female). Participants were assessed with cognitive tests of sustained attention (continuous performance test) and effort-based decision-making (effort expenditure for rewards task) within three weeks of entering treatment and rated their treatment motivation at baseline and at follow up six weeks later (n = 50). Multiple regression was used to examine the predictive value of cognitive variables after controlling for nuisance variables. RESULTS Cognitive measures significantly predicted change in treatment motivation after accounting for nuisance variables, F(5,43) = 2.89, p = .025. Analysis of individual predictors showed that sustained attention, but not decision-making, was a significant negative predictor of improvement in treatment motivation (β = -0.34, p = .015). CONCLUSIONS Poorer attentional function was associated with limited improvement in motivation during early treatment. These findings help to characterise cognitive predictors of treatment motivation and suggest directions for tailored treatment programs. Individuals entering treatment with attentional deficits may benefit from adjustments to therapy and/or cognitive remediation.
Collapse
Affiliation(s)
- Adam J Rubenis
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC 3800, Australia
| | - Rebecca E Fitzpatrick
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC 3800, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, VIC 3121, Australia; Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - Antonio Verdejo-Garcia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC 3800, Australia.
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Forster SE, Finn PR, Brown JW. Neural responses to negative outcomes predict success in community-based substance use treatment. Addiction 2017; 112:884-896. [PMID: 28029198 PMCID: PMC5382058 DOI: 10.1111/add.13734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/25/2016] [Accepted: 12/22/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Patterns of brain activation have demonstrated promise as prognostic indicators in substance dependent individuals (SDIs) but have not yet been explored in SDIs typical of community-based treatment settings. DESIGN Prospective clinical outcome design, evaluating baseline functional magnetic resonance imaging data from the Balloon Analogue Risk Task (BART) as a predictor of 3-month substance use treatment outcomes. SETTING Community-based substance use programs in Bloomington, Indiana, USA. PARTICIPANTS Twenty-three SDIs (17 male, aged 18-43 years) in an intensive outpatient or residential treatment program; abstinent 1-4 weeks at baseline. MEASUREMENTS Event-related brain response, BART performance and self-report scores at treatment onset, substance use outcome measure (based on days of use). FINDINGS Using voxel-level predictive modeling and leave-one-out cross-validation, an elevated response to unexpected negative feedback in bilateral amygdala and anterior hippocampus (Amyg/aHipp) at baseline successfully predicted greater substance use during the 3-month study interval (P ≤ 0.006, cluster-corrected). This effect was robust to inclusion of significant non-brain-based covariates. A larger response to negative feedback in bilateral Amyg/aHipp was also associated with faster reward-seeking responses after negative feedback (r(23) = -0.544, P = 0.007; r(23) = -0.588, P = 0.003). A model including Amyg/aHipp activation, faster reward-seeking after negative feedback and significant self-report scores accounted for 45% of the variance in substance use outcomes in our sample. CONCLUSIONS An elevated response to unexpected negative feedback in bilateral amygdala and anterior hippocampus (Amyg/aHipp) appears to predict relapse to substance use in people attending community-based treatment.
Collapse
Affiliation(s)
- Sarah E. Forster
- Indiana University, Department of Psychological and Brain Sciences,VA Pittsburgh Healthcare System,University of Pittsburgh, Department of Psychiatry
| | - Peter R. Finn
- Indiana University, Department of Psychological and Brain Sciences
| | - Joshua W. Brown
- Indiana University, Department of Psychological and Brain Sciences
| |
Collapse
|
14
|
Forster SE, Finn PR, Brown JW. A preliminary study of longitudinal neuroadaptation associated with recovery from addiction. Drug Alcohol Depend 2016; 168:52-60. [PMID: 27620345 PMCID: PMC5086261 DOI: 10.1016/j.drugalcdep.2016.08.626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/24/2016] [Accepted: 08/15/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Few studies have explored longitudinal change in event-related brain responses during early recovery from addiction. Moreover, existing findings yield evidence of both increased and decreased signaling within reward and control centers over time. The current study explored reward- and control-related signals in a risky decision-making task and specifically investigated parametric modulations of the BOLD signal, rather than signal magnitude alone. It was hypothesized that risk-related signals during decision-making and outcome evaluation would reflect recovery and that change in specific signals would correspond with improved treatment outcomes. METHODS Twenty-one substance dependent individuals were recruited upon enrollment in community-based substance use treatment programs, wherein they received treatment-as-usual. Participants completed functional neuroimaging assessments at baseline and 3-month follow-up while performing the Balloon Analogue Risk Task (BART). Risk- and reward-sensitive signals were identified using parametric modulators. Substance use was tracked throughout the 3-month study interval using the timeline follow-back procedure. RESULTS Longitudinal contrasts of parametric modulators suggested improved formation of risk-informed outcome expectations at follow-up. Specifically, a greater response to high risk (low-likelihood) positive feedback was identified in caudal anterior cingulate cortex (ACC) and a greater response to low risk (low-likelihood) negative feedback was identified in caudal ACC and inferior frontal gyrus. In addition, attenuation of a ventromedial prefrontal cortex (vmPFC) "reward-seeking" signal (i.e., increasing response with greater reward) during risky decisions at follow-up was associated with less substance use during the study interval. CONCLUSIONS Changes in risk- and reward-related signaling in ACC/vmPFC appear to reflect recovery and may support sobriety.
