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Ekhtiari H, Sangchooli A, Carmichael O, Moeller FG, O'Donnell P, Oquendo M, Paulus MP, Pizzagalli DA, Ramey T, Schacht J, Zare-Bidoky M, Childress AR, Brady K. Neuroimaging Biomarkers in Addiction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.02.24312084. [PMID: 39281741 PMCID: PMC11398440 DOI: 10.1101/2024.09.02.24312084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
As a neurobiological process, addiction involves pathological patterns of engagement with substances and a range of behaviors with a chronic and relapsing course. Neuroimaging technologies assess brain activity, structure, physiology, and metabolism at scales ranging from neurotransmitter receptors to large-scale brain networks, providing unique windows into the core neural processes implicated in substance use disorders. Identified aberrations in the neural substrates of reward and salience processing, response inhibition, interoception, and executive functions with neuroimaging can inform the development of pharmacological, neuromodulatory, and psychotherapeutic interventions to modulate the disordered neurobiology. Based on our systematic search, 409 protocols registered on ClinicalTrials.gov include the use of one or more neuroimaging paradigms as an outcome measure in addiction, with the majority (N=268) employing functional magnetic resonance imaging (fMRI), followed by positron emission tomography (PET) (N=71), electroencephalography (EEG) (N=50), structural magnetic resonance imaging (MRI) (N=35) and magnetic resonance spectroscopy (MRS) (N=35). Furthermore, in a PubMed systematic review, we identified 61 meta-analyses including 30 fMRI, 22 structural MRI, 8 EEG, 7 PET, and 3 MRS meta-analyses suggesting potential biomarkers in addictions. These studies can facilitate the development of a range of biomarkers that may prove useful in the arsenal of addiction treatments in the coming years. There is evidence that these markers of large-scale brain structure and activity may indicate vulnerability or separate disease subtypes, predict response to treatment, or provide objective measures of treatment response or recovery. Neuroimaging biomarkers can also suggest novel targets for interventions. Closed or open loop interventions can integrate these biomarkers with neuromodulation in real-time or offline to personalize stimulation parameters and deliver the precise intervention. This review provides an overview of neuroimaging modalities in addiction, potential neuroimaging biomarkers, and their physiologic and clinical relevance. Future directions and challenges in bringing these putative biomarkers from the bench to the bedside are also discussed.
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Affiliation(s)
- Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Arshiya Sangchooli
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Owen Carmichael
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - F Gerard Moeller
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Patricio O'Donnell
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Maria Oquendo
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Martin P Paulus
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Diego A Pizzagalli
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Tatiana Ramey
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Joseph Schacht
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Mehran Zare-Bidoky
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Anna Rose Childress
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
| | - Kathleen Brady
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA (Ekhtiari); Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA (Ekhtiari, Paulus); School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia (Sangchooli); Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA (Carmichael); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Oquendo, Childress); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA (Moeller); Translational Medicine, Sage Therapeutics, Cambridge, MA, USA and McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA (O'Donnell); Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA (Pizzaggali); National Institute on Drug Abuse, Bethesda, MD, USA (Ramey); Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA (Schacht); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (Zare-Bidoky); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA (Brady)
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Sangchooli A, Zare-Bidoky M, Fathi Jouzdani A, Schacht J, Bjork JM, Claus ED, Prisciandaro JJ, Wilson SJ, Wüstenberg T, Potvin S, Ahmadi P, Bach P, Baldacchino A, Beck A, Brady KT, Brewer JA, Childress AR, Courtney KE, Ebrahimi M, Filbey FM, Garavan H, Ghahremani DG, Goldstein RZ, Goudriaan AE, Grodin EN, Hanlon CA, Haugg A, Heilig M, Heinz A, Holczer A, Van Holst RJ, Joseph JE, Juliano AC, Kaufman MJ, Kiefer F, Khojasteh Zonoozi A, Kuplicki RT, Leyton M, London ED, Mackey S, McClernon FJ, Mellick WH, Morley K, Noori HR, Oghabian MA, Oliver JA, Owens M, Paulus MP, Perini I, Rafei P, Ray LA, Sinha R, Smolka MN, Soleimani G, Spanagel R, Steele VR, Tapert SF, Vollstädt-Klein S, Wetherill RR, Witkiewitz K, Yuan K, Zhang X, Verdejo-Garcia A, Potenza MN, Janes AC, Kober H, Zilverstand A, Ekhtiari H. Parameter Space and Potential for Biomarker Development in 25 Years of fMRI Drug Cue Reactivity: A Systematic Review. JAMA Psychiatry 2024; 81:414-425. [PMID: 38324323 PMCID: PMC11304510 DOI: 10.1001/jamapsychiatry.2023.5483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Importance In the last 25 years, functional magnetic resonance imaging drug cue reactivity (FDCR) studies have characterized some core aspects in the neurobiology of drug addiction. However, no FDCR-derived biomarkers have been approved for treatment development or clinical adoption. Traversing this translational gap requires a systematic assessment of the FDCR literature evidence, its heterogeneity, and an evaluation of possible clinical uses of FDCR-derived biomarkers. Objective To summarize the state of the field of FDCR, assess their potential for biomarker development, and outline a clear process for biomarker qualification to guide future research and validation efforts. Evidence Review The PubMed and Medline databases were searched for every original FDCR investigation published from database inception until December 2022. Collected data covered study design, participant characteristics, FDCR task design, and whether each study provided evidence that might potentially help develop susceptibility, diagnostic, response, prognostic, predictive, or severity biomarkers for 1 or more addictive disorders. Findings There were 415 FDCR studies published between 1998 and 2022. Most focused on nicotine (122 [29.6%]), alcohol (120 [29.2%]), or cocaine (46 [11.1%]), and most used visual cues (354 [85.3%]). Together, these studies recruited 19 311 participants, including 13 812 individuals with past or current substance use disorders. Most studies could potentially support biomarker development, including diagnostic (143 [32.7%]), treatment response (141 [32.3%]), severity (84 [19.2%]), prognostic (30 [6.9%]), predictive (25 [5.7%]), monitoring (12 [2.7%]), and susceptibility (2 [0.5%]) biomarkers. A total of 155 interventional studies used FDCR, mostly to investigate pharmacological (67 [43.2%]) or cognitive/behavioral (51 [32.9%]) interventions; 141 studies used FDCR as a response measure, of which 125 (88.7%) reported significant interventional FDCR alterations; and 25 studies used FDCR as an intervention outcome predictor, with 24 (96%) finding significant associations between FDCR markers and treatment outcomes. Conclusions and Relevance Based on this systematic review and the proposed biomarker development framework, there is a pathway for the development and regulatory qualification of FDCR-based biomarkers of addiction and recovery. Further validation could support the use of FDCR-derived measures, potentially accelerating treatment development and improving diagnostic, prognostic, and predictive clinical judgments.
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Affiliation(s)
- Arshiya Sangchooli
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Mehran Zare-Bidoky
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Fathi Jouzdani
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Joseph Schacht
- Department of Psychiatry, University of Colorado School of Medicine, Aurora
| | - James M Bjork
- Institute for Drug and Alcohol Studies, Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Eric D Claus
- Department of Biobehavioral Health, The Pennsylvania State University, University Park
| | - James J Prisciandaro
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Stephen J Wilson
- Department of Psychology, The Pennsylvania State University, State College
| | - Torsten Wüstenberg
- Field of Focus IV, Core Facility for Neuroscience of Self-Regulation (CNSR), Heidelberg University, Heidelberg, Germany
| | - Stéphane Potvin
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Quebec, Canada
| | - Pooria Ahmadi
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Bach
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alex Baldacchino
- School of Medicine, University of St Andrews, St Andrews, Scotland
| | - Anne Beck
- Faculty of Health, Health and Medical University, Potsdam, Germany
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kathleen T Brady
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Judson A Brewer
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | | | - Mohsen Ebrahimi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas
| | - Hugh Garavan
- Department of Psychiatry, University of Vermont, Burlington
| | - Dara G Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Rita Z Goldstein
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anneke E Goudriaan
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Erica N Grodin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- BrainsWay Inc, Winston-Salem, North Carolina
| | - Amelie Haugg
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Adrienn Holczer
- Department of Neurology, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary
| | - Ruth J Van Holst
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jane E Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston
| | | | - Marc J Kaufman
- McLean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arash Khojasteh Zonoozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Marco Leyton
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Scott Mackey
- Department of Psychiatry, University of Vermont, Burlington
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - William H Mellick
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Kirsten Morley
- Specialty of Addiction Medicine, Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Hamid R Noori
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge
| | - Mohammad Ali Oghabian
- Neuroimaging and Analysis Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Jason A Oliver
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Max Owens
- Department of Psychiatry, University of Vermont, Burlington
| | | | - Irene Perini
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Parnian Rafei
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Lara A Ray
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Michael N Smolka
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Ghazaleh Soleimani
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Mannheim, Germany
| | - Vaughn R Steele
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Susan F Tapert
- Department of Psychiatry, University of California, San Diego
| | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xiaochu Zhang
- Department of Psychology, School of Humanities and Social Science, University of Science and Technology of China, Anhui, China
| | | | - Marc N Potenza
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Amy C Janes
- Cognitive and Pharmacological Neuroimaging Unit, National Institute on Drug Abuse, Baltimore, Maryland
| | - Hedy Kober
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Anna Zilverstand
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis
| | - Hamed Ekhtiari
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis
- Laureate Institute for Brain Research, Tulsa, Oklahoma
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3
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Mestre-Bach G, Potenza MN. Neural mechanisms linked to treatment outcomes and recovery in substance-related and addictive disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2023; 25:75-91. [PMID: 37594217 PMCID: PMC10444012 DOI: 10.1080/19585969.2023.2242359] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
The present review focuses on potential neural mechanisms underlying recovery from psychiatric conditions characterised by impaired impulse control, specifically substance use disorders, gambling disorder, and internet gaming disorder. Existing treatments (both pharmacological and psychological) for these addictions may impact brain processes, and these have been evaluated in neuroimaging studies. Medication challenge and short-term intervention administration will be considered with respect to treatment utility. Main models of addiction (e.g., dual process, reward deficiency syndrome) will be considered in the context of extant data. Additionally, advanced analytic approaches (e.g., machine-learning approaches) will be considered with respect to guiding treatment development efforts. Thus, this narrative review aims to provide directions for treatment development for addictive disorders.
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Affiliation(s)
- Gemma Mestre-Bach
- Centro de Investigación, Transferencia e Innovación (CITEI), Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
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Kahnt T. Computationally Informed Interventions for Targeting Compulsive Behaviors. Biol Psychiatry 2023; 93:729-738. [PMID: 36464521 PMCID: PMC9989040 DOI: 10.1016/j.biopsych.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/04/2022] [Accepted: 08/30/2022] [Indexed: 11/02/2022]
Abstract
Compulsive behaviors are central to addiction and obsessive-compulsive disorder and can be understood as a failure of adaptive decision making. Particularly, they can be conceptualized as an imbalance in behavioral control, such that behavior is guided predominantly by learned rather than inferred outcome expectations. Inference is a computational process required for adaptive behavior, and recent work across species has identified the neural circuitry that supports inference-based decision making. This includes the orbitofrontal cortex, which has long been implicated in disorders of compulsive behavior. Inspired by evidence that modulating orbitofrontal cortex activity can alter inference-based behaviors, here we discuss noninvasive approaches to target these circuits in humans. Specifically, we discuss the potential of network-targeted transcranial magnetic stimulation and real-time neurofeedback to modulate the neural underpinnings of inference. Both interventions leverage recent advances in our understanding of the neurocomputational mechanisms of inference-based behavior and may be used to complement current treatment approaches for behavioral disorders.
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Affiliation(s)
- Thorsten Kahnt
- National Institute on Drug Abuse Intramural Research Program, Baltimore, Maryland.
