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Syan SK, McIntyre-Wood C, Vandehei E, Vidal ML, Hargreaves T, Levitt EE, Scarfe M, Marsden E, MacKillop E, Sarles-Whittlesey H, Amlung M, Sweet L, MacKillop J. Resting state functional connectivity as a predictor of brief intervention response in adults with alcohol use disorder: A preliminary study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1590-1602. [PMID: 37572293 DOI: 10.1111/acer.15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Brief interventions for alcohol use disorder (AUD) are generally efficacious, albeit with variability in response. Resting state functional connectivity (rsFC) may characterize neurobiological indicators that predict the response to brief interventions and is the focus of the current investigation. MATERIALS AND METHODS Forty-six individuals with AUD (65.2% female) completed a resting state functional magnetic resonance imaging (fMRI) scan immediately followed by a brief intervention aimed at reducing alcohol consumption. Positive clinical response was defined as a reduction in alcohol consumption by at least one World Health Organization (WHO) risk drinking level at 3-month follow-up. rsFC was analyzed using seed-to-voxel analysis with seed regions from four networks: salience network, reward network, frontoparietal network, and default mode network. RESULTS At baseline, responders had greater rsFC between the following seed regions in relation to voxel-based clusters than non-responders: (i) anterior cingulate cortex (ACC) in relation to left postcentral gyrus and right supramarginal gyrus (salience network); (ii) right posterior parietal cortex in relation to right ventral ACC (salience network); (iii) right interior frontal gyrus (IFG) pars opercularis in relation to right cerebellum and right occipital fusiform gyrus (frontoparietal); and (iv) right primary motor cortex in relation to left thalamus (default mode). Lower rsFC in responders vs. nonresponders was seen between the (i) right rostral prefrontal cortex in relation to left IFG pars triangularis (frontoparietal); (ii) right IFG pars triangularis in relation to right cerebellum (frontoparietal); (iii) right IFG pars triangularis in relation to right frontal eye fields and right angular gyrus (frontoparietal); and (iv) right nucleus accumbens in relation to right orbital frontal cortex and right insula (reward). CONCLUSIONS Resting state functional connectivity in the frontoparietal, salience, and reward networks predicts the response to a brief intervention in individuals with AUD and could reflect greater receptivity or motivation for behavior change.
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Affiliation(s)
- Sabrina K Syan
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Carly McIntyre-Wood
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emily Vandehei
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mae Linda Vidal
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Tegan Hargreaves
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emily E Levitt
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Molly Scarfe
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emma Marsden
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emily MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Michael Amlung
- Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
- Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas, USA
| | - Lawrence Sweet
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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2
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Rieser NM, Herdener M, Preller KH. Psychedelic-Assisted Therapy for Substance Use Disorders and Potential Mechanisms of Action. Curr Top Behav Neurosci 2022; 56:187-211. [PMID: 34910289 DOI: 10.1007/7854_2021_284] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Substance use disorders (SUD) represent a significant public health issue with a high need for novel and efficacious treatment options. In light of this high unmet need, recent results reporting beneficial outcomes of psychedelic-assisted therapy in SUD are particularly relevant. However, several questions remain with regard to this treatment approach. The clinical mechanisms of action of psychedelic substances in the treatment of SUD are not well understood. Closing this knowledge gap is critical to inform and optimize the psychotherapeutic embedding of the acute substance administration. In this chapter, we discuss potential mechanisms that have implications on psychotherapeutic approaches including induced neuroplasticity, alterations in brain network connectivity, reward and emotion processing, social connectedness, insight, and mystical experiences. Furthermore, we outline considerations and approaches that leverage these mechanisms in order to optimize the therapeutic embedding by maximizing synergy between substance effects and psychotherapy. Understanding the mechanisms of action, developing psychotherapeutic approaches accordingly, and evaluating their synergistic efficacy in scientific studies will be critical to advance the framework of psychedelic-assisted therapy for addiction, create evidence-based approaches, and achieve the best treatment outcome for patients with SUD.
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Affiliation(s)
- Nathalie M Rieser
- Pharmaco-Neuroimaging and Cognitive-Emotional Processing, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Psychiatric University Hospital Zurich, Zurich, Switzerland.
| | - Marcus Herdener
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Katrin H Preller
- Pharmaco-Neuroimaging and Cognitive-Emotional Processing, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Psychiatric University Hospital Zurich, Zurich, Switzerland
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3
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Loganathan K. Value-based cognition and drug dependency. Addict Behav 2021; 123:107070. [PMID: 34359016 DOI: 10.1016/j.addbeh.2021.107070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/03/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Value-based decision-making is thought to play an important role in drug dependency. Achieving elevated levels of euphoria or ameliorating dysphoria/pain may motivate goal-directed drug consumption in both drug-naïve and long-time users. In other words, drugs become viewed as the preferred means of attaining a desired internal state. The bias towards choosing drugs may affect one's cognition. Observed biases in learning, attention and memory systems within the brain gradually focus one's cognitive functions towards drugs and related cues to the exclusion of other stimuli. In this narrative review, the effects of drug use on learning, attention and memory are discussed with a particular focus on changes across brain-wide functional networks and the subsequent impact on behaviour. These cognitive changes are then incorporated into the cycle of addiction, an established model outlining the transition from casual drug use to chronic dependency. If drug use results in the elevated salience of drugs and their cues, the studies highlighted in this review strongly suggest that this salience biases cognitive systems towards the motivated pursuit of addictive drugs. This bias is observed throughout the cycle of addiction, possibly contributing to the persistent hold that addictive drugs have over the dependent. Taken together, the excessive valuation of drugs as the preferred means of achieving a desired internal state affects more than just decision-making, but also learning, attentional and mnemonic systems. This eventually narrows the focus of one's thoughts towards the pursuit and consumption of addictive drugs.
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4
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Bryant VE, Britton MK, Gullett JM, Porges EC, Woods AJ, Cook RL, Williamson J, Ennis N, Bryant KJ, Bradley C, Cohen RA. Reduced Working Memory is Associated with Heavier Alcohol Consumption History, Role Impairment and Executive Function Difficulties. AIDS Behav 2021; 25:2720-2727. [PMID: 33550519 PMCID: PMC8935631 DOI: 10.1007/s10461-021-03170-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/14/2022]
Abstract
Both HIV status and heavy alcohol use have been associated with reduced cognitive function, particularly in the domains of working memory and executive function. It is unclear what aspects of working memory and executive function are associated with HIV status and heavy alcohol use and whether performance on these measures are associated with functional impairment. We examined the relationship between HIV, history of heavy alcohol consumption, and HIV/alcohol interaction on speeded tests of frontal inhibitory abilities, a working memory task related to mental manipulation of letters and numbers, cognitive flexibility, and measures of functional impairment. Study participants included 284 individuals (151 HIV +) recruited from two different studies focusing on HIV associated brain dysfunction, one specific to the effects of alcohol, the other specific to the effects of aging. HIV status was not independently associated with working memory and executive function measures. Higher level of alcohol consumption was associated with reduced performance on Letter Number Sequencing. Poorer Letter Number Sequencing performance was associated with role impairment (an inability to do certain kinds of work, housework, or schoolwork) and executive function difficulties. Future studies should examine causal associations and interventions targeting working memory abilities.