Collapse
Affiliation(s)
- Sarah E Forster
- Indiana University, Department of Psychological and Brain Sciences, United States; VA Pittsburgh Healthcare System, United States; University of Pittsburgh, Department of Psychiatry, United States
| | - Peter R Finn
- Indiana University, Department of Psychological and Brain Sciences, United States
| | - Joshua W Brown
- Indiana University, Department of Psychological and Brain Sciences, United States.
| |
Collapse
|
15
|
Contreras-Rodríguez O, Albein-Urios N, Perales JC, Martínez-Gonzalez JM, Vilar-López R, Fernández-Serrano MJ, Lozano-Rojas O, Verdejo-García A. Cocaine-specific neuroplasticity in the ventral striatum network is linked to delay discounting and drug relapse. Addiction 2015. [PMID: 26212416 DOI: 10.1111/add.13076] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS To contrast functional connectivity on ventral and dorsal striatum networks in cocaine dependence relative to pathological gambling, via a resting-state functional connectivity approach; and to determine the association between cocaine dependence-related neuroadaptations indexed by functional connectivity and impulsivity, compulsivity and drug relapse. DESIGN Cross-sectional study of 20 individuals with cocaine dependence (CD), 19 individuals with pathological gambling (PG) and 21 healthy controls (HC), and a prospective cohort study of 20 CD followed-up for 12 weeks to measure drug relapse. SETTING AND PARTICIPANTS CD and PG were recruited through consecutive admissions to a public clinic specialized in substance addiction treatment (Centro Provincial de Drogodependencias) and a public clinic specialized in gambling treatment (AGRAJER), respectively; HC were recruited through community advertisement in the same area in Granada (Spain). MEASUREMENTS Seed-based functional connectivity in the ventral striatum (ventral caudate and ventral putamen) and dorsal striatum (dorsal caudate and dorsal putamen), the Kirby delay-discounting questionnaire, the reversal-learning task and a dichotomous measure of cocaine relapse indicated with self-report and urine tests. FINDINGS CD relative to PG exhibit enhanced connectivity between the ventral caudate seed and subgenual anterior cingulate cortex, the ventral putamen seed and dorsomedial pre-frontal cortex and the dorsal putamen seed and insula (P≤0.001, kE=108). Connectivity between the ventral caudate seed and subgenual anterior cingulate cortex is associated with steeper delay discounting (P≤0.001, kE=108) and cocaine relapse (P≤0.005, kE=34). CONCLUSIONS Cocaine dependence-related neuroadaptations in the ventral striatum of the brain network are associated with increased impulsivity and higher rate of cocaine relapse.