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Porrino LJ, Smith HR, Beveridge TJ, Miller MD, Nader SH, Nader MA. Prolonged Exposure to Cocaine Self-Administration Results in a Continued Progression of Alterations in Functional Activity in a Nonhuman Primate Model. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100148. [PMID: 37033159 PMCID: PMC10074498 DOI: 10.1016/j.dadr.2023.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
Background Studies of nonhuman primates with exposures of up to 100 days of cocaine self-administration (SA) have provided evidence that the central effects of cocaine progress over time. These durations of cocaine exposure, however, may be insufficient to capture the extent of the neurobiological alterations observed in cocaine users, many of whom use the drug for years. The goal of the present study was to determine whether 1.5 years of cocaine SA would result in further progression of alterations in functional brain activity. Methods Adult male rhesus monkeys were exposed to 300 sessions of high-dose cocaine SA over 1.5 years. Following the final session rates of local cerebral glucose utilization (LCGU) were assessed with the 2-[14C]-deoxyglucose method and compared to rates of LCGU in control monkeys who responded for food reinforcement. In addition, LCGU in these animals was compared to a previously published group of monkeys that had self-administered cocaine or food for 100 sessions over a 4-5 month period. Results Compared to 100 days of exposure, 300 days of cocaine SA further reduced LCGU in the post-commissural striatum and produced reductions in areas unaffected by the shorter duration of exposure, such as the hypothalamus, all of the amygdala, and large expanses of cortex. Conclusions These findings demonstrate a clear progression of the impact of cocaine on functional activity with increasing durations of drug experience and have important implications for the development of potential strategies for the treatment of cocaine use disorder.
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Abstract
BACKGROUND Alcohol use disorder (AUD) is one of the most widespread psychiatric disorders leading to detrimental consequences to people with this disorder and others. Worldwide, the prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) is estimated at 20% and the prevalence of AUD at 5% of the adult general population, with highest prevalence in Europe and North America. Therapeutic approaches, including pharmacotherapy, play an important role in treating people with AUD. This is an update of a Cochrane Review first published in 2018. OBJECTIVES To evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 22 November 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) of at least four weeks' treatment duration and 12 weeks' overall study duration comparing baclofen for AUD treatment with placebo, no treatment or other treatments. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. relapse, 2. frequency of use, 3. amount of use, 4. adverse events, 5. dropouts from treatment and 6. dropouts from treatment due to adverse events. Our secondary outcomes were 7. craving, 8. anxiety, 9. depression and 10. frequency of most relevant adverse events. MAIN RESULTS We included 17 RCTs (1818 participants) with a diagnosis of alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition or International Classification of Diseases 10th edition criteria. Mean age was 46.5 years and 70% were men. Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. We judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg). Compared to placebo, moderate-certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants. High-certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non-detoxified or those who received medium doses. There was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) -0.18, 95% CI -0.48 to 0.11; 13 studies, 840 participants; moderate-certainty evidence); number of drinks per drinking days (MD -0.45, 95% CI -1.20 to 0.30; 9 studies, 392 participants; moderate-certainty evidence); number of participants with at least one adverse event (RR 1.05, 95% CI 0.99 to 1.11; 10 studies, 738 participants; high-certainty evidence); dropouts (RR 0.88, 95% CI 0.74 to 1.03; 17 studies, 1563 participants; high-certainty evidence); dropouts due to adverse events (RR 1.39, 95% CI 0.89 to 2.18; 16 studies, 1499 participants; high-certainty evidence). These results were confirmed by subgroup analyses except than for the dropouts that resulted lower among participants who received high doses of baclofen and studies longer than 12 weeks. Compared to placebo, there was no difference in craving (SMD -0.16, 95% CI -0.37 to 0.04; 17 studies, 1275 participants), anxiety (MD -0.01, 95% CI -0.14 to 0.11; 15 studies, 1123 participants) and depression (SMD 0.07, 95% CI -0.12 to 0.27; 11 studies, 1029 participants). Concerning the specific adverse events, baclofen increases fatigue, dizziness, somnolence/sedation, dry mouth, paraesthesia and muscle spasms/rigidity. There was no difference in the other adverse events. Compared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low-certainty evidence); number of participants with at least one adverse event (RR 0.63, 95% CI 0.23 to 1.69; very low-certainty evidence); dropouts (RR 0.56, 95% CI 0.21 to 1.46; very low-certainty evidence); dropouts due to adverse events (RR 0.33, 95% CI 0.01 to 7.87; very low-certainty evidence) and craving (MD 5.80, 95% CI -11.84 to 23.44); and all the adverse events evaluated. Compared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low-certainty evidence) and decrease the number of participants with at least one adverse event (RR 0.35, 95% CI 0.15 to 0.80; 2 studies, 80 participants; very low-certainty evidence) but the evidence is very uncertain. One study (60 participants) found no difference between baclofen and naltrexone in the dropouts at the end of treatment (RR 1.00, 95% CI 0.32 to 3.10; very low-certainty evidence), craving (MD 2.08, 95% CI -3.71 to 7.87), and all the adverse events evaluated. AUTHORS' CONCLUSIONS Baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study.
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Affiliation(s)
- Roberta Agabio
- Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato (CA), Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Pelz P, Genauck A, Lorenz RC, Wüstenberg T, Wackerhagen C, Charlet K, Gleich T, Geisel O, Heinz A, Müller CA, Beck A. Effects of baclofen on insular gain anticipation in alcohol-dependent patients - a randomized, placebo-controlled, pharmaco-fMRI pilot trial. Psychopharmacology (Berl) 2023; 240:171-183. [PMID: 36538099 PMCID: PMC9816215 DOI: 10.1007/s00213-022-06291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE One hallmark of addiction is an altered neuronal reward processing. In healthy individuals (HC), reduced activity in fronto-striatal regions including the insula has been observed when a reward anticipation task was performed repeatedly. This effect could indicate a desensitization of the neural reward system due to repetition. Here, we investigated this hypothesis in a cohort of patients with alcohol use disorder (AUD), who have been treated with baclofen or a placebo. The efficacy of baclofen in AUD patients has been shown to have positive clinical effects, possibly via indirectly affecting structures within the neuronal reward system. OBJECTIVES Twenty-eight recently detoxified patients (13 receiving baclofen (BAC), 15 receiving placebo (PLA)) were investigated within a longitudinal, double-blind, and randomized pharmaco-fMRI design with an individually adjusted daily dosage of 30-270 mg. METHODS Brain responses were captured by functional magnetic resonance imaging (fMRI) during reward anticipation while participating in a slot machine paradigm before (t1) and after 2 weeks of individual high-dose medication (t2). RESULTS Abstinence rates were significantly higher in the BAC compared to the PLA group during the 12-week high-dose medication phase. At t1, all patients showed significant bilateral striatal activation. At t2, the BAC group showed a significant decrease in insular activation compared to the PLA group. CONCLUSIONS By affecting insular information processing, baclofen might enable a more flexible neuronal adaptation during recurrent reward anticipation, which could resemble a desensitization as previously observed in HC. This result strengthens the modulation of the reward system as a potential mechanism of action of baclofen. TRIAL REGISTRATION Identifier of the main trial (the BACLAD study) at clinical.gov: NCT0126665.
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Affiliation(s)
- Patricia Pelz
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Alexander Genauck
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin (BCCN), Unter Den Linden 6, 10099, Berlin, Germany
| | - Robert C Lorenz
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Lentzallee 94, 14195, Berlin, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Research Council Field of Focus IV, Core Facility for Neuroscience of Self-Regulation (CNSR), Heidelberg University, Hauptstr. 51, Building 3011, 69117, Heidelberg, Germany
| | - Carolin Wackerhagen
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Katrin Charlet
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Section On Clinical Genomics and Experimental Therapeutics (CGET), National Institute On Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892-1540, USA
| | - Tobias Gleich
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstr. 79, 10365, Berlin, Germany
| | - Olga Geisel
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian A Müller
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anne Beck
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Health and Medical University, Campus Potsdam, Olympischer Weg 1, 14471, Potsdam, Germany
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Martins B, Rutland W, De Aquino JP, Kazer BL, Funaro M, Potenza MN, Angarita GA. Helpful or Harmful? The Therapeutic Potential of Medications with Varying Degrees of Abuse Liability in the Treatment of Substance Use Disorders. CURRENT ADDICTION REPORTS 2022; 9:647-659. [PMID: 35990796 PMCID: PMC9376579 DOI: 10.1007/s40429-022-00432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review This review summarizes recent clinical trial research on pharmacological treatments for substance use disorders, with a specific focus on agents with potential abuse liability. Recent Findings Pharmacological treatments for substance use disorders may include gabapentinoids, baclofen, modafinil, ketamine, cannabinoids, gamma-hydroxybutyrate, and psychedelics. Gabapentinoids may decrease negative subjective effects of withdrawal in alcohol and cannabis use disorders. Cannabinoids similarly appear to decrease use and withdrawal symptoms in cannabis use disorder, while research shows stimulant medications may reduce cravings and increase abstinence in cocaine use disorder. Ketamine and psychedelics may help treat multiple substance use disorders. Ketamine may reduce withdrawal symptoms, promote abstinence, and diminish cravings in alcohol and cocaine use disorders and psychedelics may promote remission, decrease use, and reduce cravings in alcohol and opioid use disorders. Summary Regardless of current regulatory approval statuses and potentials for abuse, multiple agents should not be dismissed prematurely as possible treatments for substance use disorders. However, further clinical research is needed before effective implementation can begin in practice. Supplementary Information The online version contains supplementary material available at 10.1007/s40429-022-00432-9.
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Affiliation(s)
- Bradford Martins
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
| | - Will Rutland
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
| | - Joao P. De Aquino
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
| | - Benjamin L. Kazer
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT 06510 USA
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Child Study Center, Yale University School of Medicine, New Haven, CT 06510 USA
- Department of Neuroscience, Yale University, New Haven, CT 06510 USA
- Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
- Connecticut Council On Problem Gambling, Wethersfield, CT 06109 USA
- Wu Tsai Institute, Yale University, New Haven, CT 06510 USA
| | - Gustavo A. Angarita
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519 USA
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Mistarz N, Andersen K, Nielsen AS, Goudriaan AE, Michel TM, Skøt L, Anhøj SJ, Mellentin AI. Pharmacological compounds targeting emotional cognition in alcohol use disorder: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2022; 116:110535. [PMID: 35182608 DOI: 10.1016/j.pnpbp.2022.110535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 01/15/2023]
Abstract
Non-emotional (e.g., executive functions) and emotional cognitive (e.g., facial emotion recognition) impairments are a well-known aspect of alcohol use disorder (AUD). These deficits may impede on treatment outcomes, increase the risk of relapse, and lead to socio-occupational disabilities. Previous systematic reviews have examined the effectiveness of cognitive enhancing pharmacological agents (CEPAs) targeting non-emotional, but not emotional, cognition in AUD. Our aim was to systematically review the effectiveness of CEPAs targeting emotional cognition in subclinical and clinical AUD populations. A qualitative synthesis of controlled trials was conducted, and the studies were assessed for risk of bias. Eight studies were eligible (15 ≤ ns ≤ 143), and they all had a moderate risk of bias. Modafinil and nalmefene were the most examined agents, with the findings suggesting a potential beneficial effect of the agents on implicit emotional domains (i.e., reward processing). Methodological shortcomings and heterogeneous findings across the studies do not allow inferences about the effectiveness of these compounds in AUD. Future studies should examine CEPAs targeting emotional cognition in more detail.
