1
|
Garland EL. Mindfulness-Oriented Recovery Enhancement: Implementing an evidence-based intervention for chronic pain, opioid use, and opioid addiction in clinical settings. Br J Clin Pharmacol 2024. [PMID: 39046159 DOI: 10.1111/bcp.16147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 07/25/2024] Open
Abstract
The opioid crisis emerged in part due to the overprescribing of opioid analgesics for chronic pain. Although not the only source of the current epidemic of opioid use disorder (OUD), the prescription of opioids for chronic pain remains one vector for the development of opioid misuse and OUD. However, opioid tapering is not appropriate for all patients, and some patients may need to remain on opioid therapy for the long term. To reduce the risk of opioid-related harm among people with chronic pain and to treat incipient or entrenched addictive behaviours, new interventions are needed. This review discusses the clinical outcomes, biobehavioural mechanisms and implementation considerations for a novel, evidence-based intervention for chronic pain, opioid use and OUD called Mindfulness-Oriented Recovery Enhancement (MORE). MORE unites complementary aspects of mindfulness training, cognitive behavioural therapy and principles from positive psychology to simultaneously address addictive behaviour, emotion dysregulation and chronic pain by targeting brain reward and stress systems. MORE has been tested in 13 completed randomized clinical trials, including over 1300 patients, and has demonstrated efficacy against a range of active control conditions for reducing opioid dosing, opioid misuse, illicit drug use, depression, post-traumatic stress symptoms and chronic pain. Opportunities for implementing MORE include facilitating opioid tapering and promoting safe opioid use in primary care and specialty pain clinics, decreasing opioid misuse and enhancing medication-assisted treatment for OUD. Given evidence of MORE's efficacy, it is now time to consider disseminating this evidence-based treatment in the United States, the United Kingdom and worldwide.
Collapse
Affiliation(s)
- Eric L Garland
- Department of Psychiatry, University of California-San Diego, La Jolla, California, USA
- Sanford Institute for Empathy and Compassion, University of California-San Diego, La Jolla, California, USA
| |
Collapse
|
2
|
Dejoie JM, Senia N, Konova A, Smith D, Fareri D. Common and Distinct Drug Cue Reactivity Patterns Associated with Cocaine and Heroin: An fMRI Meta-Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.19.23297268. [PMID: 37905133 PMCID: PMC10615011 DOI: 10.1101/2023.10.19.23297268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Substance use and substance use disorders represent ongoing major public health crises. Specifically, the use of substances such as cocaine and heroin are responsible for over 50,000 drug related deaths combined annually. We used a comparative meta-analysis procedure to contrast activation patterns associated with cocaine and heroin cue reactivity, which may reflect substance use risk for these substances. PubMed and Google Scholar were searched for studies with within-subject whole brain analyses comparing drug to neutral cues for users of cocaine and heroin published between 1995 and 2022. A total of 18 studies were included, 9 in each subgroup. Voxel-based meta-analyses were performed using seed-based d mapping with permuted subject images (SDM-PSI) for subgroup mean analyses and a contrast meta-regression comparing the two substances. Results from our mean analysis indicated that users of heroin showed more widespread activation in the nucleus accumbens, right inferior and left middle temporal gyrus, right thalamus, and right cerebellum. Cocaine use was associated with recruitment of dorsolateral prefrontal cortex during cue reactivity. Direct comparison of cue reactivity studies in heroin relative to cocaine users revealed greater activation in dopaminergic targets for users of heroin compared to users of cocaine. Differential activation patterns between substances may underlie differences in the clinical characteristics observed in users of cocaine and heroin, including seeking emotional blunting in users of heroin. More consistent research methodology is needed to provide adequate studies for stringent meta-analyses examining common and distinct neural activation patterns across substances and moderation by clinically relevant factors.
Collapse
|
3
|
Pollard AA, Hauson AO, Lackey NS, Zhang E, Khayat S, Carson B, Fortea L, Radua J, Grant I. Functional neuroanatomy of craving in heroin use disorder: voxel-based meta-analysis of functional magnetic resonance imaging (fMRI) drug cue reactivity studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:418-430. [PMID: 36880845 DOI: 10.1080/00952990.2023.2172423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 03/08/2023]
Abstract
Background: The neuroanatomy of craving, typically investigated using the functional magnetic resonance imaging (fMRI) drug cue reactivity (FDCR) paradigm, has been shown to involve the mesocorticolimbic, nigrostriatal, and corticocerebellar systems in several substances. However, the neuroanatomy of craving in heroin use disorder is still unclear.Objective: The current meta-analysis examines previous research on the neuroanatomy of craving in abstinent individuals with opioid use disorder (OUD).Method: Seven databases were searched for studies comparing abstinent OUD versus healthy controls on drug > neutral contrast interaction at the whole-brain level. Voxel-based meta-analysis was performed using seed-based d mapping with permuted subject images (SDM-PSI). Thresholds were set at a family-wise error rate of less than 5% with the default pre-processing parameters of SDM-PSI.Results: A total of 10 studies were included (296 OUD and 187 controls). Four hyperactivated clusters were identified with Hedges' g of peaks that ranged from 0.51 to 0.82. These peaks and their associated clusters correspond to the three systems identified in the previous literature: a) mesocorticolimbic, b) nigrostriatal, and c) corticocerebellar. There were also newly revealed hyperactivation regions including the bilateral cingulate, precuneus, fusiform gyrus, pons, lingual gyrus, and inferior occipital gyrus. The meta-analysis did not reveal areas of hypoactivation.Conclusion: Recommendations based on the functional neuroanatomical findings of this meta-analysis include pharmacological interventions such as buprenorphine/naloxone and cognitive-behavioral treatments such as cue-exposure combined with HRV biofeedback. In addition, research should utilize FDCR as pre- and post-measurement to determine the effectiveness and mechanism of action of such interventions.
Collapse
Affiliation(s)
- Anna A Pollard
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Alexander O Hauson
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
- Department of Psychiatry, University of San Diego, La Jolla, CA, USA
| | - Nicholas S Lackey
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Emily Zhang
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Sarah Khayat
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Bryce Carson
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Igor Grant
- Department of Psychiatry, University of San Diego, La Jolla, CA, USA
| |
Collapse
|
4
|
Jin L, Yuan M, Zhang W, Wang L, Chen J, Wang F, Zhu J, Liu T, Wei Y, Li Y, Wang W, Li Q, Wei L. Default mode network mechanisms of repeated transcranial magnetic stimulation in heroin addiction. Brain Imaging Behav 2023; 17:54-65. [PMID: 36418675 DOI: 10.1007/s11682-022-00741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/27/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to reduce cravings in heroin-dependent (HD) individuals, but the mechanisms underlying the anti-craving effects of rTMS are unknown. Abnormalities in the default mode network (DMN) are known to be consistent findings in HD individuals and are involved in cravings. We assessed the effect of rTMS on DMN activity and its relationship to the treatment response. Thirty HD individuals were included in this self-controlled study, and all HD participants received 10-Hz rTMS 7-session during a week. Data for cravings and withdrawal symptoms and resting-state functional magnetic resonance imaging data were collected before and after rTMS treatment. Thirty demographically matched healthy individuals who did not receive rTMS were included as controls. We focused on changes in coupling seeded from the medial prefrontal cortex (MPFC), posterior cingulate cortex (PCC), and bilateral inferior parietal lobe (IPL), which are the core regions of the DMN. The craving and withdrawal symptom score of HD individuals decreased significantly after rTMS treatment. The left IPL-left middle frontal gyrus coupling and the left IPL-right inferior occipital gyrus coupling decreased significantly, and the changes in the left IPL-left middle frontal gyrus coupling were positively correlated with changes in drug-cue induced cravings. rTMS could modulate the coupling between the DMN and executive control network (ECN). Alterations of the left IPL-left middle frontal gyrus coupling may play an important mechanistic role in reducing drug cue-induced cravings.
Collapse
Affiliation(s)
- Long Jin
- Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China
| | - Menghui Yuan
- Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China
| | - Wei Zhang
- Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China
| | - Lei Wang
- Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China
| | - Fan Wang
- Department of Radiology, Qinhuang Hospital, Xi'an, Shaanxi, China
| | - Jia Zhu
- Department of Radiology, Qinhuang Hospital, Xi'an, Shaanxi, China
| | - Tao Liu
- Department of Radiology, Qinhuang Hospital, Xi'an, Shaanxi, China
| | - Yixin Wei
- Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China
| | - Yunbo Li
- Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China
| | - Wei Wang
- Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China.