Collapse
Affiliation(s)
- Oren Contreras-Rodríguez
- Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain.,Institute of Neuroscience F. Oloriz, Universidad de Granada, Granada, Spain
| | | | - José C Perales
- Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain
| | - José M Martínez-Gonzalez
- Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain.,Centro Provincial de Drogodependencias, Diputación de Granada, Granada, Spain
| | | | - María J Fernández-Serrano
- Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain.,Department of Psychology, Universidad de Jaén, Jaén, Spain
| | - Oscar Lozano-Rojas
- Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain.,School of Psychology, Universidad de Huelva, Huelva, Spain
| | - Antonio Verdejo-García
- Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain.,Institute of Neuroscience F. Oloriz, Universidad de Granada, Granada, Spain.,School of Psychological Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
16
|
Fernández-Calderón D, Fernández F, Ruiz-Curado S, Verdejo-García A, Lozano ÓM. Profiles of substance use disorders in patients of therapeutic communities: link to social, medical and psychiatric characteristics. Drug Alcohol Depend 2015; 149:31-9. [PMID: 25682479 DOI: 10.1016/j.drugalcdep.2015.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Therapeutic community (TC) clients frequently display a pattern of multiple substance use disorders (SUDs) which is associated with poorer treatment outcomes. This study aimed to characterize multiple SUD profiles in patients enrolled in TCs, and examine the association of these profiles with social, medical and psychiatric outcomes. METHODS Observational study. We acquired substance use diagnoses and sociodemographic, medical and psychiatric comorbidity data for 4102 patients who had been admitted to six public TCs in Andalusia (Spain) from 2004 to 2012. Latent class analysis was applied to participants' substance use diagnoses, and the resulting classes were associated with social (i.e., education, employment, criminality), medical (i.e., infectious diseases) and psychiatric comorbidity. RESULTS We found four differentiated profiles of substance use diagnoses among TC patients: cocaine/opiates (Class 1: 37% of participants); cocaine/opiates/benzodiazepines (Class 2: 25.3%); alcohol (Class 3: 24.7%); and cocaine/cannabis/alcohol (Class 4: 12.9%). Classes 1 and 2 were associated with poorer social and medical characteristics. Class 2 was also associated with greater prevalence of impulsive spectrum mental disorders. Class 3 was associated with greater prevalence of mood and anxiety disorders and cognitive dysfunction, and Class 4 was associated with higher prevalence of psychotic illness. CONCLUSIONS Patients admitted to TCs have heterogeneous substance use diagnostic profiles. Profiles involving multiple use of heroin, cocaine, alcohol and benzodiazepines are associated with poorer social and medical function and impulse control disorders. Profiles involving alcohol use and cannabis/cocaine use are associated with cognitive dysfunction and psychotic illness respectively.
Collapse
Affiliation(s)
- David Fernández-Calderón
- Therapeutic Community of Cartaya, Agency of Social Services and Dependence of Ansalusia, Huelva, Spain
| | - Fermín Fernández
- Research and Information System Department, Agency of Social Services and Dependence of Ansalusia, Sevilla, Spain; Clinical, Experimental and Social Psychology Department, University of Huelva, Huelva, Spain
| | - Sofía Ruiz-Curado
- Education and Social Psychology Department, University of Pablo de Olavide, Sevilla, Spain
| | - Antonio Verdejo-García
- Red de Trastornos Adictivos, University of Granada, Spain; School of Psychological Sciences, Monash University, Australia
| | - Óscar M Lozano
- Clinical, Experimental and Social Psychology Department, University of Huelva, Huelva, Spain; Red de Trastornos Adictivos, University of Granada, Spain.
| |
Collapse
|
17
|
Decision-making impairment predicts 3-month hair-indexed cocaine relapse. Psychopharmacology (Berl) 2014; 231:4179-87. [PMID: 24728653 DOI: 10.1007/s00213-014-3563-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/24/2014] [Indexed: 01/18/2023]
Abstract
RATIONALE One of the key outstanding challenges in cocaine dependence research is determining who is at risk of relapsing during treatment. OBJECTIVES We examined whether cognitive decision-making profiles predict objectively (hair) indexed cocaine relapse at 3-month follow-up. METHODS Thirty-three cocaine-dependent patients commencing outpatient treatment in a public clinic performed baseline decision-making assessments with the original and variant versions of the Iowa Gambling Task, and provided a 3-cm hair sample 3 months afterwards. Based on Iowa Gambling Tasks' performance cut-offs, 5 patients had intact decision-making skills, 17 patients showed impaired sensitivity to reward or punishment (impairment in one of the tasks), and 9 patients showed insensitivity to future consequences (impairment in both tasks). Based on a 0.3 ng/mg cocaine cut-off, 23 patients were classified as relapsers and 10 as non-relapsers at the 3-month follow-up. RESULTS Eighty percent of patients with intact decision-making were abstinent at follow-up, whereas 90% of patients with insensitivity to future consequences had relapsed. The two subgroups (relapsers and non-relapsers) showed no significant differences on drug use, comorbidities, or psychosocial function, and significantly differed on verbal but not performance IQ. A regression model including decision-making scores and verbal IQ predicted abstinence status with high sensitivity (95%) and moderately high specificity (81%). CONCLUSION These preliminary findings demonstrate that decision-making profiles are associated with cocaine relapse. Moreover, combined decision-making and IQ assessments provide optimal predictive values over stimulant relapse, yielding significant opportunities for clinical translation.