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Affiliation(s)
- Nicolaj Mistarz
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.
| | - Kjeld Andersen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Anette Søgaard Nielsen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Anneke E Goudriaan
- Amsterdam University Medical Centre, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Institute for Addiction Research, Department of Research, Arkin, Amsterdam, the Netherlands
| | - Tanja Maria Michel
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Simon Jesper Anhøj
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark; Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Kaplan G, Xu H, Abreu K, Feng J. DNA Epigenetics in Addiction Susceptibility. Front Genet 2022; 13:806685. [PMID: 35145550 PMCID: PMC8821887 DOI: 10.3389/fgene.2022.806685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Addiction is a chronically relapsing neuropsychiatric disease that occurs in some, but not all, individuals who use substances of abuse. Relatively little is known about the mechanisms which contribute to individual differences in susceptibility to addiction. Neural gene expression regulation underlies the pathogenesis of addiction, which is mediated by epigenetic mechanisms, such as DNA modifications. A growing body of work has demonstrated distinct DNA epigenetic signatures in brain reward regions that may be associated with addiction susceptibility. Furthermore, factors that influence addiction susceptibility are also known to have a DNA epigenetic basis. In the present review, we discuss the notion that addiction susceptibility has an underlying DNA epigenetic basis. We focus on major phenotypes of addiction susceptibility and review evidence of cell type-specific, time dependent, and sex biased effects of drug use. We highlight the role of DNA epigenetics in these diverse processes and propose its contribution to addiction susceptibility differences. Given the prevalence and lack of effective treatments for addiction, elucidating the DNA epigenetic mechanism of addiction vulnerability may represent an expeditious approach to relieving the addiction disease burden.
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11
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Sivils A, Wang JQ, Chu XP. Striatonigrostriatal Spirals in Addiction. Front Neural Circuits 2021; 15:803501. [PMID: 34955762 PMCID: PMC8703003 DOI: 10.3389/fncir.2021.803501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
A biological reward system is integral to all animal life and humans are no exception. For millennia individuals have investigated this system and its influences on human behavior. In the modern day, with the US facing an ongoing epidemic of substance use without an effective treatment, these investigations are of paramount importance. It is well known that basal ganglia contribute to rewards and are involved in learning, approach behavior, economic choices, and positive emotions. This review aims to elucidate the physiological role of striatonigrostriatal (SNS) spirals, as part of basal ganglia circuits, in this reward system and their pathophysiological role in perpetuating addiction. Additionally, the main functions of neurotransmitters such as dopamine and glutamate and their receptors in SNS circuits will be summarized. With this information, the claim that SNS spirals are crucial intermediaries in the shift from goal-directed behavior to habitual behavior will be supported, making this circuit a viable target for potential therapeutic intervention in those with substance use disorders.
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Affiliation(s)
| | | | - Xiang-Ping Chu
- Department of Biomedical Sciences, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
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12
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Regier PS, Jagannathan K, Franklin TR, Wetherill RR, Langleben DD, Gawyrsiak M, Kampman KM, Childress AR. Sustained brain response to repeated drug cues is associated with poor drug-use outcomes. Addict Biol 2021; 26:e13028. [PMID: 33634928 PMCID: PMC9906797 DOI: 10.1111/adb.13028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 12/12/2022]
Abstract
A threefold increase in fatal cocaine overdoses during the past decade highlights the critical lack of medications for cocaine use disorders. The brain response to drug cues can predict future drug use; however, results have been mixed. We present preliminary evidence that a sustained response to repeated cocaine cues within a single task is a significant predictor of drug-use outcomes. Seventy-three cocaine inpatients were administered a passive-viewing fMRI task, featuring 500 ms novel evocative (cocaine, sexual, aversive) and neutral comparator cues in the first half (Half1), which were then repeated in the second half (Half2). After the baseline scan, patients received eight outpatient treatment weeks with twice-weekly drug screens. Drug-use outcome groups were empirically defined based on cocaine-positive or missing urines averaged across the outpatient phase: GOOD (<40%), POOR (>85%), and Intermediate (INT, between 40% and 85%) outcomes. Differences of response to initial (Half1) and repeated (Half2) cues in a priori (cue-reactive) regions were tested between outcome groups (3 [Group] × 2 [Halves] ANOVA). An interaction was found in the brain response to drug (but not sex or aversive) cues, with a significant difference between the GOOD and POOR outcome groups in Half2, driven by a significant decrease in brain response by the GOOD outcome group and a sustained brain response by the POOR outcome group, to repeated cocaine cues. The brain response to repeated drug cues may be a useful predictor of future drug use, encouraging future intervention studies to restore a "healthy" (decreasing) response to the repeated presentation of drug cues.
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Affiliation(s)
- Paul S. Regier
- Perelman School of Medicine, Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - Kanchana Jagannathan
- Perelman School of Medicine, Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - Teresa R. Franklin
- Perelman School of Medicine, Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - Reagan R. Wetherill
- Perelman School of Medicine, Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - Daniel D. Langleben
- Perelman School of Medicine, Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - Michael Gawyrsiak
- Perelman School of Medicine, Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - Kyle M. Kampman
- Perelman School of Medicine, Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - Anna Rose Childress
- Perelman School of Medicine, Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
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Cheron J, Kerchove d'Exaerde AD. Drug addiction: from bench to bedside. Transl Psychiatry 2021; 11:424. [PMID: 34385417 PMCID: PMC8361217 DOI: 10.1038/s41398-021-01542-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Drug addiction is responsible for millions of deaths per year around the world. Still, its management as a chronic disease is shadowed by misconceptions from the general public. Indeed, drug consumers are often labelled as "weak", "immoral" or "depraved". Consequently, drug addiction is often perceived as an individual problem and not societal. In technical terms, drug addiction is defined as a chronic, relapsing disease resulting from sustained effects of drugs on the brain. Through a better characterisation of the cerebral circuits involved, and the long-term modifications of the brain induced by addictive drugs administrations, first, we might be able to change the way the general public see the patient who is suffering from drug addiction, and second, we might be able to find new treatments to normalise the altered brain homeostasis. In this review, we synthetise the contribution of fundamental research to the understanding drug addiction and its contribution to potential novel therapeutics. Mostly based on drug-induced modifications of synaptic plasticity and epigenetic mechanisms (and their behavioural correlates) and after demonstration of their reversibility, we tried to highlight promising therapeutics. We also underline the specific temporal dynamics and psychosocial aspects of this complex psychiatric disease adding parameters to be considered in clinical trials and paving the way to test new therapeutic venues.
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Affiliation(s)
- Julian Cheron
- Laboratory of Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels, B-1070, Belgium
| | - Alban de Kerchove d'Exaerde
- Laboratory of Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels, B-1070, Belgium.
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Keefer SE, Gyawali U, Calu DJ. Choose your path: Divergent basolateral amygdala efferents differentially mediate incentive motivation, flexibility and decision-making. Behav Brain Res 2021; 409:113306. [PMID: 33887310 PMCID: PMC8189324 DOI: 10.1016/j.bbr.2021.113306] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
To survive in a complex environment, individuals form associations between environmental stimuli and rewards to organize and optimize reward seeking behaviors. The basolateral amygdala (BLA) uses these learned associations to inform decision-making processes. In this review, we describe functional projections between BLA and its cortical and striatal targets that promote learning and motivational processes central to decision-making. Specifically, we compare and contrast divergent projections from the BLA to the orbitofrontal (OFC) and to the nucleus accumbens (NAc) and examine the roles of these pathways in associative learning, value-guided decision-making, choice behaviors, as well as cue and context-driven drug seeking. Finally, we consider how these projections are involved in disorders of motivation, with a focus on Substance Use Disorder.
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Affiliation(s)
- Sara E Keefer
- Department of Anatomy and Neurobiology, University of Maryland, School of Medicine, Baltimore, MD, United States
| | - Utsav Gyawali
- Department of Anatomy and Neurobiology, University of Maryland, School of Medicine, Baltimore, MD, United States; Program in Neuroscience, University of Maryland, School of Medicine, Baltimore, MD, United States
| | - Donna J Calu
- Department of Anatomy and Neurobiology, University of Maryland, School of Medicine, Baltimore, MD, United States; Program in Neuroscience, University of Maryland, School of Medicine, Baltimore, MD, United States.
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15
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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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Patti MA, Wochele S, Hu Y, Regier PS, Childress AR, Troiani V. Orbitofrontal sulcogyral morphology in patients with cocaine use disorder. Psychiatry Res Neuroimaging 2020; 305:111174. [PMID: 32920245 PMCID: PMC8126989 DOI: 10.1016/j.pscychresns.2020.111174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 11/18/2022]
Abstract
Orbitofrontal cortex (OFC) is thought to be involved in appropriate processing of rewarding stimuli, and abnormal OFC structure and function has been found in patients with substance use disorders. Atypical patterns of the H-sulcus in the OFC have been primarily identified with schizophrenia, but also with bipolar disorder, both of which are associated with comorbid substance use. Given the high rates of substance use within Axis I psychiatric disorders, it is reasonable to consider how frequencies of OFC patterns in populations with only substance use compare to controls. This information is crucial to disentangle whether atypical frequencies of H-sulcus sulcogyral patterns within psychopathology are associated with the psychiatric or substance use phenotype. Here, we present the first analysis of H-sulcus sulcogyral patterns in a population of adult black men with (n = 84) and without (n = 24) cocaine use disorder (CUD). We find that OFC sulcogyral patterns are not significantly different from the control group, indicating that OFC sulcogyral patterns are not disrupted in patients with CUD. As exploratory analyses, we describe OFC sulcogyral pattern subtypes in this cohort as well as an additional control group (n = 52), in order to add to the growing body of literature on OFC sulcogyral pattern characterization.
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Affiliation(s)
- Marisa A Patti
- Geisinger-Bucknell Autism & Developmental Medicine Institute, Geisinger, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, United States.
| | - Sarah Wochele
- Geisinger-Bucknell Autism & Developmental Medicine Institute, Geisinger, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, United States
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, PA, United States
| | - Paul S Regier
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Anna Rose Childress
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Vanessa Troiani
- Geisinger-Bucknell Autism & Developmental Medicine Institute, Geisinger, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, United States; Department of Imaging Science and Innovation, Center for Health Research, Geisinger, Danville, Pennsylvania, United States; Neuroscience Institute, Geisinger, Danville, Pennsylvania, United States; Department of Basic Sciences, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States.
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17
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Ketcherside A, Jagannathan K, Dolui S, Hager N, Spilka N, Nutor C, Rao H, Franklin T, Wetherill R. Baclofen-induced Changes in the Resting Brain Modulate Smoking Cue Reactivity: A Double-blind Placebo-controlled Functional Magnetic Resonance Imaging Study in Cigarette Smokers. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:289-302. [PMID: 32329309 PMCID: PMC7242101 DOI: 10.9758/cpn.2020.18.2.289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/01/2019] [Accepted: 01/04/2020] [Indexed: 01/04/2023]
Abstract
Objective Smoking cue-(SC) elicited craving can lead to relapse in SC-vulnerable individuals. Thus, identifying treatments that target SC-elicited craving is a top research priority. Reduced drug cue neural activity is associated with recovery and is marked by a profile of greater tonic (resting) activation in executive control regions, and increased connectivity between executive and salience regions. Evidence suggests the GABA-B agonist baclofen can reduce drug cue-elicited neural activity, potentially through its actions on the resting brain. Based on the literature, we hypothesize that baclofen’s effects in the resting brain can predict its effects during SC exposure. Methods In this longitudinal, double blind, placebo-controlled neuropharmacological study 43 non-abstinent, sated treatment-seeking cigarette smokers (63% male) participated in an fMRI resting-state scan and a SC-reactivity task prior to (T1) and 3 weeks following randomization (T2; baclofen: 80 mg/day; n = 21). Subjective craving reports were acquired before and after SC exposure to explicitly examine SC-induced craving. Results Whole-brain full-factorial analysis revealed a group-by-time interaction with greater resting brain activation of the right dorsolateral prefrontal cortex (dlPFC) at T2 in the baclofen group (BAC) (pFWEcorr = 0.02), which was associated with reduced neural responses to SCs in key cue-reactive brain regions; the anterior ventral insula and ventromedial prefrontal cortex (pFWEcorr < 0.01). BAC, but not the placebo group reported decreased SC-elicited craving (p = 0.02). Conclusion Results suggest that baclofen mitigates the reward response to SCs through an increase in tonic activation of the dlPFC, an executive control region. Through these mechanisms, baclofen may offer SC-vulnerable smokers protection from SC-induced relapse.