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China.
| | - Longxiao Wei
- Department of Nuclear Medicine, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, 710038, Xi'an, Shaanxi, China.
| |
Collapse
|
5
|
Lu L, Yang W, Zhang X, Tang F, Du Y, Fan L, Luo J, Yan C, Zhang J, Li J, Liu J, von Deneen KM, Yu D, Liu J, Yuan K. Potential brain recovery of frontostriatal circuits in heroin users after prolonged abstinence: A preliminary study. J Psychiatr Res 2022; 152:326-334. [PMID: 35785575 DOI: 10.1016/j.jpsychires.2022.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Neuroscientists have devoted efforts to explore potential brain recovery after prolonged abstinence in heroin users (HU). However, not much is known about whether frontostriatal circuits can recover after prolonged abstinence in HU. An eight-month longitudinal study was carried out for HU. Two MRI scans were obtained at baseline (HU1) and 8-month follow-up (HU2). The functional and structural connectivities of dorsal and ventral frontostriatal pathways were measured by resting-state functional connectivity (RSFC) and diffusion tensor imaging (DTI). Correlation analyses were employed to reveal the associations between neuroimaging and behavioral changes. Results suggested that relative to healthy controls (HCs), HU1 showed lower fractional anisotropy (FA) in the right dorsolateral prefrontal cortex (DLPFC)-to-caudate tracts and medial orbitofrontal cortex (mOFC)-to-nucleus accumbens (NAc) tracts as well as decreased RSFC in the left mOFC-NAc circuits. Longitudinal results revealed reduced craving and enhanced cognitive control in HU2 compared with HU1. After prolonged abstinence, HU2 showed increased FA values in the right DLPFC-caudate and mOFC-NAc tracts as well as increased RSFC strength in the bilateral mOFC-NAc circuits compared with HU1. In addition, changes in RSFC and FA values in the right mOFC-NAc circuit were negatively correlated with craving score changes. Similarly, negative correlations were also found between changes of RSFC in the bilateral DLPFC-caudate circuits and TMT-A scores. We provided scientific evidence for brain recovery of the dorsal and ventral frontostriatal circuits in HU after prolonged abstinence, and these circuits may be potential neuroimaging biomarkers for cognition and craving changes.
Collapse
Affiliation(s)
- Ling Lu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China; Engineering Research Center of Molecular and Neuroimaging, Ministry of Education, Xi'an, Shaanxi, 710071, China
| | - Wenhan Yang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaozi Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China; Engineering Research Center of Molecular and Neuroimaging, Ministry of Education, Xi'an, Shaanxi, 710071, China
| | - Fei Tang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanyao Du
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Li Fan
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Jing Luo
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Cui Yan
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun Zhang
- Hunan Judicial Police Academy, Changsha, China
| | - Jun Li
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China; Engineering Research Center of Molecular and Neuroimaging, Ministry of Education, Xi'an, Shaanxi, 710071, China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China; Engineering Research Center of Molecular and Neuroimaging, Ministry of Education, Xi'an, Shaanxi, 710071, China
| | - Karen M von Deneen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China
| | - Dahua Yu
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China.
| | - Kai Yuan
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China; Engineering Research Center of Molecular and Neuroimaging, Ministry of Education, Xi'an, Shaanxi, 710071, China; International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China; Information Processing Laboratory, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, 014010, China.
| |
Collapse
|
6
|
Herlinger K, Lingford-Hughes A. Opioid use disorder and the brain: a clinical perspective. Addiction 2022; 117:495-505. [PMID: 34228373 DOI: 10.1111/add.15636] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023]
Abstract
Opioid use disorder (OUD) has gained increasing publicity and interest during recent years, with many countries describing problems of epidemic proportions with regard to opioid use and deaths related to opioids. While opioids are not themselves acutely neurotoxic, the chronic relapsing and remitting nature of this disorder means that individuals are often exposed to exogenous opioids for lengthy periods of time (either illicit or prescribed as treatment). We are increasingly characterizing the effect of such long-term opioid exposure on the brain. This narrative review aims to summarize the literature regarding OUD and the brain from a clinical perspective. Alterations of brain structure and function are discussed, as well as neurological and psychiatric disorders in OUD. Finally, we review current and new directions for assessment and treatment.
Collapse
Affiliation(s)
- Katherine Herlinger
- MRC Addiction Research Clinical Training Programme, Imperial College London, London, UK
| | | |
Collapse
|
7
|
Tolomeo S, Steele JD, Ekhtiari H, Baldacchino A. Chronic heroin use disorder and the brain: Current evidence and future implications. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110148. [PMID: 33169674 DOI: 10.1016/j.pnpbp.2020.110148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/10/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
The incidence of chronic heroin use disorder, including overdose deaths, has reached epidemic proportions. Here we summarise and evaluate our knowledge of the relationship between chronic heroin use disorder and the brain through a narrative review. A broad range of areas was considered including causal mechanisms, cognitive and neurological consequences of chronic heroin use and novel neuroscience-based clinical interventions. Chronic heroin use is associated with limited or very limited evidence of impairments in memory, cognitive impulsivity, non-planning impulsivity, compulsivity and decision-making. Additionally, there is some evidence for certain neurological disorders being caused by chronic heroin use, including toxic leukoencephalopathy and neurodegeneration. However, there is insufficient evidence on whether these impairments and disorders recover after abstinence. Whilst there is a high prevalence of comorbid psychiatric disorders, there is no clear evidence that chronic heroin use per se causes depression, bipolar disorder, PTSD and/or psychosis. Despite the growing burden on society from heroin use, knowledge of the long-term effects of chronic heroin use disorder on the brain remains limited. Nevertheless, there is evidence for progress in neuroscience-based interventions being made in two areas: assessment (cognitive assessment and neuroimaging) and interventions (cognitive training/remediation and neuromodulation). Longitudinal studies are needed to unravel addiction and neurotoxic mechanisms and clarify the role of pre-existing psychiatric symptoms and cognitive impairments.
Collapse
Affiliation(s)
- Serenella Tolomeo
- Department of Psychology, National University of Singapore (NUS), Singapore.
| | - J Douglas Steele
- School of Medicine, University of Dundee and Department of Neurology, NHS Tayside, Ninewells Hospital and Medical School, UK
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA
| | - Alex Baldacchino
- Division of Population and Behavioural Sciences, University of St Andrews, Fife, Scotland, United Kingdom
| |
Collapse
|
8
|
Zeng J, Yu S, Cao H, Su Y, Dong Z, Yang X. Neurobiological correlates of cue-reactivity in alcohol-use disorders: A voxel-wise meta-analysis of fMRI studies. Neurosci Biobehav Rev 2021; 128:294-310. [PMID: 34171325 DOI: 10.1016/j.neubiorev.2021.06.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/31/2021] [Accepted: 06/19/2021] [Indexed: 02/08/2023]
Abstract
Altered brain responses to alcohol-associated stimuli are a neural hallmark of alcohol-use disorder (AUD) and a promising target for pharmacotherapy. However, findings in cue-reactivity based functional MRI (fMRI) studies are inconclusive. To investigate the neural substrates of cue-reactivity and their relevance to treatment outcomes, alcohol craving and relapse in AUD patients, we performed five meta-analyses using signed differential mapping software. Our meta-analysis revealed that alcohol cues evoke greater cue-reactivity than neutral cues in the mesocorticolimbic circuit and lower reactivity in the parietal and temporal regions in AUD patients. Compared to controls, AUD individuals displayed hyperactivations in the medial prefrontal cortex and anterior/middle part of the cingulate cortex. After receiving AUD treatment, AUD patients exhibited greater activations in the precentral gyrus but reduced activations in the bilateral caudate nucleus, insula, right DLPFC, and left superior frontal gyrus. No significant results were found in cue-reactivity correlates of alcohol craving and relapse. Our results implicate cue-induced abnormalities in corticostriatal-limbic circuits may underline the pathophysiology of AUD, and have translational value for treatment development.
Collapse
Affiliation(s)
- Jianguang Zeng
- School of Economics and Business Administration, Chongqing University, Chongqing, 400044, China
| | - Shuxian Yu
- School of Economics and Business Administration, Chongqing University, Chongqing, 400044, China
| | - Hengyi Cao
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Hempstead, NY, USA; Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Yueyue Su
- School of Public Policy and Administration, Chongqing University, Chongqing, 400044, China
| | - Zaiquan Dong
- Department of Psychiatry, State Key Lab of Biotherapy, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xun Yang
- School of Public Policy and Administration, Chongqing University, Chongqing, 400044, China.
| |
Collapse
|
9
|
Wei X, Li Q, Chen J, Shen B, Wang W, Li W. Differences in cue-induced brain activation between long-term methadone maintenance treatment and protracted abstinence in heroin use disorder patients: a functional magnetic resonance imaging study. Quant Imaging Med Surg 2021; 11:2104-2113. [PMID: 33936991 DOI: 10.21037/qims-20-1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Heroin use disorder (HUD) remains one of the gravest public health issues in China. Methadone maintenance treatment (MMT) and protracted abstinence (PA) are the most commonly used treatments for HUD. Although both treatment approaches can alleviate heroin cravings, a previous study found that MMT patients had stronger cue-induced brain activation than patients undergoing PA; however, the changes associated with long-term treatment are unclear. Methods Male patients with HUD who had been undergoing either PA (n=24) or MTT (n=21) for approximately 12 months, together with 20 demographically matched healthy controls, completed an event-related functional magnetic resonance imaging (fMRI) task. The subjective craving for heroin was evaluated using a visual analog scale. Results Compared to the healthy controls, the MMT and PA groups demonstrated significantly higher brain activation in the left pallidum, middle occipital gyrus, postcentral gyrus, anterior cingulate cortex, middle cingulate cortex, inferior parietal lobule, superior parietal lobule, amygdala, hippocampus, right inferior temporal gyrus, inferior frontal gyrus triangularis, and caudate during exposure to heroin-related cues. Compared to those undergoing PA, patients in the MMT group demonstrated significantly higher brain activation in all of these regions. Except for the left inferior parietal lobule and left superior parietal lobule, there were no statistically significant differences between the PA and healthy control groups. The MMT patients showed significantly higher subjective cravings before and after exposure to heroin cues than the PA group, but there was no significant difference in the change in subjective cravings between the 2 groups. Conclusions The results suggested that although the HUD patients receiving long-term MMT complied with the treatment, they still had higher subjective cravings and cue-induced brain activation than those undergoing PA. Therefore, long-term PA appears to be more beneficial than MMT in reducing the salience value of drug cues in patients with HUD.