Collapse
|
18
|
Stewart JL, Connolly CG, May AC, Tapert SF, Wittmann M, Paulus MP. Striatum and insula dysfunction during reinforcement learning differentiates abstinent and relapsed methamphetamine-dependent individuals. Addiction 2014; 109:460-71. [PMID: 24329936 PMCID: PMC3945155 DOI: 10.1111/add.12403] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/13/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Individuals with methamphetamine dependence (MD) exhibit dysfunction in brain regions involved in goal maintenance and reward processing when compared with healthy individuals. We examined whether these characteristics also reflect relapse vulnerability within a sample of MD patients. DESIGN Longitudinal, with functional magnetic resonance imaging (fMRI) and clinical interview data collected at baseline and relapse status collected at 1-year follow-up interview. SETTING Keck Imaging Center, University of California San Diego, USA. PARTICIPANTS MD patients (n = 60) enrolled into an in-patient drug treatment program at baseline. MD participants remaining abstinent at 1-year follow-up (abstinent MD group; n = 42) were compared with MD participants who relapsed within this period (relapsed MD group; n = 18). MEASUREMENTS Behavioral and neural responses to a reinforcement learning (paper-scissors-rock) paradigm recorded during an fMRI session at time of treatment. FINDINGS The relapsed MD group exhibited greater bilateral inferior frontal gyrus (IFG) and right striatal activation than the abstinent MD group during the learning of reward contingencies (Cohen's d range: 0.60-0.83). In contrast, the relapsed MD group displayed lower bilateral striatum, bilateral insula, left IFG and left anterior cingulate activation than the abstinent MD group (Cohen's d range: 0.90-1.23) in response to winning, tying and losing feedback. CONCLUSIONS Methamphetamine-dependent individuals who achieve abstinence and then relapse show greater inferior frontal gyrus activation during learning, and relatively attenuated striatal, insular and frontal activation in response to feedback, compared with methamphetamine-dependent people who remain abstinent.
Collapse
Affiliation(s)
| | - Colm G. Connolly
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - April C. May
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Susan F. Tapert
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Psychiatry Service, VA San Diego Healthcare System, La Jolla, CA
| | - Marc Wittmann
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Psychiatry Service, VA San Diego Healthcare System, La Jolla, CA,Department of Empirical and Analytical Psychophysics, Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| | - Martin P. Paulus
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Psychiatry Service, VA San Diego Healthcare System, La Jolla, CA
| |
Collapse
|
19
|
Peciña M, Azhar H, Love TM, Lu T, Fredrickson BL, Stohler CS, Zubieta JK. Personality trait predictors of placebo analgesia and neurobiological correlates. Neuropsychopharmacology 2013; 38. [PMID: 23187726 PMCID: PMC3572460 DOI: 10.1038/npp.2012.227] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Personality traits have been shown to interact with environmental cues to modulate biological responses including treatment responses, and potentially having a role in the formation of placebo effects. Here, we assessed psychological traits in 50 healthy controls as to their capacity to predict placebo analgesic effects, placebo-induced activation of μ-opioid neurotransmission and changes in cortisol plasma levels during a sustained experimental pain challenge (hypertonic saline infused in the masseter muscle) with and without placebo administration. Statistical analyses showed that an aggregate of scores from Ego-Resiliency, NEO Altruism, NEO Straightforwardness (positive predictors) and NEO Angry Hostility (negative predictor) scales accounted for 25% of the variance in placebo analgesic responses. Molecular imaging showed that subjects scoring above the median in a composite of those trait measures also presented greater placebo-induced activation of μ-opioid neurotransmission in the subgenual and dorsal anterior cingulate cortex (ACC), orbitofrontal cortex, insula, nucleus accumbens, amygdala and periaqueductal gray (PAG). Endogenous opioid release in the dorsal ACC and PAG was positively correlated with placebo-induced reductions in pain ratings. Significant reductions in cortisol levels were observed during placebo administration and were positively correlated with decreases in pain ratings, μ-opioid system activation in the dorsal ACC and PAG, and as a trend, negatively with NEO Angry Hostility scores. Our results show that personality traits explain a substantial proportion of the variance in placebo analgesic responses and are further associated with activations in endogenous opioid neurotransmission, and as a trend cortisol plasma levels. This initial data, if replicated in larger sample, suggest that simple trait measures easily deployable in the field could be utilized to reduce variability in clinical trials, but may also point to measures of individual resiliency in the face of aversive stimuli such as persistent pain and potentially other stressors.