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Affiliation(s)
- Vaughn E Bryant
- Department of Epidemiology, University of Florida, Emerging Pathogens Institute, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL, 32610, USA.
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA.
| | - Mark K Britton
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Joseph M Gullett
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Eric C Porges
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Emerging Pathogens Institute, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL, 32610, USA
| | - John Williamson
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University, 2010 Levy Ave, Suite 254, Tallahassee, FL, 32310, USA
| | - Kendall J Bryant
- National Institute of Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD, 20892-6902, USA
| | - Carolyn Bradley
- Department of Epidemiology, University of Florida, Emerging Pathogens Institute, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL, 32610, USA
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
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Neuroimaging evidence for structural correlates in adolescents resilient to polysubstance use: A five-year follow-up study. Eur Neuropsychopharmacol 2021; 49:11-22. [PMID: 33770525 DOI: 10.1016/j.euroneuro.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022]
Abstract
Early initiation of polysubstance use (PSU) is a strong predictor of subsequent addiction, however scarce individuals present resilience capacity. This neuroimaging study aimed to investigate structural correlates associated with cessation or reduction of PSU and determine the extent to which brain structural features accounted for this resilient outcome. Participants from a European community-based cohort self-reported their alcohol, tobacco and cannabis use frequency at ages 14, 16 and 19 and had neuroimaging sessions at ages 14 and 19. We included three groups in the study: the resilient-to-PSU participants showed PSU at 16 and/or 14 but no more at 19 (n = 18), the enduring polysubstance users at 19 displayed PSU continuation from 14 or 16 (n = 193) and the controls were abstinent or low drinking participants (n = 460). We conducted between-group comparisons of grey matter volumes on whole brain using voxel-based morphometry and regional fractional anisotropy using tract-based spatial statistics. Random-forests machine-learning approach generated individual-level PSU-behavior predictions based on personality and neuroimaging features. Adolescents resilient to PSU showed significant larger grey matter volumes in the bilateral cingulate gyrus compared with enduring polysubstance users and controls at ages 19 and 14 (p<0.05 corrected) but no difference in fractional anisotropy. The larger cingulate volumes and personality trait "openness to experience" were the best precursors of resilience to PSU. Early in adolescence, a larger cingulate gyrus differentiated adolescents resilient to PSU, and this feature was critical in predicting this outcome. This study encourages further research into the neurobiological bases of resilience to addictive behaviors.
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6
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Reese ED, Kane LF, Paquette CE, Frohlich F, Daughters SB. Lost in Translation: the Gap Between Neurobiological Mechanisms and Psychosocial Treatment Research for Substance Use Disorders. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Loganathan K, Ho ETW. Value, drug addiction and the brain. Addict Behav 2021; 116:106816. [PMID: 33453587 DOI: 10.1016/j.addbeh.2021.106816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/17/2020] [Accepted: 01/02/2021] [Indexed: 12/15/2022]
Abstract
Over the years, various models have been proposed to explain the psychology and biology of drug addiction, built primarily around the habit and compulsion models. Recent research indicates drug addiction may be goal-directed, motivated by excessive valuation of drugs. Drug consumption may initially occur for the sake of pleasure but may transition to a means of escaping withdrawal, stress and negative emotions. In this hypothetical paper, we propose a value-based neurobiological model for drug addiction. We posit that during dependency, the value-based decision-making system in the brain is not inactive but has instead prioritized drugs as the reward of choice. In support of this model, we consider the role of valuation in choice, its influence on pleasure and punishment, and how valuation is contrasted in impulsive and compulsive behaviours. We then discuss the neurobiology of value, beginning with the dopaminergic system and its relationship with incentive salience before moving to brain-wide networks involved in valuation, control and prospection. These value-based neurobiological components are then integrated into the cycle of addiction as we consider the development of drug dependency from a valuation perspective. We conclude with a discussion of cognitive interventions utilizing value-based decision-making, highlighting not just advances in recalibrating the valuation system to focus on non-drug rewards, but also areas for improvement in refining this approach.
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Affiliation(s)
- Kavinash Loganathan
- Centre for Intelligent Signal & Imaging, Universiti Teknologi PETRONAS, Perak, Malaysia.
| | - Eric Tatt Wei Ho
- Centre for Intelligent Signal & Imaging, Universiti Teknologi PETRONAS, Perak, Malaysia; Dept of Electrical & Electronics Engineering, Universiti Teknologi PETRONAS, Perak, Malaysia
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8
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Grodin EN, Ray LA, MacKillop J, Lim AC, Karno MP. Elucidating the Effect of a Brief Drinking Intervention Using Neuroimaging: A Preliminary Study. Alcohol Clin Exp Res 2019; 43:367-377. [PMID: 30556913 DOI: 10.1111/acer.13941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brief interventions have empirical support for acutely reducing alcohol use among non-treatment-seeking heavy drinkers. Neuroimaging techniques allow for the examination of the neurobiological effect of behavioral interventions, probing brain systems putatively involved in clinical response to treatment. Few studies have prospectively evaluated whether psychosocial interventions attenuate neural cue reactivity that in turn reduces drinking in the same population. This study aimed to examine the effect of a brief intervention on drinking outcomes, neural alcohol cue reactivity, and the ability of neural alcohol cue reactivity to prospectively predict drinking outcomes. METHODS Non-treatment-seeking heavy drinking participants were randomized to receive a brief interview intervention (n = 22) or an attention-matched control (n = 24). Immediately following the intervention or control, participants underwent a functional magnetic resonance imaging scan comprised of the alcohol taste cues paradigm. Four weeks after the intervention (or control), participants completed a follow-up visit to report on their past-month drinking. Baseline and follow-up percent heavy drinking days (PHDD) were calculated for each participant. RESULTS There was no significant effect of the brief intervention on PHDD at follow-up or on modulating neural activation to alcohol relative to water taste cues. There was a significant association between neural response to alcohol taste cues and PHDD across groups (Z > 2.3, p < 0.05), such that individuals who had greater neural reactivity to alcohol taste cues in the precuneus and prefrontal cortex (PFC) had fewer PHDD at follow-up. CONCLUSIONS This study did not find an effect of the brief intervention on alcohol use in this sample, and the intervention was not associated with differential neural alcohol cue reactivity. Nevertheless, greater activation of the precuneus and PFC during alcohol cue exposure predicted less alcohol use prospectively suggesting that these neural substrates subserve the effects of alcohol cues on drinking behavior.