Collapse
Affiliation(s)
- Xuan Wei
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China.,Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Baorui Shen
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China.,Basic Medical College, Air Force Medical University, Xi'an, China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| |
Collapse
|
10
|
Huhn AS, Brooner RK, Sweeney MM, Antoine D, Hammond AS, Ayaz H, Dunn KE. The association of prefrontal cortex response during a natural reward cue-reactivity paradigm, anhedonia, and demoralization in persons maintained on methadone. Addict Behav 2021; 113:106673. [PMID: 33022538 PMCID: PMC7736228 DOI: 10.1016/j.addbeh.2020.106673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 12/23/2022]
Abstract
Persons with opioid use disorder (OUD) often experience anhedonia and demoralization, yet there is relatively little research on the pathophysiology of anhedonia and demoralization in OUD treatment and recovery. In the current study, persons maintained on methadone (N = 29) underwent a natural reward-cue paradigm during functional near-infrared spectroscopy (fNIRS) imaging. Natural reward cues included highly palatable food, positive social interactions (e.g., a happy family at the dinner table), and emotional intimacy (e.g. couples embracing or kissing, but no erotic images). Participants also self-reported symptoms of anhedonia on the Snaith-Hamilton Pleasure Scale (SHPS) and demoralization on the Demoralization Scale II (DS-II). Participants who reported clinically-significant anhedonia on the SHPS displayed decreased neural activity in the right prefrontal cortex (PFC) in response to natural reward cues (F(1,25) = 3.612, p = 0.027, ηp2 = 0.302). In linear regression models of positive social cues, decreased neural activity in the right VMPFC was associated with increased SHPS total score (F(1,27) = 7.131, R2 = 0.209, p = .013), and decreased neural activity in an area encompassing the right lateral VMPFC and DLPFC was associated with increased DS-II total score (F(1,27) = 10.641, R2 = 0.283, p = 0.003). This study provides initial evidence that the prefrontal cortex is involved in the pathophysiology of anhedonia and demoralization in persons in recovery from OUD. Anhedonia and demoralization are important treatment outcomes that should be queried along with a constellation of physical and mental health outcomes, to assess areas of needed improvement in methadone maintenance and other OUD treatment modalities.
Collapse
Affiliation(s)
- Andrew S Huhn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Mary M Sweeney
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Denis Antoine
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Alexis S Hammond
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, United States; Drexel University, College of Arts and Sciences, Department of Psychology, United States; University of Pennsylvania, Department of Family and Community Health, United States; Children's Hospital of Philadelphia, Center for Injury Research and Prevention, United States
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| |
Collapse
|
11
|
Altered brain intrinsic functional hubs and connectivity associated with relapse risk in heroin dependents undergoing methadone maintenance treatment: A resting-state fMRI study. Drug Alcohol Depend 2021; 219:108503. [PMID: 33444899 DOI: 10.1016/j.drugalcdep.2020.108503] [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: 07/04/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The neural substrates underlying the relapse behavior of heroin dependents (HD) who received long-term methadone maintenance treatment (MMT) have yet to be thoroughly expounded. This study investigated the relapse-related intrinsic functional hubs of HD and their functional integration feature at whole brain network level. METHODS 57 male HD receiving MMT and 49 matched healthy controls (HC) were enrolled. All of the subjects received resting-state functional magnetic resonance imaging scan. And the 57 patients were assigned a 26-month follow-up for collecting illegal drug use information. Of them, 11 were non-relapsers and 46 relapsers. We analyzed the voxel-based degree centrality (DC) to reveal the differences in nodule centrality between HD and HC, conducted Pearson partial-correlation analysis to confirm the relationship between relapse frequency and DC value of the nodes with significant intergroup differences, and finally compared the functional connectivity (FC) of the relapse-related hubs between non-relapsers and relapsers. RESULTS We found the DC values of right insula and left nucleus accumbens (NAc) were negatively correlated with relapse frequency. Compared with the non-relapsers, the relapsers had a significant decreased FC between left NAc and inhibitory control circuitry, including left dorsolateral prefrontal cortex, left inferior frontal gyrus and motor regions. CONCLUSIONS These findings suggest that the neural substrates of relapse vulnerability in HD undergoing MMT are the intrinsic functional hubs of introceptive and reward systems and the latter modulates relapse behavior via interaction with inhibitory control circuit.
Collapse
|
12
|
Wei X, Chen J, Zhu J, Li Q, Li W, Wang W. Functional connectivity of posterior cingulate gyrus in heroin dependents treated by methadone maintenance and protracted abstinence measures: an event-related fMRI study. Brain Imaging Behav 2021; 15:2472-2480. [PMID: 33502720 DOI: 10.1007/s11682-020-00447-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
Protracted abstinence (PA) and Methadone maintenance treatment (MMT) are two main types of heroin addiction treatment, however, the effects of both measures on the functional connectivity (FC) of the brain in heroin dependents in the drug cue event-related response are unclear. Functional magnetic resonance imaging (fMRI) based drug cue-reactivity task has been widely used in addiction research, which may provide a new way to understand the change of brain function during a certain period of treatment. The default function network (DMN) with posterior cingulate cortex (PCC) as the core is generally involved in the process of addiction. The aim of the present study was to explore the brain response of FC in patients with heroin-dependent during PA, MMT treatment under task-fMRI. Twenty-two heroin-dependent patients during PA, 18 heroin-dependent patients during MMT and 16 healthy control (HC) individuals were included to conduct the heroin cue-reactivity task during fMRI. The MMT and PA patients' subjective craving for heroin was evaluated. The psychophysiological interaction (PPI) analysis of SPM12 was used to get FC during the task state. There was a significant difference on FC between PCC and the right medial Prefrontal Cortex (mPFC) in three groups. The post-hoc analysis showed that there was a significant difference of brain regions between the MMT and the PA group. The FC of PCC-mPFC in the MMT group was significantly stronger than that in the PA group. Compared with the PA group, the FC of the DMN in the MMT group was significantly increased under drug cue response. Therefore, PA is more beneficial for the heroin-dependent patients to lower the salience value of drug related cues, in turn to reduce relapse risks. It also reflected the important role of PCC-mPFC pathway in heroin dependents induced by heroin cues.
Collapse
Affiliation(s)
- Xuan Wei
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China.,Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No.95, Yong An Road, Xicheng District, Beijing, 100050, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China.
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China.
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, BaQiao District, Xi'an, 710038, Shaanxi, China
| |
Collapse
|
13
|
Shi H, Liang Z, Chen J, Li W, Zhu J, Li Y, Ye J, Zhang J, Xue J, Liu W, Wang F, Wang W, Li Q, He X. Gray matter alteration in heroin-dependent men: An atlas-based magnetic resonance imaging study. Psychiatry Res Neuroimaging 2020; 304:111150. [PMID: 32717665 PMCID: PMC8170872 DOI: 10.1016/j.pscychresns.2020.111150] [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: 04/03/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022]
Abstract
Previous imaging studies on heroin addiction have reported brain morphological alterations. However, the effects of heroin exposure on gray matter volume varied among different studies due to different factors such as substitution treatment or mandatory abstinence. Meanwhile, the relationship between gray matter and heroin use history remains unknown. Thirty-three male heroin-dependent (HD) individuals who are not under any substitution treatment or mandatory abstinence and 40 male healthy controls (HC) were included in this structural magnetic resonance imaging study. With an atlas-based approach, gray matter structures up to individual functional area were delineated, and the differences in their volumes between the HD and HC groups were analyzed. In addition, the relationship between gray matter volume and duration of heroin use was explored. The HD group demonstrated significantly lower cortical volume mainly in the prefrontal cortex and mesolimbic dopaminergic regions across different parcellation levels, whereas several visual and somatosensory cortical regions in the HD group had greater volume relative to the HC group at a more detailed parcellation level. The duration of heroin use was negatively correlated with the gray matter volume of prefrontal cortex. These findings suggest that heroin addiction be related to gray matter alteration and might be related to damage/maladaption of the inhibitory control, reward, visual, and somatosensory functions of the brain, although cognitive correlates are warranted in future study. In addition, the atlas-based morphology analysis is a potential tool to help researchers search biomarkers of heroin addiction.