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Affiliation(s)
- Ariel Ketcherside
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kanchana Jagannathan
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sudipto Dolui
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nathan Hager
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Nathaniel Spilka
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Chaela Nutor
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hengyi Rao
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Teresa Franklin
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Reagan Wetherill
- The Center for Studies of Addiction, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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18
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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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Li X, Slesinger PA. GABA B Receptors and Drug Addiction: Psychostimulants and Other Drugs of Abuse. Curr Top Behav Neurosci 2020; 52:119-155. [PMID: 33442842 DOI: 10.1007/7854_2020_187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Metabotropic GABAB receptors (GABABRs) mediate slow inhibition and modulate synaptic plasticity throughout the brain. Dysfunction of GABABRs has been associated with psychiatric illnesses and addiction. Drugs of abuse alter GABAB receptor (GABABR) signaling in multiple brain regions, which partly contributes to the development of drug addiction. Recently, GABABR ligands and positive allosteric modulators (PAMs) have been shown to attenuate the initial rewarding effect of addictive substances, inhibit seeking and taking of these drugs, and in some cases, ameliorate drug withdrawal symptoms. The majority of the anti-addiction effects seen with GABABR modulation can be localized to ventral tegmental area (VTA) dopamine neurons, which receive complex inhibitory and excitatory inputs that are modified by drugs of abuse. Preclinical research suggests that GABABR PAMs are emerging as promising candidates for the treatment of drug addiction. Clinical studies on drug dependence have shown positive results with GABABR ligands but more are needed, and compounds with better pharmacokinetics and fewer side effects are critically needed.
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Affiliation(s)
- Xiaofan Li
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Paul A Slesinger
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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20
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Bal A, Gerena J, Olekanma DI, Arguello AA. Neuronal activation in orbitofrontal cortex subregions: Cfos expression following cue-induced reinstatement of cocaine-seeking behavior. Behav Neurosci 2019; 133:489-495. [PMID: 31058522 DOI: 10.1037/bne0000319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cocaine-use disorders are characterized by repeated relapse to drug-seeking and drug-taking behavior following periods of abstinence. Former drug users display increased activation of the orbitofrontal cortex (OFC) in response to drug-related cues, and similar phenomena are also observed in rodent models of drug relapse. The lateral, but not medial, OFC functionally contributes to the maintenance of cue-drug associations; however, less is known about the role of the ventral OFC in this process. To examine the pattern of neuronal activation in OFC subregions in response to drug-associated cues, rats were trained to respond on a lever for a cocaine infusion paired with a complex cue (2-hr sessions, minimum 10 days). Cocaine self-administration was followed by extinction training, in which lever responses resulted in no consequences (2-hr sessions, minimum 7 days). During a 1-hr reinstatement test, drug-seeking behavior (i.e., responses on the drug-paired lever) was examined in the presence or absence of contingent drug-paired cues (Cue TEST vs. Ext TEST, respectively). Rats were overdosed with a ketamine + xylazine cocktail 30-min post session, and transcardially perfused with 4% paraformaldehyde. Cfos protein expression was utilized to measure potential changes in neural activation between the reinstatement test groups. An increase in the number of Cfos-Immunoreactive cells was observed in the ventral and lateral subregions of the OFC in the Cue TEST group. The present findings provide evidence that the ventral and lateral regions of the rat OFC display similar patterns of neuronal activation in response to cocaine-paired cues. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Amy A Arguello
- Department of Psychology and Neuroscience Program, Michigan State University
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21
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Abstract
Cognitive impairments in substance use disorders have been extensively researched, especially since the advent of cognitive and computational neuroscience and neuroimaging methods in the last 20 years. Conceptually, altered cognitive function can be viewed as a hallmark feature of substance use disorders, with documented alterations in the well-known "executive" domains of attention, inhibition/regulation, working memory, and decision-making. Poor cognitive (sometimes referred to as "top-down") regulation of downstream motivational processes-whether appetitive (reward, incentive salience) or aversive (stress, negative affect)-is recognized as a fundamental impairment in addiction and a potentially important target for intervention. As addressed in this special issue, cognitive impairment is a transdiagnostic domain; thus, advances in the characterization and treatment of cognitive dysfunction in substance use disorders could have benefit across multiple psychiatric disorders. Toward this general goal, we summarize current findings in the abovementioned cognitive domains of substance use disorders, while suggesting a potentially useful expansion to include processes that both precede (precognition) and supersede (social cognition) what is usually thought of as strictly cognition. These additional two areas have received relatively less attention but phenomenologically and otherwise are important features of substance use disorders. The review concludes with suggestions for research and potential therapeutic targeting of both the familiar and this more comprehensive version of cognitive domains related to substance use disorders.
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Browne CA, Hammack R, Lucki I. Dysregulation of the Lateral Habenula in Major Depressive Disorder. Front Synaptic Neurosci 2018; 10:46. [PMID: 30581384 PMCID: PMC6292991 DOI: 10.3389/fnsyn.2018.00046] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/22/2018] [Indexed: 12/31/2022] Open
Abstract
Clinical and preclinical evidence implicates hyperexcitability of the lateral habenula (LHb) in the development of psychiatric disorders including major depressive disorder (MDD). This discrete epithalamic nucleus acts as a relay hub linking forebrain limbic structures with midbrain aminergic centers. Central to reward processing, learning and goal directed behavior, the LHb has emerged as a critical regulator of the behaviors that are impaired in depression. Stress-induced activation of the LHb produces depressive- and anxiety-like behaviors, anhedonia and aversion in preclinical studies. Moreover, deep brain stimulation of the LHb in humans has been shown to alleviate chronic unremitting depression in treatment resistant depression. The diverse neurochemical processes arising in the LHb that underscore the emergence and treatment of MDD are considered in this review, including recent optogenetic studies that probe the anatomical connections of the LHb.
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Affiliation(s)
- Caroline A Browne
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Robert Hammack
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Irwin Lucki
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Abstract
BACKGROUND Alcohol use disorder (AUD) and alcohol-related impairments belong to the most widespread psychiatric disorders leading to specific psychophysical, affective and cognitive symptoms and consequences for psychosocial well-being and health. Alcohol consumption is increasingly becoming a problem in many developing regions and AUD prevalence is estimated at 4.1% worldwide, with highest prevalence in European countries (7.5%), and the North America (6.0%). Therapeutic approaches, including pharmacotherapy, play an important role in treating patients with AUD. OBJECTIVES To assess the efficacy and safety of baclofen for treating people with AUD, who are currently drinking, with the aim of achieving and maintaining abstinence or reducing alcohol consumption. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Specialised Register, CENTRAL, MEDLINE, Embase, two further databases and two clinical trials registries, conference proceedings, and the reference lists of retrieved articles. The date of the most recent search was 30 January 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) of at least four weeks' treatment duration and 12 weeks' overall study duration comparing baclofen for relapse prevention of AUD with placebo, no treatment or other treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 12 RCTs (1128 participants). All studies but three recruited fewer than 100 participants. Participants had a diagnosis of alcohol dependence according the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV or the International Classification of Diseases (ICD)-10 criteria who were currently drinking. The mean age of participants was 48 years, and there were more men (69%), than women. All studies compared baclofen to placebo, except for one study that evaluated baclofen versus acamprosate. The included studies considered baclofen at different doses (range 10 mg a day to 150 mg a day). In all but one of the studies, participants in both the baclofen and placebo groups received psychosocial treatment or counselling of various intensity.We judged most of the studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias.We did not find any difference between baclofen and placebo for the primary outcomes: relapse-return to any drinking (RR 0.88, 95% CI 0.74 to 1.04; 5 studies, 781 participants, moderate certainty evidence); frequency of use by percentage of days abstinent (MD 0.39, 95% CI -11.51 to 12.29; 6 studies, 465 participants, low certainty evidence) and frequency of use by percentage of heavy drinking days at the end of treatment (MD 0.25, 95% CI -1.25 to 1.76; 3 studies, 186 participants, moderate certainty evidence); number of participants with at least one adverse event (RR 1.04, 95% CI 0.99 to 1.10; 4 studies, 430 participants, high certainty evidence); the dropout rate at the end of treatment (RR 0.98, 95% CI 0.77 to 1.26, 8 studies, 977 participants, high certainty evidence) and dropout due to adverse events (RR 1.11, 95% CI 0.59 to 2.07; 7 studies, 913 participants, high certainty evidence).We found evidence that baclofen increases amount of use (drink per drinking days), (MD 1.55, 95% CI 1.32 to 1.77; 2 studies, 72 participants, low certainty evidence).Among secondary outcomes, there was no difference on craving (MD 1.38, 95% CI -1.28 to 4.03, 5 studies, 469 participants), and anxiety (SMD 0.07, 95% CI -0.14 to 0.28; 5 trials, 509 participants). We found that baclofen increased depression (SMD 0.27, 95% CI 0.05 to 0.48; 3 studies, 387 participants).Concerning the specific adverse events we found that baclofen increased: vertigo (RR 2.16, 95% CI 1.24 to 3.74; 7 studies, 858 participants), somnolence/sedation (RR 1.48, 95%CI 1.11 to 1.96; 8 studies, 946 participants), paraesthesia (RR 4.28, 95% CI 2.11 to 8.67; 4 studies, 593 participants), and muscle spasms/rigidity (RR 1.94, 95%CI 1.08 to 3.48; 3 studies, 551 participants). For all the other adverse events we did not find significant differences between baclofen and placebo.For the comparison baclofen versus acamprosate, we were only able to extract data for one outcome, craving. For this outcome, we found that baclofen increased craving compared with acamprosate (MD 14.62, 95% CI 12.72 to 16.52; 1 study, 49 participants). AUTHORS' CONCLUSIONS None of the primary or secondary outcomes of the review showed evidence of a difference between baclofen and placebo. The high heterogeneity among primary studies results limits the interpretation of the summary estimate, the identification of moderators and mediators of baclofen's effects on alcohol use remains a challenge for further research. Even though some results from RCTs are promising, current evidence remains uncertain regarding the use of baclofen as a first-line treatment for people with AUDs.