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Affiliation(s)
- Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, 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, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Mitchell P Karno
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
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9
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Tuchina OD, Agibalova TV, Shustov DI, Shustova SA, Buzik ОG, Petrosyan YE. [The practical use of placebo effect in psychotherapeutic treatment of patients with substance use disorders: therapeutic and ethic consequences]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 116:61-68. [PMID: 28300816 DOI: 10.17116/jnevro201611611261-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article discusses therapeutic potential of placebo and nocebo effects in treatment of substance use disorders. The authors review the background of the issue, describe neurobiological and psychological mechanisms of placebo effects and demonstrate their impact on psychotherapy of patients with substance use disorders. Attention is drawn to the clinical and ethical issues of practical use of placebo effects including that in terms of placebo-therapy, indirect suggestion psychotherapy, motivational interventions and cognitive-behavioral psychotherapy, psychotherapy with the use of disulfiram, psychopharmacotherapy with opioid antagonists. The authors conclude that the ethical use of placebo-effects in treatment of substance use disorders may improve its overall efficiency.
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Affiliation(s)
- O D Tuchina
- Peoples' Friendship University of Russia, Moscow, Russia
| | - T V Agibalova
- Peoples' Friendship University of Russia, Moscow, Russia; Serbsky Federal Medical Research Center for Psychiatry and Narcology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - D I Shustov
- Academician Pavlov Ryazan State Medical University, Ryazan, Russia
| | - S A Shustova
- Academician Pavlov Ryazan State Medical University, Ryazan, Russia
| | - О G Buzik
- Peoples' Friendship University of Russia, Moscow, Russia
| | - Yu E Petrosyan
- Peoples' Friendship University of Russia, Moscow, Russia
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10
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Neuropsychological Interventions for Decision-Making in Addiction: a Systematic Review. Neuropsychol Rev 2018; 29:79-92. [DOI: 10.1007/s11065-018-9384-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
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11
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Houston RJ, Schlienz NJ. Event-Related Potentials as Biomarkers of Behavior Change Mechanisms in Substance Use Disorder Treatment. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 3:30-40. [PMID: 29397076 DOI: 10.1016/j.bpsc.2017.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 12/21/2022]
Abstract
Substance use disorders (SUDs) are one of the most prevalent psychiatric conditions and represent a significant public health concern. Substantial research has identified key processes related to reinforcement and cognition for the development and maintenance of SUDs, and these processes represent viable treatment targets for psychosocial and pharmacological interventions. Research on SUD treatments has suggested that most approaches are comparable in effectiveness. As a result, recent work has focused on delineating the underlying mechanisms of behavior change that drive SUD treatment outcome. Given the rapid fluctuations associated with the key neurocognitive processes associated with SUDs, high-temporal-resolution measures of human brain processing, namely event-related potentials (ERPs), are uniquely suited to expand our understanding of the underlying neural mechanisms of change during and after SUD treatment. The value of ERPs in the context of SUD treatment are discussed along with work demonstrating the predictive validity of ERPs as biomarkers of SUD treatment response. Example associations between multiple ERP components and psychosocial and/or pharmacological treatment outcome include the P3a and P3b (in response to neutral and substance-related cues), the attention-related negativities (e.g., N170, N200), the late positive potential, and the error-related negativity. Also addressed are limitations of the biomarker approach to underscore the need for research programs evaluating mechanisms of change. Finally, we emphasize the advantages of ERPs as indices of behavior change in SUD treatment and outline issues relevant for future directions in this context.
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Affiliation(s)
- Rebecca J Houston
- Health and Addictions Research Center, Department of Psychology, Rochester Institute of Technology, Rochester, New York.
| | - Nicolas J Schlienz
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Garrison KA, Yip SW, Balodis IM, Carroll KM, Potenza MN, Krishnan-Sarin S. Reward-related frontostriatal activity and smoking behavior among adolescents in treatment for smoking cessation. Drug Alcohol Depend 2017; 177. [PMID: 28651213 PMCID: PMC5564393 DOI: 10.1016/j.drugalcdep.2017.03.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Tobacco use is often initiated during adolescence and continued into adulthood despite desires to quit. A better understanding of the neural correlates of abstinence from smoking in adolescents may inform more effective smoking cessation interventions. Neural reward systems are implicated in tobacco use disorder, and adolescent smokers have shown reduced reward-related ventral striatal activation related to increased smoking. METHODS The current study evaluated nondrug reward anticipation in adolescent smokers using a monetary incentive delay task in fMRI pre- and post- smoking cessation treatment (n=14). This study tested how changes in neural responses to reward anticipation pre- to post-treatment were related to reduced smoking. An exploratory analysis in a larger sample of adolescents with only pre-treatment fMRI (n=28) evaluated how neural responses to reward anticipation were related to behavioral inhibition and behavioral activation scales. RESULTS Adolescent smokers showed pre- to post-treatment increases in reward anticipation-related activity in the bilateral nucleus accumbens and insula, and medial prefrontal cortex, and greater increases in reward anticipation-related activity were correlated with larger percent days of smoking abstinence during treatment. CONCLUSIONS These findings suggest that reduced smoking during smoking cessation treatment is associated with a "recovery of function" in frontostriatal responses to nondrug reward anticipation in adolescent smokers, although comparison with a developmental control group of adolescent nonsmokers is warranted.
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Affiliation(s)
| | - Sarah W Yip
- Department of Psychiatry, Yale School of Medicine,The National Center on Addictions and Substance Abuse, Yale School of Medicine
| | - Iris M Balodis
- Department of Psychiatry, Yale School of Medicine,Department of Psychology, McMaster University
| | | | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine,The National Center on Addictions and Substance Abuse, Yale School of Medicine,Connecticut Mental Health Center,Department of Neuroscience, Yale School of Medicine,Child Study Center, Yale School of Medicine
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13
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Houck JM, Feldstein Ewing SW. Working memory capacity and addiction treatment outcomes in adolescents. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:185-192. [PMID: 28726525 DOI: 10.1080/00952990.2017.1344680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Brief addiction treatments including motivational interviewing (MI) have shown promise with adolescents, but the factors that influence treatment efficacy in this population remain unknown. One candidate is working memory, the ability to hold a fact or thought in mind. This is relevant, as in therapy, a client must maintain and manipulate ideas while working with a clinician. Working memory depends upon brain structures and functions that change markedly during neurodevelopment and that can be negatively impacted by substance use. OBJECTIVES In a secondary analysis of data from a clinical trial for adolescent substance use comparing alcohol/marijuana education and MI, we evaluated the relationship between working memory and three-month treatment-outcomes with the hypothesis that the relationship between intervention conditions and outcome would be moderated by working memory. METHODS With a diverse sample of adolescents currently using alcohol and/or marijuana (N = 153, 64.7% male, 70.6% Hispanic), we examined the relationship between baseline measures of working memory and alcohol and cannabis-related problem scores measured at the three-month follow-up. RESULTS The results showed that lower working memory scores were associated with poorer treatment response only for alcohol use, and only within the education group. No relationship was found between working memory and treatment outcomes in the MI group. CONCLUSION The results suggest that issues with working memory capacity may interfere with adolescents' ability to process and implement didactic alcohol and marijuana content in standard education interventions. These results also suggest that MI can be implemented equally effectively across the range of working memory functioning in youth.
