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Deshpande HU, Fedota JR, Castillo J, Salmeron BJ, Ross TJ, Stein EA. Not all smokers are alike: the hidden cost of sustained attention during nicotine abstinence. Neuropsychopharmacology 2022; 47:1633-1642. [PMID: 35091674 PMCID: PMC9283548 DOI: 10.1038/s41386-022-01275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022]
Abstract
Nicotine Withdrawal Syndrome (NWS)-associated cognitive deficits are notably heterogeneous, suggesting underlying endophenotypic variance. However, parsing this variance in smokers has remained challenging. In this study, we identified smoker subgroups based on response accuracy during a Parametric Flanker Task (PFT) and then characterized distinct neuroimaging endophenotypes using a nicotine state manipulation. Smokers completed the PFT in two fMRI sessions (nicotine sated, abstinent). Based on response accuracy in the stressful, high cognitive demand PFT condition, smokers split into high (HTP, n = 21) and low task performer (LTP, n = 24) subgroups. Behaviorally, HTPs showed greater response accuracy (88.68% ± 5.19 SD) vs. LTPs (51.04% ± 4.72 SD), independent of nicotine state, and greater vulnerability to abstinence-induced errors of omission (EOm, p = 0.01). Neurobiologically, HTPs showed greater BOLD responses in attentional control brain regions, including bilateral insula, dorsal ACC, and frontoparietal Cx for the [correct responses (-) errors of commission] PFT contrast in both states. A whole-brain functional connectivity (FC) analysis with these subgroup-derived regions as seeds identified two circuits: Precentral Cx↔Insula and Insula↔Occipital Cx, with abstinence-induced FC strength increases seen only in HTPs. Finally, abstinence-induced FC and behavior (EOm) differences were positively correlated for HTPs in a Precentral Cx↔Orbitofrontal cortical circuit. In sum, only the HTP subgroup demonstrated sustained attention deficits following 48-hr nicotine abstinence, a stressor in dependent smokers. Unpacking underlying smoker heterogeneity with this 'dual (task and abstinence) stressor' approach revealed discrete smoker subgroups with differential attentional deficits to withdrawal that could be novel pharmacological/behavioral targets for therapeutic interventions to improve cessation outcomes.
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Affiliation(s)
- Harshawardhan U. Deshpande
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA
| | - John R. Fedota
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA ,grid.420090.f0000 0004 0533 7147Present Address: Behavioral and Cognitive Neuroscience Branch, Division of Neuroscience Behavior, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD USA
| | - Juan Castillo
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA
| | - Betty Jo Salmeron
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA
| | - Thomas J. Ross
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA
| | - Elliot A. Stein
- grid.420090.f0000 0004 0533 7147Neuroimaging Research Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, Baltimore, MD USA
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Joutsa J, Moussawi K, Siddiqi SH, Abdolahi A, Drew W, Cohen AL, Ross TJ, Deshpande HU, Wang HZ, Bruss J, Stein EA, Volkow ND, Grafman JH, van Wijngaarden E, Boes AD, Fox MD. Brain lesions disrupting addiction map to a common human brain circuit. Nat Med 2022; 28:1249-1255. [PMID: 35697842 PMCID: PMC9205767 DOI: 10.1038/s41591-022-01834-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
Drug addiction is a public health crisis for which new treatments are urgently needed. In rare cases, regional brain damage can lead to addiction remission. These cases may be used to identify therapeutic targets for neuromodulation. We analyzed two cohorts of patients addicted to smoking at the time of focal brain damage (cohort 1 n = 67; cohort 2 n = 62). Lesion locations were mapped to a brain atlas and the brain network functionally connected to each lesion location was computed using human connectome data (n = 1,000). Associations with addiction remission were identified. Generalizability was assessed using an independent cohort of patients with focal brain damage and alcohol addiction risk scores (n = 186). Specificity was assessed through comparison to 37 other neuropsychological variables. Lesions disrupting smoking addiction occurred in many different brain locations but were characterized by a specific pattern of brain connectivity. This pattern involved positive connectivity to the dorsal cingulate, lateral prefrontal cortex, and insula and negative connectivity to the medial prefrontal and temporal cortex. This circuit was reproducible across independent lesion cohorts, associated with reduced alcohol addiction risk, and specific to addiction metrics. Hubs that best matched the connectivity profile for addiction remission were the paracingulate gyrus, left frontal operculum, and medial fronto-polar cortex. We conclude that brain lesions disrupting addiction map to a specific human brain circuit and that hubs in this circuit provide testable targets for therapeutic neuromodulation.