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Affiliation(s)
- Silvia Minozzi
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | - Rosella Saulle
- Lazio Regional Health ServiceDepartment of EpidemiologyVia Cristoforo Colombo, 112RomeItaly00154
| | - Susanne Rösner
- Forel KlinikIslikonerstrasse 5Ellikon an der ThurSwitzerland8548
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24
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Lim AC, Roche DJO, Ray LA. Distress Tolerance and Craving for Cigarettes Among Heavy Drinking Smokers. J Stud Alcohol Drugs 2018; 79:918-928. [PMID: 30573023 PMCID: PMC6308171 DOI: 10.15288/jsad.2018.79.918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/23/2018] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Heavy drinking smokers experience significant difficulties with smoking cessation. Craving is closely tied to relapses during cessation attempts, and alcohol consumption increases cigarette craving among heavy drinking smokers. To date, however, few moderators of the relationship between craving and relapse have been identified. Individuals' capacity for distress tolerance predicts smoking cessation outcomes and may be connected to craving. Relatedly, pharmacotherapies like varenicline and naltrexone reduce cigarette and alcohol cravings, respectively. No studies have examined the interrelationships among distress tolerance, craving, and pharmacotherapy effects. This study therefore examines distress tolerance as a moderator of the relationship between overnight abstinence-induced cigarette craving and subsequent alcohol- and cigarette-induced changes in craving among heavy drinking smokers. This study also examines the impact of varenicline and naltrexone on these relationships. METHOD A total of 120 non-treatment-seeking heavy drinking smokers were randomized and titrated to one of the following conditions: (a) placebo, (b) varenicline, (c) naltrexone, or (d) varenicline + naltrexone. Participants then completed a laboratory paradigm after overnight abstinence that included consumption of alcohol (target .06 g/dl breath alcohol concentration) and one cigarette. Craving was assessed as abstinence-induced (Time 1), alcohol-induced (Time 2), and cigarette-induced (Time 3). RESULTS Within varenicline + naltrexone, low distress tolerance individuals exhibited higher increases from abstinence- to alcohol-induced cigarette craving relative to high distress tolerance individuals. Across medications, low distress tolerance individuals reported flatter decreases from abstinence- to cigarette-induced cigarette craving relative to high distress tolerance individuals. CONCLUSIONS Distress tolerance may differentially predict alcohol-induced cigarette craving when titrated to pharmacotherapy, as well as moderate decreases in craving after cigarette consumption. Future exploration of the identified interactive effects could elucidate specific conditions in which cravings are more proximally related to abstinence-induced smoking.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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25
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Lim AC, Roche DJO, Ray LA. Distress Tolerance and Craving for Cigarettes Among Heavy Drinking Smokers. J Stud Alcohol Drugs 2018; 79:918-928. [PMID: 30573023 PMCID: PMC6308171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Heavy drinking smokers experience significant difficulties with smoking cessation. Craving is closely tied to relapses during cessation attempts, and alcohol consumption increases cigarette craving among heavy drinking smokers. To date, however, few moderators of the relationship between craving and relapse have been identified. Individuals' capacity for distress tolerance predicts smoking cessation outcomes and may be connected to craving. Relatedly, pharmacotherapies like varenicline and naltrexone reduce cigarette and alcohol cravings, respectively. No studies have examined the interrelationships among distress tolerance, craving, and pharmacotherapy effects. This study therefore examines distress tolerance as a moderator of the relationship between overnight abstinence-induced cigarette craving and subsequent alcohol- and cigarette-induced changes in craving among heavy drinking smokers. This study also examines the impact of varenicline and naltrexone on these relationships. METHOD A total of 120 non-treatment-seeking heavy drinking smokers were randomized and titrated to one of the following conditions: (a) placebo, (b) varenicline, (c) naltrexone, or (d) varenicline + naltrexone. Participants then completed a laboratory paradigm after overnight abstinence that included consumption of alcohol (target .06 g/dl breath alcohol concentration) and one cigarette. Craving was assessed as abstinence-induced (Time 1), alcohol-induced (Time 2), and cigarette-induced (Time 3). RESULTS Within varenicline + naltrexone, low distress tolerance individuals exhibited higher increases from abstinence- to alcohol-induced cigarette craving relative to high distress tolerance individuals. Across medications, low distress tolerance individuals reported flatter decreases from abstinence- to cigarette-induced cigarette craving relative to high distress tolerance individuals. CONCLUSIONS Distress tolerance may differentially predict alcohol-induced cigarette craving when titrated to pharmacotherapy, as well as moderate decreases in craving after cigarette consumption. Future exploration of the identified interactive effects could elucidate specific conditions in which cravings are more proximally related to abstinence-induced smoking.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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Beck A, Pelz P, Lorenz RC, Charlet K, Geisel O, Heinz A, Wüstenberg T, Müller CA. Effects of high-dose baclofen on cue reactivity in alcohol dependence: A randomized, placebo-controlled pharmaco-fMRI study. Eur Neuropsychopharmacol 2018; 28:1206-1216. [PMID: 30217552 DOI: 10.1016/j.euroneuro.2018.08.507] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 07/10/2018] [Accepted: 08/14/2018] [Indexed: 01/31/2023]
Abstract
Increased functional brain response towards alcohol-associated stimuli is a neural hallmark of alcohol dependence and a promising target for pharmacotherapy. For the first time, we assessed the effects of individually titrated high-dose baclofen on cue reactivity and functional connectivity in alcohol-dependent (AD) patients in a randomized controlled trial (RCT). We investigated 23 recently detoxified AD patients and 23 matched healthy controls (HC) with a cue reactivity functional magnetic resonance imaging task. Patients were further scanned at baseline without medication and during treatment with high-dose baclofen/placebo (30-270 mg/d). Analyses were conducted for alcohol cue-elicited brain response, alcohol cue-modulated and stimulus-independent functional connectivity with left ventral tegmental area (VTA) as seed region. At baseline, AD patients (N = 23) showed increased cue-elicited brain activation in the ventral striatum (VS) compared to HC (N = 23), which was decreased at the second scanning session compared to baseline. Patients receiving baclofen (N = 10) showed a significant stronger decrease in cue-elicited brain activation in left orbitofrontal cortex (OFC), bilateral amygdala and left VTA than patients receiving placebo (N = 13). Treatment with baclofen further led to a decrease in alcohol cue-modulated functional connectivity between left VTA and left anterior cingulate cortex (ACC) as well as left medial prefrontal cortex (MPFC). Regarding clinical outcome, significantly more patients of the baclofen group remained abstinent during the high-dose period. Baclofen specifically decreased cue-elicited brain responses in areas known to be involved in the processing of salient (appetitive and aversive) stimuli. Treatment with high-dose baclofen seems to provide a pharmacological relief of this neural "warning signal" evoked by alcohol-related cues, thereby possibly supporting patients in remaining abstinent. Trial Registration Identifier of the main trial [BACLAD study] at clinicaltrials.gov: NCT01266655.
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Affiliation(s)
- Anne Beck
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Patricia Pelz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Robert C Lorenz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany; Center for Adaptive Rationality, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Katrin Charlet
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Olga Geisel
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany; Systems Neuroscience in Psychiatry (SNiP), Central Institute of Mental Health, Mannheim, Germany
| | - Christian A Müller
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Beraha EM, Salemink E, Krediet E, Wiers RW. Can baclofen change alcohol-related cognitive biases and what is the role of anxiety herein? J Psychopharmacol 2018; 32:867-875. [PMID: 29897022 PMCID: PMC6125818 DOI: 10.1177/0269881118780010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Baclofen has shown promise in the treatment of alcohol dependence. However, its precise (neuro-) psychological working mechanism is still under debate. AIMS This study aimed to get a better understanding of baclofen's working mechanism by examining the effect of baclofen on cognitive biases. It was hypothesized that baclofen, compared to placebo, would lead to weaker cognitive biases. Furthermore, given a suggested anxiolytic effect of baclofen, we expected that anxiety would moderate this effect. METHODS From a larger randomized clinical trial (RCT) with 151 participants, a subset of 143 detoxified alcohol-dependent patients, either taking baclofen or placebo, was examined. Attentional bias for alcohol (500 and 1500 ms), alcohol approach tendencies, implicit alcohol-relaxation associations and trait anxiety were assessed before the administration of baclofen or placebo. Four weeks later, 94 patients were still abstinent (53 in the baclofen and 41 in the placebo condition) and cognitive biases were assessed again. RESULTS At baseline, patients showed a vigilance-avoidance pattern for the attentional bias (at 500 and 1500 ms, respectively) and alcohol-negative associations. After 4 weeks, an indication for an attentional bias away from alcohol at 500 ms was found only in the baclofen group; however, cognitive biases did not differ significantly between treatment groups. No moderating role of anxiety on cognitive biases was found. CONCLUSIONS Baclofen did not lead to a differential change in cognitive biases compared with placebo, and trait anxiety levels did not moderate this. A better understanding of the working mechanism of baclofen and predictors of treatment success would allow prescribing of baclofen in a more targeted manner.
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Affiliation(s)
- Esther M Beraha
- Esther M Beraha, Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, 1018 WS Amsterdam, The Netherlands.
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Efficacy and side effects of baclofen and the novel GABA B receptor positive allosteric modulator CMPPE in animal models for alcohol and cocaine addiction. Psychopharmacology (Berl) 2018; 235:1955-1965. [PMID: 29651507 DOI: 10.1007/s00213-018-4893-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/28/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE Preclinical studies suggest that the GABAB receptor is a potential target for treatment of substance use disorders. However, recent clinical trials report adverse effects in patients treated with the GABAB receptor agonist baclofen and even question efficacy. How can the discrepancy between preclinical and clinical findings be explained? OBJECTIVE To test efficacy and adverse effects of baclofen and the novel GABAB positive allosteric modulator (PAM) CMPPE in rat addiction models, which were developed in accordance with DSM. METHODS We used a well-characterized rat model of long-term alcohol consumption with repeated deprivation phases that result in compulsive alcohol drinking in a relapse situation, and a rat model of long-term intravenous cocaine self-administration resulting in key symptoms of addictive behavior. We tested repeated baclofen (0, 1, and 3 mg/kg; i.p.) and CMPPE doses (0, 10, and 30 mg/kg; i.p.) in relapse-like situations, in either alcohol or cocaine addicted-like rats. RESULTS Baclofen produced a weak anti-relapse effect at the highest dose in alcohol addicted-like rats, and this effect was mainly due to the treatment-induced sedation. CMPPE had a better profile, with a dose-dependent reduction of relapse-like alcohol drinking and without any signs of sedation. The cue-induced cocaine-seeking response was completely abolished by both compounds. CONCLUSION Positive allosteric modulation of the GABAB receptor provides efficacy, and no observable side effects in relapse behavior whereas baclofen may cause, not only sedation, but also considerable impairment of food intake or metabolism. However, targeting GABAB receptors may be effective in reducing certain aspects of addictive-like behavior, such as cue-reactivity.
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Tooley J, Marconi L, Alipio JB, Matikainen-Ankney B, Georgiou P, Kravitz AV, Creed MC. Glutamatergic Ventral Pallidal Neurons Modulate Activity of the Habenula-Tegmental Circuitry and Constrain Reward Seeking. Biol Psychiatry 2018; 83:1012-1023. [PMID: 29452828 PMCID: PMC5972062 DOI: 10.1016/j.biopsych.2018.01.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The ability to appropriately integrate and respond to rewarding and aversive stimuli is essential for survival. The ventral pallidum (VP) plays a critical role in processing both rewarding and aversive stimuli. However, the VP is a heterogeneous structure, and how VP subpopulations integrate into larger reward networks to ultimately modulate these behaviors is not known. We identify a noncanonical population of glutamatergic VP neurons that play a unique role in responding to aversive stimuli and constraining inappropriate reward seeking. METHODS Using neurochemical, genetic, and electrophysiological approaches, we characterized glutamatergic VP neurons (n = 4-8 mice/group). We performed patch clamp and in vivo electrophysiology recordings in the lateral habenula, rostromedial tegmental nucleus, and ventral tegmental area to determine the effect of glutamatergic VP neuron activation in these target regions (n = 6-10 mice/group). Finally, we selectively optogenetically stimulated glutamatergic VP neurons in a real-time place preference task and ablated these neurons using a virally expressed caspase to determine their necessity for reward seeking. RESULTS Glutamatergic VP neurons exhibit little overlap with cholinergic or gamma-aminobutyric acidergic markers, the canonical VP subtypes, and exhibit distinct membrane properties. Glutamatergic VP neurons innervate and increase firing activity of the lateral habenula, rostromedial tegmental nucleus, and gamma-aminobutyric acidergic ventral tegmental area neurons. While nonselective optogenetic stimulation of the VP induced a robust place preference, selective activation of glutamatergic VP neurons induced a place avoidance. Viral ablation of glutamatergic VP neurons increased reward responding and abolished taste aversion to sucrose. CONCLUSIONS Glutamatergic VP neurons constitute a noncanonical subpopulation of VP neurons. These glutamatergic VP neurons increase activity of the lateral habenula, rostromedial tegmental nucleus, and gamma-aminobutyric acidergic ventral tegmental area neurons and adaptively constrain reward seeking.