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Affiliation(s)
- Jon M Houck
- a Center on Alcoholism, Substance Abuse, and Addictions , University of New Mexico , Albuquerque , NM , USA
| | - Sarah W Feldstein Ewing
- b Department of Child & Adolescent Psychiatry , Oregon Health & Science University , Portland , OR , USA
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14
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Feldstein Ewing SW, Chung T, Caouette JD, Ketcherside A, Hudson KA, Filbey FM. Orbitofrontal cortex connectivity as a mechanism of adolescent behavior change. Neuroimage 2016; 151:14-23. [PMID: 28039093 DOI: 10.1016/j.neuroimage.2016.12.076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 12/23/2016] [Accepted: 12/27/2016] [Indexed: 01/08/2023] Open
Abstract
An increasing number of studies have implicated the role of network functional connectivity in addiction. Yet, none have examined functional connectivity as a potential mechanism of adolescent behavior change. We examined the underlying neural mechanism of a promising treatment for adolescents, motivational interviewing (MI). We began by employing psychophysiological interaction (PPI) to evaluate network response in a sample of adolescent cannabis users (N=30). Next, we examined correlations between network connectivity and clinical metrics of treatment outcome. PPI analyses seeded on the orbitofrontal cortex (OFC) showed significant increases in functional connectivity across the inferior frontal gyrus (IFG), precentral gyrus, anterior and posterior cingulate gyrus, supplementary motor area (SMA), superior frontal gyrus, pallidus, caudate, and parahippocampal gyrus. Further, greater functional connectivity between the OFC and anterior cingulate/medial frontal gyrus was associated with less behavior change (e.g., greater post-treatment cannabis problems). These data support the role of the OFC network as a mechanism of adolescent treatment response.
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Affiliation(s)
- Sarah W Feldstein Ewing
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd., M/C DC7P, Portland, OR 97239, USA.
| | - Tammy Chung
- University of Pittsburgh School of Medicine, Departments of Psychiatry and Psychology, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
| | - Justin D Caouette
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd., M/C DC7P, Portland, OR 97239, USA.
| | - Arielle Ketcherside
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA.
| | - Karen A Hudson
- Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd., M/C DC7P, Portland, OR 97239, USA.
| | - Francesca M Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, 2200 West Mockingbird Lane, Dallas, TX 75235, USA.
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Monti PM, Monnig M. Ambivalence and motivational interviewing with adolescents: ensuring that the baby does not get thrown out with the bathwater. Addiction 2016; 111:1909-1910. [PMID: 27029615 PMCID: PMC5045316 DOI: 10.1111/add.13356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Peter M. Monti
- Brown University, Center for Alcohol and Addiction Studies, Box G-S121-5, Providence, RI 02912
| | - Mollie Monnig
- Brown University, Center for Alcohol and Addiction Studies, Box G-S121-4, Providence, RI 02912
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Bujarski S, Ray LA. Experimental psychopathology paradigms for alcohol use disorders: Applications for translational research. Behav Res Ther 2016; 86:11-22. [PMID: 27266992 PMCID: PMC5067182 DOI: 10.1016/j.brat.2016.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/12/2016] [Accepted: 05/26/2016] [Indexed: 02/05/2023]
Abstract
In spite of high prevalence and disease burden, scientific consensus on the etiology and treatment of Alcohol Use Disorder (AUD) has yet to be reached. The development and utilization of experimental psychopathology paradigms in the human laboratory represents a cornerstone of AUD research. In this review, we describe and critically evaluate the major experimental psychopathology paradigms developed for AUD, with an emphasis on their implications, strengths, weaknesses, and methodological considerations. Specifically we review alcohol administration, self-administration, cue-reactivity, and stress-reactivity paradigms. We also provide an introduction to the application of experimental psychopathology methods to translational research including genetics, neuroimaging, pharmacological and behavioral treatment development, and translational science. Through refining and manipulating key phenotypes of interest, these experimental paradigms have the potential to elucidate AUD etiological factors, improve the efficiency of treatment developments, and refine treatment targets thus advancing precision medicine.
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Affiliation(s)
- Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, United States.
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, United States; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States
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17
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Lindgren KP, Neighbors C, Gasser ML, Ramirez JJ, Cvencek D. A review of implicit and explicit substance self-concept as a predictor of alcohol and tobacco use and misuse. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:237-246. [PMID: 27715328 DOI: 10.1080/00952990.2016.1229324] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This paper provides an overview of the self-concept as it relates to substance use. Self-concept has a long history in psychological theory and research; however, substance self-concept (e.g., viewing one's self as a drinker or smoker) is an understudied area of research with the potential to expand existing conceptualizations of substance use, addiction, and prevention and treatment efforts, and should receive greater research attention. OBJECTIVES First, we review and provide a theoretical framework of substance self-concept that draws from dual process models and distinguishes between implicit and explicit self-concept. Next, we summarize key findings related to substance use in the extant literature, focusing on alcohol and tobacco (smoking). RESULTS Across both substances, there is converging evidence that substance self-concept is associated with substance use outcomes, including quantity and frequency of use and problems associated with use, and that change in substance self-concept is associated with recovery from substance misuse. Recommendations for the substance self-concept research agenda include routine assessment of substance self-concept, expanded use of implicit measures, investigation of moderators of substance self-concept, and targeting substance self-concept directly in prevention and intervention efforts. CONCLUSION Ultimately, we suggest that substance self-concept is a promising, but understudied, construct. Greater research attention to substance self-concept could clarify its potential as an important risk factor for hazardous use and addiction as well as its utility as a prevention and treatment target.