Collapse
Affiliation(s)
- Hong Shi
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zifei Liang
- Department of Radiology, New York University, New York, NY, USA; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; College of Electronic and Information Engineering, Sichuan University, Chengdu, 610065, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yongbin Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jianjun Ye
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jiangyang Zhang
- Department of Radiology, New York University, New York, NY, USA; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiuhua Xue
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Liu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Xiaohai He
- College of Electronic and Information Engineering, Sichuan University, Chengdu, 610065, China.
| |
Collapse
|
14
|
Xiao F, Lu C, Zhao D, Zou Q, Xu L, Li J, Zhang J, Han F. Independent Component Analysis and Graph Theoretical Analysis in Patients with Narcolepsy. Neurosci Bull 2019; 35:743-755. [PMID: 30421271 PMCID: PMC6616568 DOI: 10.1007/s12264-018-0307-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/03/2018] [Indexed: 02/04/2023] Open
Abstract
The present study was aimed to evaluate resting-state functional connectivity and topological properties of brain networks in narcolepsy patients compared with healthy controls. Resting-state fMRI was performed in 26 adult narcolepsy patients and 30 matched healthy controls. MRI data were first analyzed by group independent component analysis, then a graph theoretical method was applied to evaluate the topological properties in the whole brain. Small-world network parameters and nodal topological properties were measured. Altered topological properties in brain areas between groups were selected as region-of-interest seeds, then the functional connectivity among these seeds was compared between groups. Partial correlation analysis was performed to evaluate the relationship between the severity of sleepiness and functional connectivity or topological properties in the narcolepsy patients. Twenty-one independent components out of 48 were obtained. Compared with healthy controls, the narcolepsy patients exhibited significantly decreased functional connectivity within the executive and salience networks, along with increased functional connectivity in the bilateral frontal lobes within the executive network. There were no differences in small-world network properties between patients and controls. The altered brain areas in nodal topological properties between groups were mainly in the inferior frontal cortex, basal ganglia, anterior cingulate, sensory cortex, supplementary motor cortex, and visual cortex. In the partial correlation analysis, nodal topological properties in the putamen, anterior cingulate, and sensory cortex as well as functional connectivity between these regions were correlated with the severity of sleepiness (sleep latency, REM sleep latency, and Epworth sleepiness score) among narcolepsy patients. Altered connectivity within the executive and salience networks was found in narcolepsy patients. Functional connection changes between the left frontal cortex and left caudate nucleus may be one of the parameters describing the severity of narcolepsy. Changes in the nodal topological properties in the left putamen and left posterior cingulate, changes in functional connectivity between the left supplementary motor area and right occipital as well as in functional connectivity between the left anterior cingulate gyrus and bilateral postcentral gyrus can be considered as a specific indicator for evaluating the severity of narcolepsy.
Collapse
Affiliation(s)
- Fulong Xiao
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Chao Lu
- Department of Radiology, Peking University International Hospital, Beijing, 102206, China
| | - Dianjiang Zhao
- Department of Radiology, Peking University International Hospital, Beijing, 102206, China
| | - Qihong Zou
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
| | - Liyue Xu
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, 102206, China
| | - Jing Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, 100044, China.
| | - Fang Han
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China.
| |
Collapse
|
15
|
Li Y, Li Q, Li W, Chen J, Hu F, Liu Y, Wei X, Zhu J, Liu J, Ye J, Shi H, Wang Y, Wang W. The polymorphism of dopamine D2 receptor TaqIA gene is associated with brain response to drug cues in male heroin-dependent individuals during methadone maintenance treatment. Drug Alcohol Depend 2019; 198:150-157. [PMID: 30928885 DOI: 10.1016/j.drugalcdep.2019.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/21/2018] [Accepted: 01/16/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Polymorphism of the dopamine D2 receptor TaqIA gene is related to reward response, relapse risks and effect of therapy for drug addiction. Whether the cue-induced craving and brain response was related to dopamine D2 receptor TaqIA gene is unknown. METHODS Forty-nine male heroin-dependent individuals [31 with A1 allele of the TaqIA (A1+), 18 A2 allele carriers (A1-)] under methadone maintenance treatment and 20 healthy control subjects performed a heroin cue-reactivity task during functional magnetic resonance imaging. Cue-elicited craving was measured. Difference in cue induced craving and brain response were analyzed among the three groups. Correlation analyses between craving and differential brain response, heroin use and treatment history were performed within A1+ and A1- group respectively. RESULTS Compared with A1- group, A1+ group showed greater cue-induced response in the ventrolateral prefrontal cortex, medial orbitofrontal gyrus, dorsomedial prefrontal cortex, pallidum, putamen, thalamus, superior parietal lobule and superior occipital gyrus. No difference in craving was found. The response in right thalamus positively correlated with daily heroin and methadone dose in A1+ group. For A1- group, response in left ventral orbitofrontal cortex, medial orbitofrontal gyrus, ventral anterior cingulate cortex, caudate, precuneus, calcarine and bilateral pallidum negatively correlated with duration of heroin use. The response in left ventral orbitofrontal cortex, medial orbitofrontal gyrus, bilateral calcarine and right cerebellum negatively correlated with duration of methadone maintenance treatment in A1- group. CONCLUSIONS The findings supported that A1 allele of the TaqIA is associated with higher salience allocation to heroin-related cues in heroin-dependent patients.
Collapse
Affiliation(s)
- Yongbin Li
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China; Department of Radiology, The Second Affliated Hospital of Xi'an Medical College, Xi'an, 167 Fangdong Street, Baqiao District, China
| | - Qiang Li
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Wei Li
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Jiajie Chen
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Feng Hu
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Yan Liu
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Xuan Wei
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Jia Zhu
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Jierong Liu
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Jianjun Ye
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Hong Shi
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China
| | - Yarong Wang
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China; Department of Radiology, The First Affliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Yanta District, Xi'an 710061, China.
| | - Wei Wang
- Department of Radiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 569 Xinsi Road, Baqiao District, China.
| |
Collapse
|
16
|
Huhn AS, Sweeney MM, Brooner RK, Kidorf MS, Tompkins DA, Ayaz H, Dunn KE. Prefrontal cortex response to drug cues, craving, and current depressive symptoms are associated with treatment outcomes in methadone-maintained patients. Neuropsychopharmacology 2019; 44:826-833. [PMID: 30375498 PMCID: PMC6372589 DOI: 10.1038/s41386-018-0252-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 12/31/2022]
Abstract
Methadone maintenance is an effective treatment for opioid use disorder, yet many methadone-maintained patients (MMPs) continue to struggle with chronic relapse. The current study evaluated whether functional near-infrared spectroscopy (fNIRS) could identify prefrontal cortex (PFC) markers of ongoing opioid use in MMPs, and whether clinical measures of depression and self-report measures of craving would also be associated with opioid use. MMPs (n = 29) underwent a drug cue reactivity paradigm during fNIRS measurements of PFC reactivity. Self-reported opioid craving (measured by a visual analog scale; 0-100) was collected before and after drug cue reactivity, and depressive symptoms were assessed via the 17-item Hamilton Depression Rating Scale (HAM-D). Hierarchical regression and partial correlations were used to evaluate associations between weekly urine drug screens over a 90-day follow-up period and fNIRS, craving, and HAM-D assessments. Neural response to drug cues in the left lateral PFC, controlling for age, sex, and days in treatment was significantly associated with percent opioid-negative urine screens during follow-up (∆F1, 24 = 13.19, p = 0.001, ∆R2 = 0.30), and correctly classified 86% of MMPs as either using opioids, or abstaining from opioids (χ2(4) = 16.28, p = 0.003). Baseline craving (p < 0.001) and HAM-D assessment (p < 0.01) were also associated with percent opioid-negative urine screens. Combining fNIRS results, baseline craving scores, and HAM-D scores created a robust predictive model (∆F3, 22 = 16.75, p < 0.001, ∆R2 = 0.59). These data provide preliminary evidence that the fNIRS technology may have value as an objective measure of treatment outcomes within outpatient methadone clinics. Depressive symptoms and drug craving were also correlated with opioid use in MMPs.