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Affiliation(s)
- Jessica Tooley
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lauren Marconi
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jason Bondoc Alipio
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bridget Matikainen-Ankney
- Eating and Addiction Section, National Institute of Digestive and Diabetes and Kidney Diseases, Bethesda, Maryland
| | - Polymnia Georgiou
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alexxai V Kravitz
- Eating and Addiction Section, National Institute of Digestive and Diabetes and Kidney Diseases, Bethesda, Maryland
| | - Meaghan C Creed
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland.
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TERUNUMA M. Diversity of structure and function of GABA B receptors: a complexity of GABA B-mediated signaling. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2018; 94:390-411. [PMID: 30541966 PMCID: PMC6374141 DOI: 10.2183/pjab.94.026] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/09/2018] [Indexed: 05/24/2023]
Abstract
γ-aminobutyric acid type B (GABAB) receptors are broadly expressed in the nervous system and play an important role in neuronal excitability. GABAB receptors are G protein-coupled receptors that mediate slow and prolonged inhibitory action, via activation of Gαi/o-type proteins. GABAB receptors mediate their inhibitory action through activating inwardly rectifying K+ channels, inactivating voltage-gated Ca2+ channels, and inhibiting adenylate cyclase. Functional GABAB receptors are obligate heterodimers formed by the co-assembly of R1 and R2 subunits. It is well established that GABAB receptors interact not only with G proteins and effectors but also with various proteins. This review summarizes the structure, subunit isoforms, and function of GABAB receptors, and discusses the complexity of GABAB receptors, including how receptors are localized in specific subcellular compartments, the mechanism regulating cell surface expression and mobility of the receptors, and the diversity of receptor signaling through receptor crosstalk and interacting proteins.
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Affiliation(s)
- Miho TERUNUMA
- Division of Oral Biochemistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Durant CF, Paterson LM, Turton S, Wilson SJ, Myers JFM, Muthukumaraswamy S, Venkataraman A, Mick I, Paterson S, Jones T, Nahar LK, Cordero RE, Nutt DJ, Lingford-Hughes A. Using Baclofen to Explore GABA-B Receptor Function in Alcohol Dependence: Insights From Pharmacokinetic and Pharmacodynamic Measures. Front Psychiatry 2018; 9:664. [PMID: 30618857 PMCID: PMC6302106 DOI: 10.3389/fpsyt.2018.00664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/19/2018] [Indexed: 12/20/2022] Open
Abstract
Background: The role of GABA-B neurotransmission in addiction has recently received increased attention, with clinical trials indicating that baclofen, a GABA-B receptor agonist, may reduce alcohol consumption, craving and promote abstinence. However, the optimal dose to treat alcohol dependence is unclear with patients requesting and tolerating much higher doses of baclofen, compared with other clinical uses. We assessed the pharmacokinetics and pharmacodynamics (PK/PD) of baclofen to provide insight into GABA-B sensitivity in this patient group, relative to controls. Methods: Male healthy volunteers (controls, n = 12) and abstinent alcohol dependent individuals (AD, n = 8) received single oral doses of baclofen or placebo in a 3-way crossover design. Controls received placebo/10 mg/60 mg baclofen in a randomized, double-blind design, AD received placebo/60 mg/90 mg baclofen in a single-blind design. PK/PD measures were recorded at baseline and multiple time-points up to 6 h post-dosing, including plasma baclofen, plasma growth hormone (GH), Subjective High Assessment Scale (SHAS) and biphasic alcohol effects scale (BAES). Repeated measures ANOVA analysis explored "change from baseline" dose, time, group, and interaction effects, t-tests compared peak effects. Results: Dose-dependent effects of baclofen on PK and PD measures were observed in both control and AD groups. Whilst there were no significant group differences in any baclofen PK parameters (t 1/2, t max , C max , AUC), marked differences in PD effects were clearly evident. In controls, 60 mg baclofen significantly increased total SHAS and BAES scores, and significantly increased plasma GH levels compared with placebo, with peak effects at 60-120 min, in line with its PK profile. In AD, 60 mg baclofen had limited effects on these parameters; SHAS scores, BAES scores and plasma GH levels were significantly blunted compared with controls (significant group*time interactions P = 0.0014, 0.0015 and P < 0.0001, respectively). Conclusions: Our study shows blunted sensitivity to baclofen in AD relative to controls, with no difference in PK suggesting a lower GABA-B receptor sensitivity. This may explain why higher baclofen doses are requested and tolerated in the treatment of alcohol dependence. Our data has implications for choice of dose in future clinical trials in AD and possibly other substances of dependence.
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Affiliation(s)
- Claire F Durant
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Louise M Paterson
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Sam Turton
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Susan J Wilson
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - James F M Myers
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | | | - Ashwin Venkataraman
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Inge Mick
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Susan Paterson
- Centre for Brain Science, University of Auckland, Auckland, New Zealand
| | - Tessa Jones
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Limon K Nahar
- Centre for Brain Science, University of Auckland, Auckland, New Zealand
| | - Rosa E Cordero
- Centre for Brain Science, University of Auckland, Auckland, New Zealand
| | - David J Nutt
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
| | - Anne Lingford-Hughes
- Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Centre for Psychiatry, Imperial College London, London, United Kingdom
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de Beaurepaire R. A Review of the Potential Mechanisms of Action of Baclofen in Alcohol Use Disorder. Front Psychiatry 2018; 9:506. [PMID: 30459646 PMCID: PMC6232933 DOI: 10.3389/fpsyt.2018.00506] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022] Open
Abstract
Baclofen, a GABA-B receptor agonist, is a promising treatment for alcohol use disorder (AUD). Its mechanism of action in this condition is unknown. GABA-B receptors interact with many biological systems potentially involved in AUD, including transduction pathways and neurotransmitter systems. Preclinical studies have shown that GABA-B receptors are involved in memory storage and retrieval, reward, motivation, mood and anxiety; neuroimaging studies in humans show that baclofen produces region-specific alterations in cerebral activity; GABA-B receptor activation may have neuroprotective effects; baclofen also has anti-inflammatory properties that may be of interest in the context of addiction. However, none of these biological effects fully explain the mechanism of action of baclofen in AUD. Data from clinical studies have provided a certain number of elements which may be useful for the comprehension of its mechanism of action: baclofen typically induces a state of indifference toward alcohol; the effective dose of baclofen in AUD is extremely variable from one patient to another; higher treatment doses correlate with the severity of the addiction; many of the side effects of baclofen resemble those of alcohol, raising the possibility that baclofen acts as a substitution drug; usually, however, there is no tolerance to the effects of baclofen during long-term AUD treatment. In the present article, the biological effects of baclofen are reviewed in the light of its clinical effects in AUD, assuming that, in many instances, clinical effects can be reliable indicators of underlying biological processes. In conclusion, it is proposed that baclofen may suppress the Pavlovian association between cues and rewards through an action in a critical part of the dopaminergic network (the amygdala), thereby normalizing the functional connectivity in the reward network. It is also proposed that this action of baclofen is made possible by the fact that baclofen and alcohol act on similar brain systems in certain regions of the brain.
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Regier PS, Monge ZA, Franklin TR, Wetherill RR, Teitelman A, Jagannathan K, Suh JJ, Wang Z, Young KA, Gawrysiak M, Langleben DD, Kampman KM, O'Brien CP, Childress AR. Emotional, physical and sexual abuse are associated with a heightened limbic response to cocaine cues. Addict Biol 2017; 22:1768-1777. [PMID: 27654662 DOI: 10.1111/adb.12445] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/08/2016] [Accepted: 08/02/2016] [Indexed: 12/24/2022]
Abstract
Drug-reward cues trigger motivational circuitry, a response linked to drug-seeking in animals and in humans. Adverse life events have been reported to increase sensitivity to drug rewards and to bolster drug reward signaling. Therefore, we hypothesized that cocaine-dependent individuals with prior emotional, physical and sexual abuse might have a heightened mesolimbic brain response to cues for drug reward in a new brief-cue probe. Cocaine-dependent human individuals (N = 68) were stabilized in an inpatient setting and then completed an event-related blood-oxygen-level dependent functional magnetic resonance imaging task featuring 500-ms evocative (cocaine, sexual, aversive) and comparator (neutral) cues. Responses to three questions about emotional, physical and sexual abuse from the Addiction Severity Index were used to divide the patients into subgroups (history of Abuse [n = 40] versus No Abuse [n = 28]). When subjects were grouped by the historical presence or absence of emotional, physical or sexual abuse, the Abuse group showed a heightened midbrain, thalamic, caudate, and caudal orbitofrontal cortex response to cocaine cues; a similar result was found in other evocative cues, as well. These findings are the first reported for a 500-ms cocaine-cue probe, and they highlight the ability of very brief evocative cues to activate the brain's motivational circuitry. Although all participants had severe cocaine use disorders, individuals reporting prior abuse had a heightened mesolimbic response to evocative cues. To our knowledge, this is the first study in humans linking a history of abuse to a brain vulnerability (heightened mesolimbic response to drug cues) previously shown to contribute to drug-seeking.
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Affiliation(s)
- Paul S. Regier
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Zachary A. Monge
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Teresa R. Franklin
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Reagan R. Wetherill
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Anne Teitelman
- School of Nursing; University of Pennsylvania; Philadelphia PA USA
| | - Kanchana Jagannathan
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Jesse J. Suh
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Ze Wang
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Kimberly A. Young
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Michael Gawrysiak
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Daniel D. Langleben
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Kyle M. Kampman
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Charles P. O'Brien
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
| | - Anna Rose Childress
- Department of Psychiatry; University of Pennsylvania Perelman School of Medicine; Philadelphia PA USA
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Gawrysiak MJ, Jagannathan K, Regier P, Suh JJ, Kampman K, Vickery T, Childress AR. Unseen scars: Cocaine patients with prior trauma evidence heightened resting state functional connectivity (RSFC) between the amygdala and limbic-striatal regions. Drug Alcohol Depend 2017; 180:363-370. [PMID: 28957777 PMCID: PMC5648604 DOI: 10.1016/j.drugalcdep.2017.08.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Substance use disorder (SUD) patients with a history of trauma exhibit poorer treatment outcome, greater functional impairment and higher risk for relapse. Endorsement of prior trauma has, in several SUD populations, been linked to abnormal functional connectivity (FC) during task-based studies. We examined amygdala FC in the resting state (RS), testing for differences between cocaine patients with and without prior trauma. METHODS Patients with cocaine use disorder (CUD; n=34) were stabilized in an inpatient setting prior to a BOLD fMRI scan. Responses to Addiction Severity Index and the Mini-International Neuropsychiatric Interview were used to characterize the No-Trauma (n=16) and Trauma (n=18) groups. Seed-based RSFC was conducted using the right and left amygdala as regions of interest. Examination of amygdala RSFC was restricted to an a priori anatomical mask that incorporated nodes of the limbic-striatal motivational network. RESULTS RSFC was compared for the Trauma versus No-Trauma groups. The Trauma group evidenced greater connectivity between the amygdala and the a priori limbic-striatal mask. Peaks within the statistically significant limbic-striatal mask included the amygdala, putamen, pallidum, caudate, thalamus, insula, hippocampus/parahippocampus, and brain stem. CONCLUSIONS Results suggest that cocaine patients with prior trauma (versus without) have heightened communication within nodes of the motivational network, even at rest. To our knowledge, this is the first fMRI study to examine amygdala RSFC among those with CUD and trauma history. Heightened RSFC intralimbic connectivity for the Trauma group may reflect a relapse-relevant brain vulnerability and a novel treatment target for this clinically-challenging population.