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Affiliation(s)
- Kristen P Lindgren
- a Department of Psychiatry & Behavioral Sciences , Center for the Study of Health and Risk Behaviors, University of Washington , Seattle , WA , USA
| | - Clayton Neighbors
- b Department of Psychology , University of Houston , Houston , TX , USA
| | - Melissa L Gasser
- a Department of Psychiatry & Behavioral Sciences , Center for the Study of Health and Risk Behaviors, University of Washington , Seattle , WA , USA
| | - Jason J Ramirez
- a Department of Psychiatry & Behavioral Sciences , Center for the Study of Health and Risk Behaviors, University of Washington , Seattle , WA , USA
| | - Dario Cvencek
- c Institute for Learning & Brain Sciences, University of Washington , Seattle , WA , USA
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18
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Borsari B, Apodaca TR, Yurasek A, Monti PM. Does mental status impact therapist and patient communication in emergency department brief interventions addressing alcohol use? J Subst Abuse Treat 2016; 73:1-8. [PMID: 28017179 DOI: 10.1016/j.jsat.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/18/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part of the screening process. Intervention sessions were audio-taped, and transcribed and coded using the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003). The MISC 2.0 coded therapist behaviors that are related to the use of motivational interviewing, and patient language reflecting movement toward (change talk) or away from (sustain talk) changing personal alcohol use. Overall, patients responded in a similar manner to therapist MI behaviors regardless of high versus low level of mental functioning at the time of the intervention. Group differences emerged on patient response to only three specific therapist skills: giving information, open questions, and complex reflection. Thus, the differential effects of SBIRT in critical care settings do not appear to be a result of differences in the therapist and patient communication process.
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Affiliation(s)
- Brian Borsari
- Mental Health Service (116B), San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA 94121; Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912; Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143.
| | - Timothy R Apodaca
- Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108; University of Missouri-Kansas City School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66103
| | - Ali Yurasek
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
| | - Peter M Monti
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
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Chung T, Noronha A, Carroll KM, Potenza MN, Hutchison K, Calhoun VD, Gabrieli JDE, Morgenstern J, Nixon SJ, Wexler BE, Brewer J, Ray L, Filbey F, Strauman TJ, Kober H, Feldstein Ewing SW. Brain mechanisms of Change in Addictions Treatment: Models, Methods, and Emerging Findings. CURRENT ADDICTION REPORTS 2016; 3:332-342. [PMID: 27990326 PMCID: PMC5155705 DOI: 10.1007/s40429-016-0113-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Increased understanding of "how" and "for whom" treatment works at the level of the brain has potential to transform addictions treatment through the development of innovative neuroscience-informed interventions. The 2015 Science of Change meeting bridged the fields of neuroscience and psychotherapy research to identify brain mechanisms of behavior change that are "common" across therapies, and "specific" to distinct behavioral interventions. Conceptual models of brain mechanisms underlying effects of Cognitive Behavioral Therapy, mindfulness interventions, and Motivational Interviewing were discussed. Presentations covered methods for integrating neuroimaging into psychotherapy research, and novel analytic approaches. Effects of heavy substance use on the brain, and recovery of brain functioning with sustained abstinence, which may be facilitated by cognitive training, were reviewed. Neuroimaging provides powerful tools for determining brain mechanisms underlying psychotherapy and medication effects, predicting and monitoring outcomes, developing novel interventions that target specific brain circuits, and identifying for whom an intervention will be effective.
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Affiliation(s)
- Tammy Chung
- University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213, Phone: 412-246-5147, Fax: 412-246-6550
| | - Antonio Noronha
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Bethesda, MD, Phone: 301-443-7722, Fax: 301-443-1650
| | - Kathleen M. Carroll
- Yale University, 950 Campbell Avenue, MIRECC 151D, West Haven, CT 06516, Phone: 203-932-3869 x7403, Fax: 203-937-3869
| | - Marc N. Potenza
- Yale University, 34 Park St, New Haven, CT 06519, Phone: 203-974-7356, Fax: 203-974-7366
| | - Kent Hutchison
- University of Colorado at Boulder, Muenzinger Psychology, 345 UCB, Boulder, CO 80309, Phone: 303-492-8163
| | - Vince D. Calhoun
- The Mind Research Network, The University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, Phone: 505-272-1817, Fax: 505-272-8002
| | - John D. E. Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, 43 Vassar Street, Building 46-4033, Cambridge, MA 02139, Phone: 617-253-8946, Fax: 617-324-5311
| | - Jon Morgenstern
- Northwell Health, 1010 Northern Blvd, Great Neck, NY 11021, Phone: 516-837-1694
| | - Sara Jo Nixon
- McKnight Brain Institute, University of Florida, PO Box 100256, Gainesville, FL 32610, Phone: 352-294-4920
| | - Bruce E. Wexler
- Yale University, 34 Park St, New Haven, CT 06519, Phone: 203-974-7339
| | - Judson Brewer
- University of Massachusetts Medical School, Worcester, MA 01655 and Yale University School of Medicine, New Haven, CT 06515, Phone: 508-856-1632; Fax 508-856-1977
| | - Lara Ray
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095, Phone: 310-794-5383
| | - Francesca Filbey
- University of Texas at Dallas Center for Brain Health, 2200 West Mockingbird Lane, Dallas, TX 75235, Phone: 972-883-3204
| | - Timothy J. Strauman
- Duke University, 316 Soc-psych Building, Durham, NC 27708, Phone: 919-660-5709
| | - Hedy Kober
- Yale University, 1 Church Street, Suite 701, New Haven, CT 06525, Phone: 203-737-5641
| | - Sarah W. Feldstein Ewing
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, Phone: 503-418-9604
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20
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DeWitt SJ, Ketcherside A, McQueeny TM, Dunlop JP, Filbey FM. The hyper-sentient addict: an exteroception model of addiction. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 41:374-81. [PMID: 26154169 DOI: 10.3109/00952990.2015.1049701] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Exteroception involves processes related to the perception of environmental stimuli important for an organism's ability to adapt to its environment. As such, exteroception plays a critical role in conditioned response. In addiction, behavioral and neuroimaging studies show that the conditioned response to drug-related cues is often associated with alterations in brain regions including the precuneus/posterior cingulate cortex, an important node within the default mode network dedicated to processes such as self-monitoring. OBJECTIVE This review aimed to summarize the growing, but largely fragmented, literature that supports a central role of exteroceptive processes in addiction. METHODS We performed a systematic review of empirical research via PubMed and Google Scholar with keywords including 'addiction', 'exteroception', 'precuneus', and 'self-awareness', to identify human behavioral and neuroimaging studies that report mechanisms of self-awareness in healthy populations, and altered self-awareness processes, specifically exteroception, in addicted populations. RESULTS Results demonstrate that exteroceptive processes play a critical role in conditioned cue response in addiction and serve as targets for interventions such as mindfulness training. Further, a hub of the default mode network, namely, the precuneus, is (i) consistently implicated in exteroceptive processes, and (ii) widely demonstrated to have increased activation and connectivity in addicted populations. CONCLUSION Heightened exteroceptive processes may underlie cue-elicited craving, which in turn may lead to the maintenance and worsening of substance use disorders. An exteroception model of addiction provides a testable framework from which novel targets for interventions can be identified.