Collapse
Affiliation(s)
- Marta Peciña
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Hamdan Azhar
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA,Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Tiffany M Love
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Tingting Lu
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA,Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Jon-Kar Zubieta
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Radiology, University of Michigan, Ann Arbor, MI, USA,Molecular and Behavioral Neuroscience Institute University of Michigan, 205 Zina Pitcher Place, Ann Arbor, MI 48109-0720, USA, Tel: +734-763-6843, Fax: +734-647-4130, E-mail:
| |
Collapse
|
20
|
De Wilde B, Verdejo-García A, Sabbe B, Hulstijn W, Dom G. Affective decision-making is predictive of three-month relapse in polysubstance-dependent alcoholics. Eur Addict Res 2013; 19:21-8. [PMID: 22948315 DOI: 10.1159/000339290] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 05/07/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS Common and long-lasting deficits in decision-making in polysubstance-dependent alcoholics (PSA) reflect neurobiological alterations that define the chronic nature of addiction. These deficits affect goal-directed behavior and might be critical risk factors predicting relapse in PSA. METHODS The Delay Discounting Task (DDT) and the Iowa Gambling Task (IGT) assessed the delay-discounting and decision-making skills among 37 abstinent PSA. RESULTS The findings indicated that IGT but not DDT performances were associated with 3-month abstinence, irrespective of the influence of personality traits and coexistent medications. CONCLUSION The results show that the IGT, which assesses processes that are important in the latter stages of addiction, is ecologically more valid compared to the DDT, which assesses processes important in the early stages. They underline the importance of using neurocognitive measures to identify high relapse risk patients and emphasize the relevance of promoting new treatments.
Collapse
Affiliation(s)
- Bieke De Wilde
- Psychiatrisch Centrum Broeders Alexianen, Boechout, Belgium
| | | | | | | | | |
Collapse
|
21
|
Verdejo-García A, Betanzos-Espinosa P, Lozano OM, Vergara-Moragues E, González-Saiz F, Fernández-Calderón F, Bilbao-Acedos I, Pérez-García M. Self-regulation and treatment retention in cocaine dependent individuals: a longitudinal study. Drug Alcohol Depend 2012; 122:142-8. [PMID: 22018602 DOI: 10.1016/j.drugalcdep.2011.09.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/27/2011] [Accepted: 09/27/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND We aimed to explore the association between baseline executive functioning and treatment outcome in Therapeutic Communities (TCs). METHODS We used a longitudinal descriptive design: a baseline neuropsychological assessment was performed within the first 30 days of treatment in TCs. Once participants finished or abandoned treatment, the information about time of stay in treatment was computed for each individual. The study was conducted across six TCs located in the region of Andalusia (Spain): Cartaya, Almonte, Mijas, Los Palacios, La Línea, and Tarifa. Participants were 131 patients with cocaine dependence who initiated and finished treatment in TCs between January 2009 and December 2010 (2 years). Cognitive assessment was composed of general measures of executive functioning: Letter Number Sequencing (working memory) and Similarities (reasoning), and executive tasks sensitive to ventromedial prefrontal cortex dysfunction, including the Delis-Kaplan Stroop test (inhibition/cognitive switching), the Revised-Strategy Application Test (strategy application/multitasking), and the Iowa Gambling Task (decision-making). The outcome measure was retention, defined as time in TC treatment (number of days). RESULTS Poor executive functioning significantly predicted shorter treatment retention in cocaine dependent individuals on TC residential treatment (14% of explained variance). Reduced performance on the R-SAT, a multitasking test taxing the ability to develop and apply the best strategy to organize multiple sub-routine tasks in order to achieve a long-term goal, was the most powerful predictor of treatment retention. CONCLUSIONS Self-regulation deficits predict the capacity to remain in residential treatment among cocaine dependents.
Collapse
Affiliation(s)
- A Verdejo-García
- Department of Clinical Psychology, Universidad de Granada, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Kishida KT, King-Casas B, Montague PR. Neuroeconomic approaches to mental disorders. Neuron 2010; 67:543-54. [PMID: 20797532 DOI: 10.1016/j.neuron.2010.07.021] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2010] [Indexed: 12/01/2022]
Abstract
The pervasiveness of decision-making in every area of human endeavor highlights the importance of understanding choice mechanisms and their detailed relationship to underlying neurobiological function. This review surveys the recent and productive application of game-theoretic probes (economic games) to mental disorders. Such games typically possess concrete concepts of optimal play, thus providing quantitative ways to track when subjects' choices match or deviate from optimal. This feature equips economic games with natural classes of control signals that should guide learning and choice in the agents that play them. These signals and their underlying physical correlates in the brain are now being used to generate objective biomarkers that may prove useful for exposing and understanding the neurogenetic basis of normal and pathological human cognition. Thus, game-theoretic probes represent some of the first steps toward producing computationally principled, objective measures of cognitive function and dysfunction useful for the diagnosis, treatment, and understanding of mental disorders.
Collapse
Affiliation(s)
- Kenneth T Kishida
- Department of Neuroscience and Computational Psychiatry Unit, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | |
Collapse
|