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Affiliation(s)
- Michael J Gawrysiak
- Department of Psychology, Delaware State University, Dover, DE, USA; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Kanchana Jagannathan
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul Regier
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jesse J Suh
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kyle Kampman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Timothy Vickery
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Anna Rose Childress
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Cross-talk between the epigenome and neural circuits in drug addiction. PROGRESS IN BRAIN RESEARCH 2017; 235:19-63. [PMID: 29054289 DOI: 10.1016/bs.pbr.2017.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Drug addiction is a behavioral disorder characterized by dysregulated learning about drugs and associated cues that result in compulsive drug seeking and relapse. Learning about drug rewards and predictive cues is a complex process controlled by a computational network of neural connections interacting with transcriptional and molecular mechanisms within each cell to precisely guide behavior. The interplay between rapid, temporally specific neuronal activation, and longer-term changes in transcription is of critical importance in the expression of appropriate, or in the case of drug addiction, inappropriate behaviors. Thus, these factors and their interactions must be considered together, especially in the context of treatment. Understanding the complex interplay between epigenetic gene regulation and circuit connectivity will allow us to formulate novel therapies to normalize maladaptive reward behaviors, with a goal of modulating addictive behaviors, while leaving natural reward-associated behavior unaffected.
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Chiamulera C, Padovani L, Corsi M. Drug discovery for the treatment of substance use disorders: novel targets, repurposing, and the need for new paradigms. Curr Opin Pharmacol 2017; 35:120-124. [PMID: 28874314 DOI: 10.1016/j.coph.2017.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/24/2017] [Accepted: 08/21/2017] [Indexed: 01/13/2023]
Abstract
Drug addiction treatment medications available nowadays are limited in both efficacy and number. The increased understanding of drug addiction circuitries leads the scientific community to look for better molecules and targets for detoxification and relapse prevention. This review focus on known targets (e.g., metabotropic glutamate receptor 5 and GABAB receptor) and on novel potential treatment acting on oxytocin system, which interacts with diverse neurotransmitters, has proved successful in both preclinical and clinical studies on ethanol, cocaine and methamphetamine. A crucial issue is the identification of new investigational paradigms, which may help to predict treatment efficacy and improve effectiveness.
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Affiliation(s)
- Cristiano Chiamulera
- Neuropsychopharmacology Lab, Sezione Farmacologia, Università di Verona, Policlinico GB Rossi, P.le Scuro 10, 37134 Verona, Italy.
| | - Laura Padovani
- Neuropsychopharmacology Lab, Sezione Farmacologia, Università di Verona, Policlinico GB Rossi, P.le Scuro 10, 37134 Verona, Italy
| | - Mauro Corsi
- Center of Drug Discovery & Development, Aptuit s.r.l., via Fleming 4, 37135 Verona, Italy
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Minozzi S, Saulle R, Rösner S. Baclofen for alcohol use disorder. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Silvia Minozzi
- Lazio Regional Health Service; Department of Epidemiology; Via Cristoforo Colombo, 112 Rome Italy 00154
| | - Rosella Saulle
- Lazio Regional Health Service; Department of Epidemiology; Via Cristoforo Colombo, 112 Rome Italy 00154
| | - Susanne Rösner
- Forel Klinik; Islikonerstrasse 5 Ellikon an der Thur Switzerland 8548
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Arguello AA, Richardson BD, Hall JL, Wang R, Hodges MA, Mitchell MP, Stuber GD, Rossi DJ, Fuchs RA. Role of a Lateral Orbital Frontal Cortex-Basolateral Amygdala Circuit in Cue-Induced Cocaine-Seeking Behavior. Neuropsychopharmacology 2017; 42:727-735. [PMID: 27534268 PMCID: PMC5240178 DOI: 10.1038/npp.2016.157] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 12/13/2022]
Abstract
Cocaine addiction is a disease characterized by chronic relapse despite long periods of abstinence. The lateral orbitofrontal cortex (lOFC) and basolateral amygdala (BLA) promote cocaine-seeking behavior in response to drug-associated conditioned stimuli (CS) and share dense reciprocal connections. Hence, we hypothesized that monosynaptic projections between these brain regions mediate CS-induced cocaine-seeking behavior. Male Sprague-Dawley rats received bilateral infusions of a Cre-dependent adeno-associated viral (AAV) vector expressing enhanced halorhodopsin 3.0 fused with a reporter protein (NpHR-mCherry) or a control AAV (mCherry) plus optic fiber implants into the lOFC (Experiment 1) or BLA (Experiment 2). The same rats also received bilateral infusions of a retrogradely transported AAV vector expressing Cre recombinase (Retro-Cre-GFP) into the BLA (Experiment 1) or lOFC (Experiment 2). Thus, NpHR-mCherry or mCherry expression was targeted to lOFC neurons that project to the BLA or to BLA neurons that project to the lOFC in different groups. Rats were trained to lever press for cocaine infusions paired with 5-s CS presentations. Responding was then extinguished. At test, response-contingent CS presentation was discretely coupled with optogenetic inhibition (5-s laser activation) or no optogenetic inhibition while lever responding was assessed without cocaine/food reinforcement. Optogenetic inhibition of lOFC to BLA, but not BLA to lOFC, projections in the NpHR-mCherry groups disrupted CS-induced reinstatement of cocaine-seeking behavior relative to (i) no optogenetic inhibition or (ii) manipulations in mCherry control or (iii) NpHR-mCherry food control groups. These findings suggest that the lOFC sends requisite input to the BLA, via monosynaptic connections, to promote CS-induced cocaine-seeking behavior.
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Affiliation(s)
- Amy A Arguello
- Department of Integrative Physiology and Neuroscience, Washington State University, College of Veterinary Medicine, Pullman, WA, USA
| | - Ben D Richardson
- Department of Integrative Physiology and Neuroscience, Washington State University, College of Veterinary Medicine, Pullman, WA, USA
| | - Jacob L Hall
- Department of Integrative Physiology and Neuroscience, Washington State University, College of Veterinary Medicine, Pullman, WA, USA
| | - Rong Wang
- Department of Integrative Physiology and Neuroscience, Washington State University, College of Veterinary Medicine, Pullman, WA, USA
| | - Matthew A Hodges
- Department of Psychiatry and Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marshall P Mitchell
- Department of Integrative Physiology and Neuroscience, Washington State University, College of Veterinary Medicine, Pullman, WA, USA
| | - Garret D Stuber
- Department of Psychiatry and Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David J Rossi
- Department of Integrative Physiology and Neuroscience, Washington State University, College of Veterinary Medicine, Pullman, WA, USA
| | - Rita A Fuchs
- Department of Integrative Physiology and Neuroscience, Washington State University, College of Veterinary Medicine, Pullman, WA, USA,Department of Integrative Physiology and Neuroscience, Washington State University, College of Veterinary Medicine, PO Box 647620, Pullman, WA 99164-7620, USA, Tel: +509 335 6164, Fax: +509 335 4650, E-mail:
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MacLean RR, Valentine GW, Jatlow PI, Sofuoglu M. Inhalation of Alcohol Vapor: Measurement and Implications. Alcohol Clin Exp Res 2017; 41:238-250. [PMID: 28054395 DOI: 10.1111/acer.13291] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/08/2016] [Indexed: 02/06/2023]
Abstract
Decades of alcohol research have established the health risks and pharmacodynamic profile of oral alcohol consumption. Despite isolated periods of public health concern, comparatively less research has evaluated exposure to alcohol vapor. Inhaled alcohol initially bypasses first-pass metabolism and rapidly reaches the arterial circulation and the brain, suggesting that this route of administration may be associated with pharmacological effects that increase the risk of addiction. However, detailed reviews assessing the possible effects of inhaled alcohol in humans are lacking. A comprehensive, systematic literature review was conducted using Google Scholar and PubMed to examine manuscripts studying exposure to inhaled alcohol and measurement of biomarkers (biochemical or functional) associated with alcohol consumption in human participants. Twenty-one publications reported on alcohol inhalation. Fourteen studies examined inhalation of alcohol vapor associated with occupational exposure (e.g., hand sanitizer) in a variety of settings (e.g., naturalistic, laboratory). Six publications measured inhalation of alcohol in a controlled laboratory chamber, and 1 evaluated direct inhalation of an e-cigarette with ethanol-containing "e-liquid." Some studies have reported that inhalation of alcohol vapor results in measurable biomarkers of acute alcohol exposure, most notably ethyl glucuronide. Despite the lack of significantly elevated blood alcohol concentrations, the behavioral consequences and subjective effects associated with repeated use of devices capable of delivering alcohol vapor are yet to be determined. No studies have focused on vulnerable populations, such as adolescents or individuals with alcohol use disorder, who may be most at risk of problems associated with alcohol inhalation.
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Affiliation(s)
- Robert Ross MacLean
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Gerald W Valentine
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Peter I Jatlow
- Laboratory Medicine, Yale University, West Haven, Connecticut
| | - Mehmet Sofuoglu
- Department of Psychiatry, School of Medicine, Yale University, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
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Cabrera EA, Wiers CE, Lindgren E, Miller G, Volkow ND, Wang GJ. Neuroimaging the Effectiveness of Substance Use Disorder Treatments. J Neuroimmune Pharmacol 2016; 11:408-33. [PMID: 27184387 DOI: 10.1007/s11481-016-9680-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/26/2016] [Indexed: 12/18/2022]
Abstract
Neuroimaging techniques to measure the function and biochemistry of the human brain such as positron emission tomography (PET), proton magnetic resonance spectroscopy ((1)H MRS), and functional magnetic resonance imaging (fMRI), are powerful tools for assessing neurobiological mechanisms underlying the response to treatments in substance use disorders. Here, we review the neuroimaging literature on pharmacological and behavioral treatment in substance use disorder. We focus on neural effects of medications that reduce craving (e.g., naltrexone, bupropion hydrochloride, baclofen, methadone, varenicline) and that improve cognitive control (e.g., modafinil, N-acetylcysteine), of behavioral treatments for substance use disorders (e.g., cognitive bias modification training, virtual reality, motivational interventions) and neuromodulatory interventions such as neurofeedback and transcranial magnetic stimulation. A consistent finding for the effectiveness of therapeutic interventions identifies the improvement of executive control networks and the dampening of limbic activation, highlighting their values as targets for therapeutic interventions in substance use disorders.