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Affiliation(s)
- Samuel J DeWitt
- a Center for BrainHealth, University of Texas at Dallas , Dallas , TX , USA
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21
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Carpenter KM, Amrhein PC, Bold KW, Mishlen K, Levin FR, Raby WN, Evans SM, Foltin RW, Nunes EV. Derived relations moderate the association between changes in the strength of commitment language and cocaine treatment response. Exp Clin Psychopharmacol 2016; 24:77-89. [PMID: 26914460 PMCID: PMC7289513 DOI: 10.1037/pha0000063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The psycholinguistic analysis of client-counselor interactions indicates that how individuals talk about their substance use is associated with treatment outcome. However, the processes by which client speech influences out-of-session behaviors have not been clearly delineated. This study investigated the relationships between deriving relations-a key behavioral process by which language and cognition may come to influence behavior, shifts in the strength of client talk in favor of change, and treatment outcome among 75 cocaine-dependent participants (23% Female). Participants were trained to relate cocaine words, nonsense syllables, and negative-consequence words and were then assessed for a derived relation of equivalence before starting treatment. The DARN-C coding system was used to quantify the strength of participant speech during an early cognitive behavior therapy counseling session. Cocaine use during treatment was the outcome of interest. The analyses (a) characterized the process of deriving relations among individuals seeking help for their misuse of cocaine, (b) tested the relationships between shifts in the strength of participants' speech in favor of change and treatment outcome, and (c) tested if deriving equivalence relations moderated the relationship between shifts in the strength of in-session speech and treatment response. Results indicated that a minority of participants derived equivalence relations, however increases in the strength of commitment language predicted less cocaine use during treatment only among those who did. The findings suggest deriving relations may be an important process by which changes in the strength of commitment language comes to influence substance use.
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22
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Dedovic K, Pruessner J, Tremblay J, Nadeau L, Ouimet MC, Lepage M, Brown TG. Examining cortical thickness in male and female DWI offenders. Neurosci Lett 2016; 619:189-95. [DOI: 10.1016/j.neulet.2016.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/14/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
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Feldstein Ewing SW, Tapert SF, Molina BSG. Uniting adolescent neuroimaging and treatment research: Recommendations in pursuit of improved integration. Neurosci Biobehav Rev 2016; 62:109-14. [PMID: 26748378 PMCID: PMC4767630 DOI: 10.1016/j.neubiorev.2015.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/10/2015] [Accepted: 12/19/2015] [Indexed: 12/21/2022]
Abstract
Many clinicians who provide mental health treatment find developmental neuroscience discoveries to be exciting. However, the utility of these findings often seem far removed from everyday clinical care. Thus, the goal of this article is to offer a bridge to connect the fields of applied adolescent treatment and developmental neuroscience investigation. An overview of the relevance of developmental neuroscience in adolescent direct practice and a rationale for how and why this integration could benefit adolescent treatment outcomes is provided. Finally, a series of practical suggestions is generated for enhancing collaborative, interdisciplinary work that ultimately advances treatment response for this important clinical population.
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Affiliation(s)
- Sarah W Feldstein Ewing
- Oregon Health & Science University, Department of Psychiatry, 3314 SW US Veteran's Hospital Rd. M/C DC7P, Portland, OR 97239, USA.
| | - Susan F Tapert
- VA San Diego Healthcare System, Psychology Service (116B), 3350 La Jolla Village Drive, San Diego, CA 92161, USA; University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093-0603 V, USA.
| | - Brooke S G Molina
- University of Pittsburgh School of Medicine, Departments of Psychiatry and Psychology, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
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24
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Neuroscience of drug craving for addiction medicine: From circuits to therapies. PROGRESS IN BRAIN RESEARCH 2015; 223:115-41. [PMID: 26806774 DOI: 10.1016/bs.pbr.2015.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Drug craving is a dynamic neurocognitive emotional-motivational response to a wide range of cues, from internal to external environments and from drug-related to stressful or affective events. The subjective feeling of craving, as an appetitive or compulsive state, could be considered a part of this multidimensional process, with modules in different levels of consciousness and embodiment. The neural correspondence of this dynamic and complex phenomenon may be productively investigated in relation to regional, small-scale networks, large-scale networks, and brain states. Within cognitive neuroscience, this approach has provided a long list of neural and cognitive targets for craving modulations with different cognitive, electrical, or pharmacological interventions. There are new opportunities to integrate different approaches for carving management from environmental, behavioral, psychosocial, cognitive, and neural perspectives. By using cognitive neuroscience models that treat drug craving as a dynamic and multidimensional process, these approaches may yield more effective interventions for addiction medicine.
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25
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Black JJ, Chung T. Mechanisms of change in adolescent substance use treatment: how does treatment work? Subst Abus 2015; 35:344-51. [PMID: 24901750 DOI: 10.1080/08897077.2014.925029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adolescent substance use treatment outcome research generally shows small to moderate effects in reducing substance use, with no specific "brand" of treatment emerging as clearly superior to any other, and treatment gains that fade over time. The relatively weak and temporary effects of treatment call for improving the potency and durability of intervention effects. In response to this call, this critical narrative review summarizes research on mechanisms of change for both adults and adolescents in substance use treatment, with a particular focus on reviewing what is known regarding "how" adolescent substance use treatment works. METHODS A comprehensive review of the adolescent (aged 11-18) substance use treatment literature was conducted to identify empirical studies that examined mediators of intervention effects. Relevant databases (e.g., PsychINFO, MEDLINE) were searched using key words (e.g., "mediator"), and relevant articles from reference sections of identified studies and review papers were considered. RESULTS Studies of mechanisms of psychotherapy change are rare in the adult, and particularly adolescent, substance use treatment outcome literature. The 4 adolescent studies that examined substance use treatment mechanisms found that positive social support, motivation to abstain, and positive parenting behaviors mediated treatment effects. To date, research has not supported therapy-specific mechanisms of change, finding instead that "common" processes of change largely account for improvements in outcome across distinct "brands" of treatment. CONCLUSIONS The lack of empirical support for treatment-specific mechanisms of change may be due to the need for greater precision in defining and measuring treatment-specific causal chains. Future directions include neuroscience approaches to examining changes in brain functioning that are associated with treatment response and recovery and examining mechanisms in adaptive treatment designs, which can accommodate individual differences in targets for intervention and response to treatment.