Collapse
Affiliation(s)
- Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Robert K Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Michael S Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - D Andrew Tompkins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| |
Collapse
|
17
|
Assessing drug cue-induced brain response in heroin dependents treated by methadone maintenance and protracted abstinence measures. Brain Imaging Behav 2019; 14:1221-1229. [DOI: 10.1007/s11682-019-00051-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
18
|
Stewart JL, May AC, Aupperle RL, Bodurka J. Forging Neuroimaging Targets for Recovery in Opioid Use Disorder. Front Psychiatry 2019; 10:117. [PMID: 30899231 PMCID: PMC6417368 DOI: 10.3389/fpsyt.2019.00117] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/15/2019] [Indexed: 01/01/2023] Open
Abstract
The United States is in the midst of an opioid epidemic and lacks a range of successful interventions to reduce this public health burden. Many individuals with opioid use disorder (OUD) consume drugs to relieve physical and/or emotional pain, a pattern that may increasingly result in death. The field of addiction research lacks a comprehensive understanding of physiological and neural mechanisms instantiating this cycle of Negative Reinforcement in OUD, resulting in limited interventions that successfully promote abstinence and recovery. Given the urgency of the opioid crisis, the present review highlights faulty brain circuitry and processes associated with OUD within the context of the Three-Stage Model of Addiction (1). This model underscores Negative Reinforcement processes as crucial to the maintenance and exacerbation of chronic substance use together with Binge/Intoxication and Preoccupation/Anticipation processes. This review focuses on cross-sectional as well as longitudinal studies of relapse and treatment outcome that employ magnetic resonance imaging (MRI), functional near-infrared spectroscopy (fNIRs), brain stimulation methods, and/or electroencephalography (EEG) explored in frequency and time domains (the latter measured by event-related potentials, or ERPs). We discuss strengths and limitations of this neuroimaging work with respect to study design and individual differences that may influence interpretation of findings (e.g., opioid use chronicity/recency, comorbid symptoms, and biological sex). Lastly, we translate gaps in the OUD literature, particularly with respect to Negative Reinforcement processes, into future research directions involving operant and classical conditioning involving aversion/stress. Overall, opioid-related stimuli may lessen their hold on frontocingulate mechanisms implicated in Preoccupation/Anticipation as a function of prolonged abstinence and that degree of frontocingulate impairment may predict treatment outcome. In addition, longitudinal studies suggest that brain stimulation/drug treatments and prolonged abstinence can change brain responses during Negative Reinforcement and Preoccupation/Anticipation to reduce salience of drug cues, which may attenuate further craving and relapse. Incorporating this neuroscience-derived knowledge with the Three-Stage Model of Addiction may offer a useful plan for delineating specific neurobiological targets for OUD treatment.
Collapse
Affiliation(s)
- Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - April C May
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, San Diego, CA, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, United States
| |
Collapse
|
19
|
Iriah SC, Trivedi M, Kenkel W, Grant SE, Moore K, Yee JR, Madularu D, Kulkarni P, Ferris CF. Oxycodone Exposure: A Magnetic Resonance Imaging Study in Response to Acute and Chronic Oxycodone Treatment in Rats. Neuroscience 2018; 398:88-101. [PMID: 30550747 DOI: 10.1016/j.neuroscience.2018.11.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/16/2022]
Abstract
The present study was designed to use blood-oxygen-level dependent (BOLD) imaging to "fingerprint" the change in activity in response to oxycodone (OXY) in drug naïve rats before and after repeated exposure to OXY. It was hypothesized that repeated exposure to OXY would initiate adaptive changes in brain organization that would be reflected in an altered response to opioid exposure. Male rats exposed to OXY repeatedly showed conditioned place preference, evidence of drug-seeking behavior and putative neuroadaptation. As these studies were done on awake rats we discovered it was not possible to image rats continuously exposed to OXY due to motion artifact judged to be withdrawal while in the scanner. To circumvent this problem manganese-enhanced MRI (MEMRI) was used to map the distributed integrated activity pattern resulting from continuous OXY exposure. Rats were administered OXY (2.5 mg/kg, i.p.) during image acquisition and changes in BOLD signal intensity were recorded and the activation and deactivation of integrated neural circuits involved in olfaction and motivation were identified. Interestingly, the circuitry of the mesencephalic dopaminergic system showed little activity to the first exposure of OXY. In the MEMRI study, rats received OXY treatments (2.5 mg/kg, twice daily) for four consecutive days following intraventricular MnCl2. Under isoflurane anesthesia, T1-weighted images were acquired and subsequently analyzed showing activity in the forebrain limbic system, ventral striatum, accumbens, amygdala and hippocampus. These results show brain activity is markedly different when OXY is presented to drug naïve rats versus rats with prior, repeated exposure to drug.
Collapse
Affiliation(s)
- Sade C Iriah
- Northeastern Univ., Center for Translational NeuroImaging, Boston, MA, USA
| | - Malav Trivedi
- NOVA Southeastern University, Ft. Lauderdale, FL, USA
| | - William Kenkel
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Simone E Grant
- Northeastern Univ., Center for Translational NeuroImaging, Boston, MA, USA
| | - Kelsey Moore
- Northeastern Univ., Center for Translational NeuroImaging, Boston, MA, USA
| | - Jason R Yee
- Northeastern Univ., Center for Translational NeuroImaging, Boston, MA, USA
| | - Dan Madularu
- Northeastern Univ., Center for Translational NeuroImaging, Boston, MA, USA; Douglas Hospital, McGill University, Montreal, QC, Canada; Carleton University, Ottawa, ON, Canada
| | - Praveen Kulkarni
- Northeastern Univ., Center for Translational NeuroImaging, Boston, MA, USA
| | - Craig F Ferris
- Northeastern Univ., Center for Translational NeuroImaging, Boston, MA, USA.
| |
Collapse
|
20
|
Murphy A, Lubman DI, McKie S, Bijral PS, Peters LA, Faiz Q, Holmes SE, Anderson IM, Deakin B, Elliott R. Time-dependent neuronal changes associated with craving in opioid dependence: an fMRI study. Addict Biol 2018; 23:1168-1178. [PMID: 28940758 PMCID: PMC6120475 DOI: 10.1111/adb.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 12/11/2022]
Abstract
Relapse after initially successful treatment is a significant problem facing the treatment of opioid dependence. Evidence suggests craving elicited by re‐exposure to drug cues may precipitate relapse. Attempts to identify neural biomarkers of cue‐elicited craving have yielded inconsistent findings. We aimed to apply a novel continuous functional magnetic resonance imaging technique to follow the minute‐to‐minute evolution of brain responses, which correlate with the waxing and waning of craving. Newly detoxified male opioid‐dependent patients and healthy control participants attended two separate, counterbalanced, functional magnetic resonance imaging scanning sessions during which they viewed a 10‐minute video (drug cue or neutral cue) followed by 5 minutes of fixation. Participants rated the intensity of their craving throughout each session. We hypothesized that subcortical/ventral prefrontal cortex (PFC) regions and dorsal PFC regions would show different associations with craving reflecting their putative roles in appetitive processing versus cognitive control. Compared with controls, drug cue (minus neutral cue) video recruited the left amygdala and was temporally correlated with craving. In contrast, dorsal anterior cingulate blood‐oxygen‐level‐dependent signal time course was higher than controls only during a period after cue exposure when craving levels were declining. Against expectations, neither the ventral striatum nor ventral PFC was significantly recruited by drug cue exposure. Findings suggest that the amygdala has a central role in craving, whereas the dorsal anterior cingulate may control craving in treatment‐seeking patients. Time course analysis yielded new insights into the neural substrates of craving that could objectively validate development of psychological and pharmacological approaches to sustained abstinence.
Collapse
Affiliation(s)
- Anna Murphy
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
- Department of Biological Sciences; University of Huddersfield; UK
| | - Dan I. Lubman
- Turning Point; Eastern Health; Australia
- Eastern Health Clinical School; Monash University; Australia
| | - Shane McKie
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
| | - Prun S. Bijral
- Chapman-Barker Unit; Greater Manchester West NHS Foundation Trust; UK
- Change, Grow, Live; UK
| | - Lesley A. Peters
- Pennine Care NHS Foundation Trust; UK
- DISC, My Recovery Tameside; UK
| | - Qasim Faiz
- Chapman-Barker Unit; Greater Manchester West NHS Foundation Trust; UK
- Pennine Care NHS Foundation Trust; UK
| | - Sophie E. Holmes
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
- Department of Psychiatry; Yale University School of Medicine; West Haven CT USA
| | - Ian M. Anderson
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
| | - Bill Deakin
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
- Greater Manchester Mental Health NHS Foundation Trust; UK
| | - Rebecca Elliott
- Neuroscience and Psychiatry Unit, Faculty of Biology, Medicine and Health; University of Manchester; UK
| |
Collapse
|
21
|
Ye JJ, Li W, Zhang DS, Li Q, Zhu J, Chen JJ, Li YB, Yan XJ, Liu JR, Wei X, Wang YR, Wang W. Longitudinal behavioral and fMRI-based assessment of inhibitory control in heroin addicts on methadone maintenance treatment. Exp Ther Med 2018; 16:3202-3210. [PMID: 30214543 DOI: 10.3892/etm.2018.6571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 06/05/2017] [Indexed: 11/05/2022] Open
Abstract
The objective of the present study was to determine whether methadone maintenance treatment (MMT) in heroin-dependent patients affects inhibitory control, whether any MMT-induced changes correlate with methadone dose and MMT duration, and whether these changes depend on the psychological characteristics of patients, such as depression, anxiety and impulsivity. Response inhibition in the GO/NO-GO test was combined with functional magnetic resonance imaging (fMRI) scanning data to examine whether MMT affects inhibitory control in 21 heroin-addicted patients who had already undergone at least three months of MMT. Patients were evaluated one year prior to and after the MMT period. Participants exhibited no difference in their GO/NO-GO reaction time and accuracy rate, or in their false alarm rate under NO-GO conditions. However, increased activation was detected in numerous brain regions in their 12-month fMRI scans, although these were not in the frontal-striatal loop. Increased fMRI activation in the left precentral gyrus and superior temporal gyrus were negatively correlated with the daily methadone dose and total methadone dose during the one-year study period. In conclusion, these results suggested that MMT over one year does not significantly change the behavioral indicators of inhibitory control function in heroin-dependent patients. The increase in activation leads to the hypothesis that MMT over one year may increase cognitive inhibitory control, which may be the result of the combined negative effect of methadone and the positive effect of functional recovery after withdrawal of heroin.