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Affiliation(s)
- Elizabeth A Cabrera
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
| | - Corinde E Wiers
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Elsa Lindgren
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Gregg Miller
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Nora D Volkow
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
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Bao X, Raguet LL, Cole SM, Howard JD, Gottfried J. The role of piriform associative connections in odor categorization. eLife 2016; 5. [PMID: 27130519 PMCID: PMC4884078 DOI: 10.7554/elife.13732] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
Distributed neural activity patterns are widely proposed to underlie object identification and categorization in the brain. In the olfactory domain, pattern-based representations of odor objects are encoded in piriform cortex. This region receives both afferent and associative inputs, though their relative contributions to odor perception are poorly understood. Here, we combined a placebo-controlled pharmacological fMRI paradigm with multivariate pattern analyses to test the role of associative connections in sustaining olfactory categorical representations. Administration of baclofen, a GABA(B) agonist known to attenuate piriform associative inputs, interfered with within-category pattern separation in piriform cortex, and the magnitude of this drug-induced change predicted perceptual alterations in fine-odor discrimination performance. Comparatively, baclofen reduced pattern separation between odor categories in orbitofrontal cortex, and impeded within-category generalization in hippocampus. Our findings suggest that odor categorization is a dynamic process concurrently engaging stimulus discrimination and generalization at different stages of olfactory information processing, and highlight the importance of associative networks in maintaining categorical boundaries. DOI:http://dx.doi.org/10.7554/eLife.13732.001 Imagine bringing your groceries home and tucking them into the refrigerator. You’ll probably organize the items by categories: lemons and oranges into the fruit drawer, carrots and cauliflower into the vegetable drawer. Categorization is essential, allowing us to interact with the world in the most efficient way possible. If the differences between objects are not relevant to the task at hand, the brain will group objects together based on their shared properties and develop mental representations of the “categories”. Importantly, we are still aware of the distinctions between objects within the same category. Categories of odor (for example, minty or fruity) are represented in a part of the brain called the olfactory (or piriform) cortex, which receives information from odor cues as well as “top-down” information from other areas of the brain. But how do these top-down pathways influence odor categorization? Bao et al. asked how the brain solves the problem of categorizing odors. For the experiments, human volunteers smelled six familiar odors belonging to three different categories while their brain activity was monitored using a magnetic resonance imaging (fMRI) scanner. Then, half of the participants were given a drug called baclofen that prevents top-down inputs, but not odor cues, from reaching the piriform cortex, while the rest received a placebo. After five days of taking the medication, all of the volunteers had another session of fMRI where they had to categorize the same odors as before. The experiments show that when comparing the fMRI scans before and after the drug treatment, the representations of odors belonging to the same category became more distinct in the piriform cortex in the placebo group. Put differently, as the volunteers were repeatedly exposed to odors of well-known categories, they became better at discriminating individual odors within the same category. However, these changes were disrupted in the group of volunteers that took baclofen. Bao et al.’s findings indicate that this “practice makes perfect” approach to recognizing odors relies on top-down inputs into the piriform cortex. In future work it will be important to study the roles of these inputs in learning new categories of odors, and to investigate whether the mechanisms identified here apply to other sensory information and to more abstract knowledge. DOI:http://dx.doi.org/10.7554/eLife.13732.002
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Affiliation(s)
- Xiaojun Bao
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | | | - Sydni M Cole
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - James D Howard
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Jay Gottfried
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, United States.,Department of Psychology, Northwestern University Weinberg College of Arts and Sciences, Evanston, United States
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Froger-Colléaux C, Castagné V. Effects of baclofen and raclopride on reinstatement of cocaine self-administration in the rat. Eur J Pharmacol 2016; 777:147-55. [DOI: 10.1016/j.ejphar.2016.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/13/2022]
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Courtney KE, Schacht JP, Hutchison K, Roche DJO, Ray LA. Neural substrates of cue reactivity: association with treatment outcomes and relapse. Addict Biol 2016; 21:3-22. [PMID: 26435524 DOI: 10.1111/adb.12314] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/26/2015] [Accepted: 08/27/2015] [Indexed: 12/18/2022]
Abstract
Given the strong evidence for neurological alterations at the basis of drug dependence, functional magnetic resonance imaging (fMRI) represents an important tool in the clinical neuroscience of addiction. fMRI cue-reactivity paradigms represent an ideal platform to probe the involvement of neurobiological pathways subserving the reward/motivation system in addiction and potentially offer a translational mechanism by which interventions and behavioral predictions can be tested. Thus, this review summarizes the research that has applied fMRI cue-reactivity paradigms to the study of adult substance use disorder treatment responses. Studies utilizing fMRI cue-reactivity paradigms for the prediction of relapse and as a means to investigate psychosocial and pharmacological treatment effects on cue-elicited brain activation are presented within four primary categories of substances: alcohol, nicotine, cocaine and opioids. Lastly, suggestions for how to leverage fMRI technology to advance addiction science and treatment development are provided.
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Affiliation(s)
- Kelly E. Courtney
- Department of Psychology; University of California; Los Angeles CA USA
| | - Joseph P. Schacht
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston SC USA
| | - Kent Hutchison
- Department of Psychology and Neuroscience; University of Colorado at Boulder; Boulder CO USA
| | | | - Lara A. Ray
- Department of Psychology; University of California; Los Angeles CA USA
- Department of Psychiatry and Biobehavioral Sciences; University of California; Los Angeles CA USA
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Mayfield J, Blednov YA, Harris RA. Behavioral and Genetic Evidence for GIRK Channels in the CNS: Role in Physiology, Pathophysiology, and Drug Addiction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 123:279-313. [PMID: 26422988 DOI: 10.1016/bs.irn.2015.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
G protein-coupled inwardly rectifying potassium (GIRK) channels are widely expressed throughout the brain and mediate the inhibitory effects of many neurotransmitters. As a result, these channels are important for normal CNS function and have also been implicated in Down syndrome, Parkinson's disease, psychiatric disorders, epilepsy, and drug addiction. Knockout mouse models have provided extensive insight into the significance of GIRK channels under these conditions. This review examines the behavioral and genetic evidence from animal models and genetic association studies in humans linking GIRK channels with CNS disorders. We further explore the possibility that subunit-selective modulators and other advanced research tools will be instrumental in establishing the role of individual GIRK subunits in drug addiction and other relevant CNS diseases and in potentially advancing treatment options for these disorders.
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Affiliation(s)
- Jody Mayfield
- Waggoner Center for Alcohol and Addiction Research, The University of Texas at Austin, Austin, Texas, USA.
| | - Yuri A Blednov
- Waggoner Center for Alcohol and Addiction Research, The University of Texas at Austin, Austin, Texas, USA
| | - R Adron Harris
- Waggoner Center for Alcohol and Addiction Research, The University of Texas at Austin, Austin, Texas, USA
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Filip M, Frankowska M, Sadakierska-Chudy A, Suder A, Szumiec Ł, Mierzejewski P, Bienkowski P, Przegaliński E, Cryan JF. GABAB receptors as a therapeutic strategy in substance use disorders: Focus on positive allosteric modulators. Neuropharmacology 2015; 88:36-47. [DOI: 10.1016/j.neuropharm.2014.06.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/10/2014] [Accepted: 06/15/2014] [Indexed: 12/16/2022]
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GIRK Channels: A Potential Link Between Learning and Addiction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 123:239-77. [PMID: 26422987 DOI: 10.1016/bs.irn.2015.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The ability of drug-associated cues to reinitiate drug craving and seeking, even after long periods of abstinence, has led to the hypothesis that addiction represents a form of pathological learning, in which drugs of abuse hijack normal learning and memory processes to support long-term addictive behaviors. In this chapter, we review evidence suggesting that G protein-gated inwardly rectifying potassium (GIRK/Kir3) channels are one mechanism through which numerous drugs of abuse can modulate learning and memory processes. We will examine the role of GIRK channels in two forms of experience-dependent long-term changes in neuronal function: homeostatic plasticity and synaptic plasticity. We will also discuss how drug-induced changes in GIRK-mediated signaling can lead to changes that support the development and maintenance of addiction.
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Morley KC, Baillie A, Leung S, Addolorato G, Leggio L, Haber PS. Baclofen for the Treatment of Alcohol Dependence and Possible Role of Comorbid Anxiety. Alcohol Alcohol 2014; 49:654-60. [PMID: 25246489 DOI: 10.1093/alcalc/agu062] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/26/2014] [Indexed: 12/20/2022] Open
Abstract
AIM To conduct a double-blind, placebo-controlled randomized clinical trial of baclofen in the treatment of alcohol dependence. METHODS Out of 69 participants consecutively screened, 42 alcohol-dependent patients were randomized to receive placebo, baclofen 30 mg/day or baclofen 60 mg/day for 12 weeks. All subjects were offered BRENDA, a structured psychosocial therapy for alcohol dependence that seeks to improve motivation for change, enhance strategies to prevent relapse and encourage compliance with treatment. RESULTS Intention-to-treat analyses revealed that alcohol consumption (heavy drinking days, drinks per drinking day) significantly reduced across all three groups during the treatment period. There were no statistically significant advantages to treatment on time to first heavy drinking day (relapse) (P = 0.08), nor time to first drink (lapse) (P = 0.18). A post hoc analysis stratifying according to whether there had been a comorbid anxiety disorder, revealed a beneficial effect of baclofen 30 mg/day versus placebo on time to lapse and relapse (P < 0.05). There was also a beneficial effect for baclofen 60 mg/day relative to placebo on time to relapse in this comorbid group (P < 0.05). Both doses of baclofen were well tolerated. There were no serious adverse events. CONCLUSIONS In spite of the small sample for a 3-arm clinical trial, this study suggests a specific role of baclofen in alcohol-dependent individuals with comorbid anxiety. Replication in larger, fully-powered studies is required.
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Affiliation(s)
- K C Morley
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, University of Sydney, Sydney, NSW, Australia
| | - A Baillie
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - S Leung
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - G Addolorato
- Institute of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - L Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - P S Haber
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, University of Sydney, Sydney, NSW, Australia Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Abstract
INTRODUCTION There is increasing evidence encouraging the development of drugs that positively modulate the γ-aminobutyric acid type B (GABA(B)) receptor for combating addiction. Compounds that target GABA(B) receptors are unique as anti-abuse therapies because of their impact against multiple addictive drugs. AREAS COVERED The authors present the basic information concerning the drug actions of GABA and GABA(B) receptor orthosteric agonists and positive allosteric modulators (PAM). Furthermore, they discuss several recent excellent reviews and newer results pertaining to GABA(B) receptor drug effects on responses to and self-administration of: alcohol (ethanol), nicotine, cocaine, (meth)amphetamine, and opioids. Preclinical and clinical data are considered. EXPERT OPINION Clinical data exist only for baclofen and mostly for alcohol use disorders. Additional trials are needed, but effects are promising. Whether PAMs, given alone or in combination with a direct GABA(B) receptor agonist, will be clinically effective and have fewer side effects requires investigation. The sedative effects of baclofen, a Food and Drug Administration (FDA)-approved drug, become less severe over time. Based on existing data, baclofen is well-tolerated. However, genetic and physiological differences are likely to contribute to individual responses to different therapeutic agents. The more immediate development of baclofen as a therapeutic for alcohol use disorders may be of significant benefit to some individuals.
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Affiliation(s)
- Tamara J Phillips
- Oregon Health & Science University, Veterans Affairs Medical Center, Department of Behavioral Neuroscience , 3710 SW US Veterans Hospital Rd, Portland, OR 97239 , USA +1 503 220 8262 Ext. 56674 ; +1 503 721 1029 ;
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Everitt BJ. Neural and psychological mechanisms underlying compulsive drug seeking habits and drug memories--indications for novel treatments of addiction. Eur J Neurosci 2014; 40:2163-82. [PMID: 24935353 PMCID: PMC4145664 DOI: 10.1111/ejn.12644] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/23/2014] [Accepted: 02/11/2014] [Indexed: 12/12/2022]
Abstract
This review discusses the evidence for the hypothesis that the development of drug addiction can be understood in terms of interactions between Pavlovian and instrumental learning and memory mechanisms in the brain that underlie the seeking and taking of drugs. It is argued that these behaviours initially are goal-directed, but increasingly become elicited as stimulus-response habits by drug-associated conditioned stimuli that are established by Pavlovian conditioning. It is further argued that compulsive drug use emerges as the result of a loss of prefrontal cortical inhibitory control over drug seeking habits. Data are reviewed that indicate these transitions from use to abuse to addiction depend upon shifts from ventral to dorsal striatal control over behaviour, mediated in part by serial connectivity between the striatum and midbrain dopamine systems. Only some individuals lose control over their drug use, and the importance of behavioural impulsivity as a vulnerability trait predicting stimulant abuse and addiction in animals and humans, together with consideration of an emerging neuroendophenotype for addiction are discussed. Finally, the potential for developing treatments for addiction is considered in light of the neuropsychological advances that are reviewed, including the possibility of targeting drug memory reconsolidation and extinction to reduce Pavlovian influences on drug seeking as a means of promoting abstinence and preventing relapse.
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Affiliation(s)
- Barry J Everitt
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
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