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Affiliation(s)
- Jessica J Black
- a Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
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26
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Feldstein Ewing SW, Yezhuvath U, Houck JM, Filbey FM. Brain-based origins of change language: a beginning. Addict Behav 2014; 39:1904-10. [PMID: 25150658 DOI: 10.1016/j.addbeh.2014.07.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/26/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
Motivational interviewing (MI) is a promising treatment for heavy drinking. Client change talk (CT), a critical component of MI, has been associated with differential brain activation. The goal of this study was to begin to deconstruct how and why CT may affect the brain. Specifically, we sought to determine whether simply repeating statements in favor of change would cause differential brain activation, or whether client statements must be spontaneously generated within a therapeutic milieu in order to influence brain activation. We therefore examined blood oxygenation level dependent (BOLD) response following two types of client language (CT; and sustain talk, ST) across two conditions: (1) Self-Generated: CT and ST were elicited during an MI session vs. (2) Experimenter-Selected: a pre-established list of CT and ST was provided to the individual in the absence of an MI session. Across both conditions, participants' CT and ST were visually and aurally presented during fMRI. We enrolled 39 recent binge drinkers (41% male; M age=19.9; n=18 in Self-Generated group; n=21 in Experimenter-Selected group). We found that both types of client language (CT and ST) elicited greater BOLD activation in the Self-Generated vs. the Experimenter-Selected group in the left inferior frontal gyrus/anterior insula and superior temporal gyri (p≤0.001). These findings indicate that the nature of client language matters. It appears that it is not just the words themselves, but the origin (naturally generated within a therapeutic session) that influences brain-based effects.
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27
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Aharonovich E, Stohl M, Ellis J, Amrhein P, Hasin D. Commitment strength, alcohol dependence and HealthCall participation: effects on drinking reduction in HIV patients. Drug Alcohol Depend 2014; 135:112-8. [PMID: 24332577 PMCID: PMC3918435 DOI: 10.1016/j.drugalcdep.2013.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/18/2013] [Accepted: 11/19/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND The role of three factors in drinking outcome after brief intervention among heavily drinking HIV patients were investigated: strength of commitment to change drinking, alcohol dependence, and treatment type: brief Motivational Interview (MI) only, or MI plus HealthCall, a technological extension of brief intervention. METHODS HIV primary care patients (N=139) who drank ≥4 drinks at least once in the 30 days before study entry participated in MI-only or MI+HealthCall in a randomized trial to reduce drinking. Patients were 95.0% minority; 23.0% female; 46.8% alcohol dependent; mean age 46.3. Outcome at end of treatment (60 days) was drinks per drinking day (Timeline Follow-Back). Commitment strength (CS) was rated from MI session recordings. RESULTS Overall, stronger CS predicted end-of-treatment drinking (p<.001). After finding an interaction of treatment, CS and alcohol dependence (p=.01), we examined treatment×CS interactions in alcohol dependent and non-dependent patients. In alcohol dependent patients, the treatment×commitment strength interaction was significant (p=.006); patients with low commitment strength had better outcomes in MI+HealthCall than in MI-only (lower mean drinks per drinking day; 3.5 and 4.6 drinks, respectively). In non-dependent patients, neither treatment nor CS predicted outcome. CONCLUSIONS Among alcohol dependent HIV patients, HealthCall was most beneficial in drinking reduction when MI ended with low commitment strength. HealthCall may not merely extend MI effects, but add effects of its own that compensate for low commitment strength. Thus, HealthCall may also be effective when paired with briefer interventions requiring less skill, training and supervision than MI. Replication is warranted.
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Affiliation(s)
- Efrat Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, United States.
| | - Malka Stohl
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - James Ellis
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Paul Amrhein
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Deborah Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 180 Ft. Washington Avenue, New York, NY 10032,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
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28
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Houck JM, Bryan AD, Feldstein Ewing SW. Functional connectivity and cannabis use in high-risk adolescents. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 39:414-23. [PMID: 24200211 PMCID: PMC4070738 DOI: 10.3109/00952990.2013.837914] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adolescence is a unique neurodevelopmental period when regions of the brain most able to assess risk and reward are still in development. Cannabis use during adolescence has been associated with persistent negative outcomes. Although measures of resting brain activity are useful in assessing functional connectivity, such measures have not been broadly applied in adolescent cannabis-users. OBJECTIVES The goal of the present study was to analyze the associations between cannabis use and resting brain activity in a sample of high-risk adolescents. METHODS Eighty-two high-risk youth between 14-18 years old were recruited from a juvenile justice day program. Youth completed a brief neurocognitive battery including assessments of cannabis use and a 5-minute resting functional magnetic resonance imaging (fMRI) scan. Intrinsic connectivity networks were extracted using the GIFT toolbox. Brain activity in a fronto-temporal network was compared in youth with high cannabis use vs. low cannabis use using an independent-samples t-test with alcohol use entered as a covariate. RESULTS Analysis revealed two elements within the fronto-temporal network related to cannabis use: one in middle frontal gyrus related to high cannabis use, and one in middle temporal gyrus related to low cannabis use. Only the frontal source survived application of a cluster size threshold and was significant at p < 0.005. CONCLUSIONS These results are consistent with patterns of activity in adult cannabis-users. The observed effect may reflect either pre-existing risk factors or near-term consequences of cannabis use. Prevention and intervention strategies that address fronto-temporal functioning may be particularly helpful in this population.
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Krishnan-Sarin S, Balodis IM, Kober H, Worhunsky PD, Liss T, Xu J, Potenza MN. An exploratory pilot study of the relationship between neural correlates of cognitive control and reduction in cigarette use among treatment-seeking adolescent smokers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:526-32. [PMID: 23586458 PMCID: PMC4106014 DOI: 10.1037/a0032479] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite high rates of tobacco use during adolescence, few empirically validated smoking cessation strategies exist for adolescent smokers. Developing an understanding of the neural underpinnings of cognitive control processes in adolescent smokers, and their relationship to quit behaviors, may help advance the development of enhanced behavioral and pharmacological therapies. The current pilot study explored the relationship between brain responses during performance of the Stroop color-word interference task and reduction in tobacco use (as measured by changes in cotinine levels) in treatment-seeking adolescent smokers participating in a high school-based smoking-cessation program. Eleven adolescent daily smokers participated in a prequit session during which neural activity in response to congruent and incongruent events in a Stroop task was examined using functional MRI (fMRI). Changes in urine cotinine levels from prequit baseline to end of treatment were calculated and correlated with brain activity. Adolescents with greater activation in the inferior frontal gyrus, insula, thalamus, and anterior cingulate had greater reductions in cotinine levels. The preliminary observation of a relationship between treatment outcome and neural correlates of cognitive control prior to treatment onset provides insight into individual differences in adolescent brain function that might relate importantly to treatment outcome.