Collapse
Affiliation(s)
- Jian-Jun Ye
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Dong-Sheng Zhang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Jia-Jie Chen
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Yong-Bin Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Xue-Jiao Yan
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Jie-Rong Liu
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Xuan Wei
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Ya-Rong Wang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| |
Collapse
|
22
|
Alizadeh M, Zahedi-Khorasani M, Miladi-Gorji H. Treadmill exercise attenuates the severity of physical dependence, anxiety, depressive-like behavior and voluntary morphine consumption in morphine withdrawn rats receiving methadone maintenance treatment. Neurosci Lett 2018; 681:73-77. [PMID: 29859324 DOI: 10.1016/j.neulet.2018.05.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 09/30/2022]
Abstract
This study was designed to examine whether treadmill exercise would attenuate the severity of physical dependence, methadone-induced anxiety, depression and voluntary morphine consumption in morphine withdrawn rats receiving methadone maintenance treatment (MMT). The rats were chronically treated with bi-daily doses (10 mg/kg, at 12 h intervals) of morphine for 14 days. The exercising rats receiving MMT were forced to run on a motorized treadmill for 30 days during morphine withdrawal. Then, rats were tested for the severity of morphine dependence, the elevated plus-maze (EPM), sucrose preference test (SPT) and voluntary morphine consumption using a two-bottle choice (TBC) paradigm. The results showed that naloxone- precipitated opioid withdrawal signs were decreased in exercising morphine-dependent rats receiving MMT than sedentary rats. Also, the exercising morphine-dependent rats receiving MMT exhibited an increased time on open arms, preference for sucrose and a lower morphine preference ratio than sedentary rats. We conclude that treadmill exercise decreased the severity of physical dependence, anxiety/depressive-like behaviors and also the voluntary morphine consumption in morphine withdrawn rats receiving MMT. Thus, exercise may benefit in the treatment of addicts during MMT.
Collapse
Affiliation(s)
- Maryam Alizadeh
- Laboratory of Animal Addiction Models, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran; Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran; Student Research Committee, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahdi Zahedi-Khorasani
- Laboratory of Animal Addiction Models, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran; Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hossein Miladi-Gorji
- Laboratory of Animal Addiction Models, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran; Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
| |
Collapse
|
23
|
Li Q, Liu J, Wang W, Wang Y, Li W, Chen J, Zhu J, Yan X, Li Y, Li Z, Ye J, Wang W. Disrupted coupling of large-scale networks is associated with relapse behaviour in heroin-dependent men. J Psychiatry Neurosci 2018; 43. [PMID: 29252165 PMCID: PMC5747535 DOI: 10.1503/jpn.170011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is unknown whether impaired coupling among 3 core large-scale brain networks (salience [SN], default mode [DMN] and executive control networks [ECN]) is associated with relapse behaviour in treated heroin-dependent patients. METHODS We conducted a prospective resting-state functional MRI study comparing the functional connectivity strength among healthy controls and heroin-dependent men who had either relapsed or were in early remission. Men were considered to be either relapsed or in early remission based on urine drug screens during a 3-month follow-up period. We also examined how the coupling of large-scale networks correlated with relapse behaviour among heroin-dependent men. RESULTS We included 20 controls and 50 heroin-dependent men (26 relapsed and 24 early remission) in our analyses. The relapsed men showed greater connectivity than the early remission and control groups between the dorsal anterior cingulate cortex (key node of the SN) and the dorsomedial prefrontal cortex (included in the DMN). The relapsed men and controls showed lower connectivity than the early remission group between the left dorsolateral prefrontal cortex (key node of the left ECN) and the dorsomedial prefrontal cortex. The percentage of positive urine drug screens positively correlated with the coupling between the dorsal anterior cingulate cortex and dorsomedial prefrontal cortex, but negatively correlated with the coupling between the left dorsolateral prefrontal cortex and dorsomedial prefrontal cortex. LIMITATIONS We examined deficits in only 3 core networks leading to relapse behaviour. Other networks may also contribute to relapse. CONCLUSION Greater coupling between the SN and DMN and lower coupling between the left ECN and DMN is associated with relapse behaviour. These findings may shed light on the development of new treatments for heroin addiction.
Collapse
Affiliation(s)
- Qiang Li
- Correspondence to: Q. Li and W. Wang, Department of Radiology, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, Xi’an, Shaanxi 710038, China; ;
| | | | | | | | | | | | | | | | | | | | | | - Wei Wang
- Correspondence to: Q. Li and W. Wang, Department of Radiology, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, BaQiao District, Xi’an, Shaanxi 710038, China; ;
| |
Collapse
|
24
|
Zare Sadeghi A, Jafari AH, Oghabian MA, Salighehrad HR, Batouli SAH, Raminfard S, Ekhtiari H. Changes in Effective Connectivity Network Patterns in Drug Abusers, Treated With Different Methods. Basic Clin Neurosci 2017; 8:285-298. [PMID: 29158879 PMCID: PMC5683686 DOI: 10.18869/nirp.bcn.8.4.285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Various treatment methods for drug abusers will result in different success rates. This is partly due to different neural assumptions and partly due to various rate of relapse in abusers because of different circumstances. Investigating the brain activation networks of treated subjects can reveal the hidden mechanisms of the therapeutic methods. Methods: We studied three groups of subjects: heroin abusers treated with abstinent based therapy (ABT) method, heroin abusers treated with Methadone Maintenance Therapy (MMT) method, and a control group. They were all scanned with functional magnetic resonance imaging (fMRI), using a 6-block task, where each block consisted of the rest-craving-rest-neutral sequence. Using the dynamic causal modeling (DCM) algorithm, brain effective connectivity network (caused by the drug craving stimulation) was quantified for all groups. In this regard, 4 brain areas were selected for this analysis based on previous findings: ventromedial prefrontal cortex (VMPFC), dorsolateral prefrontal cortex (DLPFC), amygdala, and ventral striatum. Results: Our results indicated that the control subjects did not show significant brain activations after craving stimulations, but the two other groups showed significant brain activations in all 4 regions. In addition, VMPFC showed higher activations in the ABT group compared to the MMT group. The effective connectivity network suggested that the control subjects did not have any direct input from drug-related cue indices, while the other two groups showed reactions to these cues. Also, VMPFC displayed an important role in ABT group. In encountering the craving pictures, MMT subjects manifest a very simple mechanism compared to other groups. Conclusion: This study revealed an activation network similar to the emotional and inhibitory control networks observed in drug abusers in previous works. The results of DCM analysis also support the regulatory role of frontal regions on bottom regions. Furthermore, this study demonstrates the different effective connectivity patterns after drug abuse treatment and in this way helps the experts in the field.
Collapse
Affiliation(s)
- Arash Zare Sadeghi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Nouroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Homayoun Jafari
- Department of Nouroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Oghabian
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Nouroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Salighehrad
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Hossein Batouli
- Department of Nouroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Raminfard
- Department of Nouroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neurosciences and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ekhtiari
- Department of Nouroimaging and Analysis, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Yen CF, Lin HC, Wang PW, Ko CH, Lee KH, Hsu CY, Chung KS, Wu HC, Cheng CP. Heroin craving and its correlations with clinical outcome indicators in people with heroin dependence receiving methadone maintenance treatment. Compr Psychiatry 2016; 65:50-6. [PMID: 26773990 DOI: 10.1016/j.comppsych.2015.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 09/29/2015] [Accepted: 10/08/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Craving for substance use has been added as one of the diagnostic criteria of substance use disorders in DSM-5. However, further research is necessary to examine and expand the clinical potential of craving in the assessment and treatment for heroin users. This study aimed to examine the psychometrics of the Desire for Drug Questionnaire-Chinese Mandarin version (DDQ-CM) and its clinical utility of assessing craving for heroin measured among heroin users with methadone maintenance treatment (MMT). METHOD Self-reported craving for heroin use was measured on the DDQ-CM and visual analog scale among 314 intravenous heroin users receiving MMT. Self-reported heroin dependence, attitude toward heroin use, readiness to change heroin use, and depression were collected. RESULTS The results found that although the original three-factor model was acceptable for applying the DDQ-CM for heroin users with MMT, only the concurrent validity of the subscales of Desire and Intention and Negative Reinforcement was supported but not that of Control. Meanwhile, the levels of craving on the subscales of Desire and Intention and of Negative Reinforcement on the DDQ-CM were positively associated with the levels of heroin dependence, positive and negative attitudes toward heroin use, and depression, but negatively associated with readiness to change heroin use. CONCLUSIONS This study supported the application of the subscales of Desire and Intention and Negative Reinforcement on the DDQ-CM to measure heroin craving in Taiwanese-Chinese heroin users and supported the clinical implication of craving in heroin users with MMT.