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Potenza MN, Balodis IM, Franco CA, Bullock S, Xu J, Chung T, Grant JE. Neurobiological considerations in understanding behavioral treatments for pathological gambling. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:380-92. [PMID: 23586456 PMCID: PMC3700568 DOI: 10.1037/a0032389] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pathological gambling (PG), a disorder currently categorized as an impulse-control disorder but being considered as a nonsubstance addiction in Diagnostic and Statistical Manual of Mental Disorders (5th ed.) discussions, represents a significant public health concern. Over the past decade, considerable advances have been made with respect to understanding the biological underpinnings of PG. Research has also demonstrated the efficacies of multiple treatments, particularly behavioral therapies, for treating PG. Despite these advances, relatively little is known regarding how biological measures, particularly those assessing brain function, relate to treatments for PG. In this article, we present a conceptual review focusing on the neurobiology of behavioral therapies for PG. To illustrate issues related to study design, we present proof-of-concept preliminary data that link Stroop-related brain activations prior to treatment onset to treatment outcome in individuals with PG receiving a cognitive-behavioral treatment incorporating aspects of imaginal desensitization and motivational interviewing. We conclude with recommendations about current and future directions regarding how to incorporate and translate biological findings into improved therapies for individuals with nonsubstance and substance addictions.
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Affiliation(s)
- Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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Feldstein Ewing SW, Chung T. Neuroimaging mechanisms of change in psychotherapy for addictive behaviors: emerging translational approaches that bridge biology and behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:329-35. [PMID: 23815447 PMCID: PMC3864922 DOI: 10.1037/a0031491] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Research on mechanisms of behavior change provides an innovative method to improve treatment for addictive behaviors. An important extension of mechanisms of change research involves the use of translational approaches, which examine how basic biological (i.e., brain-based mechanisms) and behavioral factors interact in initiating and sustaining positive behavior change as a result of psychotherapy. Articles in this special issue include integrative conceptual reviews and innovative empirical research on brain-based mechanisms that may underlie risk for addictive behaviors and response to psychotherapy from adolescence through adulthood. Review articles discuss hypothesized mechanisms of change for cognitive and behavioral therapies, mindfulness-based interventions, and neuroeconomic approaches. Empirical articles cover a range of addictive behaviors, including use of alcohol, cigarettes, marijuana, cocaine, and pathological gambling and represent a variety of imaging approaches including fMRI, magneto-encephalography, real-time fMRI, and diffusion tensor imaging. Additionally, a few empirical studies directly examine brain-based mechanisms of change, whereas others examine brain-based indicators as predictors of treatment outcome. Finally, two commentaries discuss craving as a core feature of addiction, and the importance of a developmental approach to examining mechanisms of change. Ultimately, translational research on mechanisms of behavior change holds promise for increasing understanding of how psychotherapy may modify brain structure and functioning and facilitate the initiation and maintenance of positive treatment outcomes for addictive behaviors.
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Affiliation(s)
- Sarah W Feldstein Ewing
- University Honors College/University of New Mexico Center on Alcoholism, Substance Abuse, and Addiction, Albuquerque, NM 87131, USA.
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Morgenstern J, Naqvi NH, Debellis R, Breiter HC. The contributions of cognitive neuroscience and neuroimaging to understanding mechanisms of behavior change in addiction. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:336-50. [PMID: 23586452 DOI: 10.1037/a0032435] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the last decade, there has been an upsurge of interest in understanding the mechanisms of behavior change (MOBC) and effective behavioral interventions as a strategy to improve addiction-treatment efficacy. However, there remains considerable uncertainty about how treatment research should proceed to address the MOBC issue. In this article, we argue that limitations in the underlying models of addiction that inform behavioral treatment pose an obstacle to elucidating MOBC. We consider how advances in the cognitive neuroscience of addiction offer an alternative conceptual and methodological approach to studying the psychological processes that characterize addiction, and how such advances could inform treatment process research. In addition, we review neuroimaging studies that have tested aspects of neurocognitive theories as a strategy to inform addiction therapies and discuss future directions for transdisciplinary collaborations across cognitive neuroscience and MOBC research.
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Affiliation(s)
- Jon Morgenstern
- Department of Psychiatry, Columbia University, New York, NY 10027, USA.
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Feldstein Ewing SW, McEachern AD, Yezhuvath U, Bryan AD, Hutchison KE, Filbey FM. Integrating brain and behavior: evaluating adolescents' response to a cannabis intervention. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 27:510-25. [PMID: 22925010 DOI: 10.1037/a0029767] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Client language (change talk [CT] and counterchange talk [CCT]) is gaining increasing support as an active ingredient of psychosocial interventions. Preliminary work with adults suggests that there may be a neural basis for this. With a diverse sample of adolescent cannabis users, we evaluated the influence of CT and CCT on blood oxygen level dependent (BOLD) response during an fMRI cannabis cue-exposure paradigm. We also investigated how BOLD activation related to treatment outcomes. Adolescent cannabis users (N = 43; 83.7% male; 53.5% Hispanic; M age = 16 years) were presented with CT and CCT derived from their prescan intervention session during the fMRI paradigm. Additionally, BOLD activation during CT (vs. CCT) was tested as a predictor of 1-month follow-up cannabis use behavior (frequency of cannabis use, cannabis problems, cannabis dependence). We observed a significant interaction, with greater activation during CT (vs. CCT) during the cannabis (but not control) cues in several areas key to self-referential processes (uncorrected p < 0.001; medial frontal gyrus, insula). Furthermore, BOLD activation during CT (vs. CCT) during cannabis (but not control) cues in areas that underlie introspection (posterior cingulate, precuneus) was significantly related to youths' 1-month follow-up cannabis use behavior (frequency of cannabis use, cannabis problems, cannabis dependence; uncorrected p < 0.001). These data indicate a unique interaction pattern, whereby CT (vs. CCT) during the cannabis (but not control) cues was associated with significantly greater activation in brain areas involved in introspection. Further, this activation was related to significantly better treatment outcomes for youth.
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Smith DC, Lanesskog D, Cleeland L, Motl R, Weikert M, Dlugonski D. Motivational interviewing may improve exercise experience for people with multiple sclerosis: A small randomized trial. HEALTH & SOCIAL WORK 2012; 37:99-109. [PMID: 23029977 DOI: 10.1093/hsw/hls011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
People with multiple sclerosis (MS) are likely to benefit from regular exercise, but physical inactivity is more common among people with MS than among the general population. This small randomized study evaluated whether motivational interviewing (MI) affects adherence to and personal experience in an exercise program. Inactive people with MS participating in an eight-week exercise program were randomized to either three brief MI (n = 7) or three health coaching (n = 6) sessions. Session attendance for both conditions was high, and MI fidelity was rigorously and reliably measured using the Motivational Interviewing Treatment Integrity Scales. The feasibility of using this approach was demonstrated with a small sample. Large effects favoring the MI condition were found for physical exertion, affect during exercise, and fatigue, but no effects were found for adherence to the exercise program. Treatment integrity measures of MI were correlated with outcomes in expected directions. Although this study demonstrated the feasibility of this MI approach, the large effect sizes found should be viewed with substantial skepticism and replicated in sufficiently powered studies using objective measures of exercise adherence.
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Affiliation(s)
- Douglas C Smith
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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