Collapse
Affiliation(s)
- Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Chi Lin
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kun-Hua Lee
- Yuli Hospital, Ministry of Health and Welfare, Hualien, Taiwan
| | - Chih-Yao Hsu
- Departments of Community Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Kuan-Sheng Chung
- Departments of Community Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Departments of Community Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan.
| | - Chung-Ping Cheng
- Department of Psychology, National Cheng Kung University, Taiwan.
| |
Collapse
|
27
|
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: 159] [Impact Index Per Article: 19.9] [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.
Collapse
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
| |
Collapse
|
28
|
Li W, Li Q, Wang D, Xiao W, Liu K, Shi L, Zhu J, Li Y, Yan X, Chen J, Ye J, Li Z, Wang Y, Wang W. Dysfunctional Default Mode Network in Methadone Treated Patients Who Have a Higher Heroin Relapse Risk. Sci Rep 2015; 5:15181. [PMID: 26469876 PMCID: PMC4606802 DOI: 10.1038/srep15181] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/09/2015] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to identify whether heroin relapse is associated with changes in the functional connectivity of the default mode network (DMN) during methadone maintenance treatment (MMT). Resting-state functional magnetic resonance imaging (fMRI) data of chronic heroin relapsers (HR) (12 males, 1 female, age: 36.1 ± 6.9 years) and abstainers (HA) (11males, 2 female; age: 42.1 ± 8.1 years) were investigated with an independent component analysis to address the functional connectivity of their DMN. Group comparison was then performed between the relapsers and abstainers. Our study found that the left inferior temporal gyrus and the right superior occipital gyrus associated with DMN showed decreased functional connectivity in HR when compared with HA, while the left precuneus and the right middle cingulum had increased functional connectivity. Mean intensity signal, extracted from left inferior temporal gyrus of HR patients, showed a significant negative correlation corresponding to the degree of heroin relapse. These findings suggest that altered functional connectivity of DMN may contribute to the potential neurobiological mechanism(s) of heroin relapse and have a predictive value concerning heroin relapse under MMT.
Collapse
Affiliation(s)
- Wei Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Wei Xiao
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Kai Liu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Yongbin Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Xuejiao Yan
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Jianjun Ye
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Zhe Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Yarong Wang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Baqiao District, Xi’an, Shaanxi 710038, China
| |
Collapse
|
29
|
Li Q, Li W, Wang H, Wang Y, Zhang Y, Zhu J, Zheng Y, Zhang D, Wang L, Li Y, Yan X, Chang H, Fan M, Li Z, Tian J, Gold MS, Wang W, Liu Y. Predicting subsequent relapse by drug-related cue-induced brain activation in heroin addiction: an event-related functional magnetic resonance imaging study. Addict Biol 2015; 20:968-78. [PMID: 25214465 DOI: 10.1111/adb.12182] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abnormal salience attribution is implicated in heroin addiction. Previously, combining functional magnetic resonance imaging (fMRI) and a drug cue-reactivity task, we demonstrated abnormal patterns of subjective response and brain reactivity in heroin-dependent individuals. However, whether the changes in cue-induced brain response were related to relapse was unknown. In a prospective study, we recruited 49 heroin-dependent patients under methadone maintenance treatment, a gold standard treatment (average daily dose 41.8 ± 16.0 mg), and 20 healthy subjects to perform the heroin cue-reactivity task during fMRI. The patients' subjective craving was evaluated. They participated in a follow-up assessment for 3 months, during which heroin use was assessed and relapse was confirmed by self-reported relapse or urine toxicology. Differences between relapsers and non-relapsers were analyzed with respect to the results from heroin-cue responses. Compared with healthy subjects, relapsers and non-relapsers commonly demonstrated significantly increased brain responses during the processing of heroin cues in the mesolimbic system, prefrontal regions and visuospatial-attention regions. However, compared with non-relapsers, relapsers demonstrated significantly greater cue-induced craving and the brain response mainly in the bilateral nucleus accumbens/subcallosal cortex and cerebellum. Although the cue-induced heroin craving was low in absolute measures, the change in craving positively correlated with the activation of the nucleus accumbens/subcallosal cortex among the patients. These findings suggest that in treatment-seeking heroin-dependent individuals, greater cue-induced craving and greater specific regional activations might be related to reward/craving and memory retrieval processes. These responses may predict relapse and represent important targets for the development of new treatment for heroin addiction.
Collapse
Affiliation(s)
- Qiang Li
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
- Department of Psychiatry; McKnight Brain Institute; University of Florida College of Medicine; Gainesville FL USA
| | - Wei Li
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Hanyue Wang
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Yarong Wang
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Yi Zhang
- School of Life Science and Technology; Xidian University; Xi'an China
| | - Jia Zhu
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Ying Zheng
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Dongsheng Zhang
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Lina Wang
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Yongbin Li
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Xuejiao Yan
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Haifeng Chang
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Min Fan
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Zhe Li
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Jie Tian
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
- School of Life Science and Technology; Xidian University; Xi'an China
| | - Mark S. Gold
- Department of Psychiatry; McKnight Brain Institute; University of Florida College of Medicine; Gainesville FL USA
| | - Wei Wang
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
| | - Yijun Liu
- Department of Radiology; Tangdu Hospital; The Fourth Military Medical University; Xi'an China
- Department of Psychiatry; McKnight Brain Institute; University of Florida College of Medicine; Gainesville FL USA
- College of Engineering; Peking University; Beijing China
| |
Collapse
|
30
|
Wang PW, Lin HC, Wu HC, Hsu CY, Chung KS, Ko CH, Yen CF. Explicit and implicit heroin-related cognitions and heroin use among patients receiving methadone maintenance treatment. Compr Psychiatry 2015; 56:155-60. [PMID: 25263518 DOI: 10.1016/j.comppsych.2014.08.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/09/2014] [Accepted: 08/14/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Craving is an important issue in substance use disorder. To achieve a better understanding of the cognitive processing systems of craving, the cognitive processes of craving have been considered as two distinct processes. One system, based on rule-based inferences and named explicit cognition, is more conscious and effortful. The other system, based on prior learned association and named implicit cognition, is unconscious and effortless. How explicit and implicit cognitions are associated with heroin use in patients with methadone maintenance treatment (MMT) is not clear. This study aimed to explore the relationship between explicit and implicit cognition and heroin use in patients undergoing MMT. METHOD This study recruited one-hundred forty intravenous heroin users. The participants were invited to provide social-demographic data, the severity of substance dependence and explicit cognition with regard to heroin. Then, participants completed a computerized test to assess implicit cognition with regards to heroin. RESULTS This study found that explicit and implicit heroin-related cognitions were associated with the frequency of heroin use. There was an interaction effect between implicit and explicit cognition on the frequency of heroin use. This study also found that higher explicit heroin-related cognition was a risk factor for continuing heroin use. CONCLUSION Both explicit and implicit cognitions were associated with the frequency of heroin use in patients undergoing MMT, but only explicit cognition was associated with whether patients could stop using heroin during MMT. Therefore, the status of heroin use in patients undergoing MMT may be related to different cognitive processes.
Collapse
Affiliation(s)
- Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Chi Lin
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chi Wu
- Departments of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chih-Yao Hsu
- Departments of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Kuan-Sheng Chung
- Departments of Addiction Science, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
31
|
Wang Y, Wang H, Li W, Zhu J, Gold MS, Zhang D, Wang L, Li Y, Yan X, Cheng J, Li Q, Wang W. Reduced responses to heroin-cue-induced craving in the dorsal striatum: effects of long-term methadone maintenance treatment. Neurosci Lett 2014; 581:120-4. [PMID: 25157798 DOI: 10.1016/j.neulet.2014.08.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/29/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022]
Abstract
Methadone maintenance treatment (MMT) is safe and effective for heroin addiction, but the neural basis of the length effects of long-term MMT on brain activity during craving in former heroin addicts is unclear. This study explored it by comparing the brain activations of heroin addicts with different length of MMT during pictorial presentation of heroin-related cue. Fifteen male former heroin addicts successfully treated by MMT less than 1 year (Group A), 15 matched patients with 2-3 year MMT (Group B) and 17 healthy controls underwent functional magnetic resonance imaging while heroin-related and neutral stimuli were present to them. Subjective cue-elicited craving was measured with visual analog scale before and after imaging. Then, partial correlation analysis to reveal the relationship between drug-related blood oxygen level dependent (BOLD) signal intensity and heroin or methadone use history. Finally, self-reported craving was not different between Group A and B before and after scanning. Compared with Group A, Group B had a significant reduced brain activity to heroin-related minus neural cues in the bilateral caudate. After controlling for the variable heroin use history, the drug-related BOLD signal intensity in the bilateral caudate was negatively correlated with MMT duration and total methadone consumption. When MMT history was controlled, the drug-related activity intensity in right caudate had a positive correlation with heroin daily dosage. Long-term MMT may improve heroin-craving response by modulating the impaired function in the bilateral dorsal striatum caused by former heroin use.
Collapse
Affiliation(s)
- Yarong Wang
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China; Department of Psychiatry and Addiction Medicine, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, Florida 32610, USA
| | - Hanyue Wang
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China
| | - Mark S Gold
- Department of Psychiatry and Addiction Medicine, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, Florida 32610, USA
| | - Dongsheng Zhang
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China
| | - Lina Wang
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China
| | - Yongbin Li
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China
| | - Xuejiao Yan
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China
| | - Jiajie Cheng
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China
| | - Qiang Li
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China.
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an 710038, China.
| |
Collapse
|
32
|
Patterns of Brain Activation During Craving in Heroin Dependents Successfully Treated by Methadone Maintenance and Abstinence-Based Treatments. J Addict Med 2014; 8:123-9. [DOI: 10.1097/adm.0000000000000022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
33
|
Cope LM, Vincent GM, Jobelius JL, Nyalakanti PK, Calhoun VD, Kiehl KA. Psychopathic traits modulate brain responses to drug cues in incarcerated offenders. Front Hum Neurosci 2014; 8:87. [PMID: 24605095 PMCID: PMC3932519 DOI: 10.3389/fnhum.2014.00087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/04/2014] [Indexed: 11/15/2022] Open
Abstract
Recent neuroscientific evidence indicates that psychopathy is associated with abnormal function and structure in limbic and paralimbic areas. Psychopathy and substance use disorders are highly comorbid, but clinical experience suggests that psychopaths abuse drugs for different reasons than non-psychopaths, and that psychopaths do not typically experience withdrawal and craving upon becoming incarcerated. These neurobiological abnormalities may be related to psychopaths' different motivations for—and symptoms of—drug use. This study examined the modulatory effect of psychopathic traits on the neurobiological craving response to pictorial drug stimuli. Drug-related pictures and neutral pictures were presented and rated by participants while hemodynamic activity was monitored using functional magnetic resonance imaging. These data were collected at two correctional facilities in New Mexico using the Mind Research Network mobile magnetic resonance imaging system. The sample comprised 137 incarcerated adult males and females (93 females) with histories of substance dependence. The outcome of interest was the relation between psychopathy scores (using the Hare Psychopathy Checklist-Revised) and hemodynamic activity associated with viewing drug-related pictures vs. neutral pictures. There was a negative association between psychopathy scores and hemodynamic activity for viewing drug-related cues in the anterior cingulate, posterior cingulate, hippocampus, amygdala, caudate, globus pallidus, and parts of the prefrontal cortex. Psychopathic traits modulate the neurobiological craving response and suggest that individual differences are important for understanding and treating substance abuse.
Collapse
Affiliation(s)
- Lora M Cope
- Department of Psychology, University of New Mexico Albuquerque, NM, USA ; The Mind Research Network Albuquerque, NM, USA
| | - Gina M Vincent
- Department of Psychiatry, University of Massachusetts Medical School Worcester, MA, USA
| | | | | | - Vince D Calhoun
- The Mind Research Network Albuquerque, NM, USA ; Department of Electrical and Computer Engineering, University of New Mexico Albuquerque, NM, USA
| | - Kent A Kiehl
- Department of Psychology, University of New Mexico Albuquerque, NM, USA ; The Mind Research Network Albuquerque, NM, USA
| |
Collapse
|
34
|
Li Q, Wang Y, Zhang Y, Li W, Zhu J, Zheng Y, Chen J, Zhao L, Zhou Z, Liu Y, Wang W, Tian J. Assessing cue-induced brain response as a function of abstinence duration in heroin-dependent individuals: an event-related fMRI study. PLoS One 2013; 8:e62911. [PMID: 23667541 PMCID: PMC3646913 DOI: 10.1371/journal.pone.0062911] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 03/26/2013] [Indexed: 11/18/2022] Open
Abstract
The brain activity induced by heroin-related cues may play a role in the maintenance of heroin dependence. Whether the reinforcement or processing biases construct an everlasting feature of heroin addiction remains to be resolved. We used an event-related fMRI paradigm to measure brain activation in response to heroin cue-related pictures versus neutral pictures as the control condition in heroin-dependent patients undergoing short-term and long-term abstinence. The self-reported craving scores were significantly increased after cue exposure in the short-term abstinent patients (t = 3.000, P = 0.008), but no increase was found in the long-term abstinent patients (t = 1.510, P = 0.149). However, no significant differences in cue-induced craving changes were found between the two groups (t = 1.193, P = 0.850). Comparing between the long-term abstinence and short-term abstinence groups, significant decreases in brain activation were detected in the bilateral anterior cingulated cortex, left medial prefrontal cortex, caudate, middle occipital gyrus, inferior parietal lobule and right precuneus. Among all of the heroin dependent patients, the abstinence duration was negatively correlated with brain activation in the left medial prefrontal cortex and left inferior parietal lobule. These findings suggest that long-term abstinence may be useful for heroin-dependent patients to diminish their saliency value of heroin-related cues and possibly lower the relapse vulnerability to some extent.
Collapse
Affiliation(s)
- Qiang Li
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Yarong Wang
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Yi Zhang
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi’an, China
| | - Wei Li
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Jia Zhu
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Ying Zheng
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Jiajie Chen
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
| | - Liyan Zhao
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Zhenyu Zhou
- College of Engineering, Peking University, Beijing, China
| | - Yijun Liu
- Department of Psychiatry, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
- College of Engineering, Peking University, Beijing, China
| | - Wei Wang
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
- * E-mail: (WW) (WW); (JT) (JT)
| | - Jie Tian
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi’an, China
- Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi’an, China
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
- * E-mail: (WW) (WW); (JT) (JT)
| |
Collapse
|
35
|
Fareed A, Eilender P, Haber M, Bremner J, Whitfield N, Drexler K. Comorbid Posttraumatic Stress Disorder and Opiate Addiction: A Literature Review. J Addict Dis 2013; 32:168-79. [DOI: 10.1080/10550887.2013.795467] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
36
|
Li Q, Wang Y, Zhang Y, Li W, Yang W, Zhu J, Wu N, Chang H, Zheng Y, Qin W, Zhao L, Yuan K, Liu J, Wang W, Tian J. Craving correlates with mesolimbic responses to heroin-related cues in short-term abstinence from heroin: an event-related fMRI study. Brain Res 2012; 1469:63-72. [PMID: 22759909 DOI: 10.1016/j.brainres.2012.06.024] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/23/2012] [Accepted: 06/17/2012] [Indexed: 12/17/2022]
Abstract
Craving is an important factor in relapse to drug abuse, and cue-induced craving is an especially powerful form of this construct. Neuroimaging methods have been utilized to study drug cue-induced craving and neural correlates in the human brain. However, very few studies have focused on characterizing craving and the neural responses to heroin-related cues in short-term abstinent heroin-dependent patients. Twenty-four heroin-dependent subjects and 20 demographically matched drug-naïve subjects participated in this study. An event-related cue-reactivity paradigm was employed, while changes in blood oxygen level-dependent (BOLD) signals were acquired by functional magnetic resonance imaging (fMRI). The heroin-dependent group reported significantly increased craving following exposure to heroin-related cues. Direct comparison between the two groups showed that brain activation to heroin-related minus neutral cues was significantly greater for the heroin-dependent group in the bilateral nucleus accumbens (NAc), caudate, putamen, amygdala, hippocampus/parahippocampus, midcingulate cortex, dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC), medial frontal gyrus (MeFG), midbrain, thalamus, left anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and subcallosal gyrus. Changes in craving in the heroin-dependent group correlated positively with brain activation in the bilateral NAc, caudate, right putamen, and left ACC. The abstinence duration correlated positively with brain activation in the left caudate and right parahippocampal gyrus. In conclusion, the cue-reactivity paradigm significantly activated neural responses in the mesolimbic dopamine (DA) system and prefrontal cortex (PFC) and induced increased craving in short-term abstinent heroin-dependent patients. We suggest that these response patterns characterize the high vulnerability of relapse in short-term abstinent heroin-dependent subjects.
Collapse
Affiliation(s)
- Qiang Li
- Department of Radiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|