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Affiliation(s)
- Juho Joutsa
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland. .,Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland. .,Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Khaled Moussawi
- National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shan H Siddiqi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Brain Circuit Therapeutics, Departments of Neurology Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amir Abdolahi
- Clinical Affairs, Philips Healthcare, Cambridge, MA, USA
| | - William Drew
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Brain Circuit Therapeutics, Departments of Neurology Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander L Cohen
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Brain Circuit Therapeutics, Departments of Neurology Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas J Ross
- National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA
| | | | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Joel Bruss
- Departments of Pediatrics, Neurology & Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Elliot A Stein
- National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA
| | - Nora D Volkow
- Intramural Research Program, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Jordan H Grafman
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Northwestern University, Chicago, IL, USA.,Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Aaron D Boes
- Departments of Pediatrics, Neurology & Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Center for Brain Circuit Therapeutics, Departments of Neurology Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Mellis AM, Snider SE, Deshpande HU, LaConte SM, Bickel WK. Practicing prospection promotes patience: Repeated episodic future thinking cumulatively reduces delay discounting. Drug Alcohol Depend 2019; 204:107507. [PMID: 31520923 PMCID: PMC6878183 DOI: 10.1016/j.drugalcdep.2019.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Delay discounting, or the preference for smaller, sooner over larger, later rewards, has been associated with alcohol use disorder and problem drinking. Episodic future thinking has been suggested as an intervention to address steep delay discounting. In the present study, we examined the effect of up to six consecutive sessions of episodic future thinking. METHODS Repeated, within-subject data were collected from current and recent problem drinkers (n = 50) over six sessions. Linear mixed-effect models were used to estimate effects of repeated sessions and manipulations. Participants completed episodic future thinking interviews at up to six sessions, in which they generated personalized future events. Participants also engaged with cues of scarcity. At each session, participants completed three delay discounting tasks under: a no-cue baseline condition, a future cue condition, and a scarcity cue condition. RESULTS Delay discounting in the no cue condition did not change over time. Discounting rates were reduced in the future cue condition, and these effects grew larger with repeated sessions. In the scarcity condition, discounting rates were slightly higher, with no effect of repeated sessions. CONCLUSIONS Episodic future thinking reduced delay discounting rate while future cues were presented, and these effects grew larger with repeated sessions. This suggests that repeated episodic future thinking may cumulatively potentiate repair of excessive preference for immediate reward.
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Affiliation(s)
| | | | | | | | - Warren K. Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, USA 24016
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Deshpande HU, Mellis AM, Lisinski JM, Stein JS, Koffarnus MN, Paluch R, Schweser F, Zivadinov R, LaConte SM, Epstein LH, Bickel WK. Reinforcer pathology: Common neural substrates for delay discounting and snack purchasing in prediabetics. Brain Cogn 2019; 132:80-88. [PMID: 30933707 PMCID: PMC6626634 DOI: 10.1016/j.bandc.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 03/14/2019] [Accepted: 03/17/2019] [Indexed: 01/04/2023]
Abstract
Reinforcer pathology theory stipulates that individuals with both (a) high preference for smaller, immediate over larger, delayed rewards; and (b) high demand for unhealthy commodities are uniquely susceptible to poor health outcomes. Specifically, two behavioral economic tasks (delay discounting, assessing preference for smaller, immediate or larger, delayed rewards; and purchasing, assessing purchases of commodities over changes in price) have been independently associated with conditions such as overweight/obesity and problem substance use. In the present study, we examined possible shared neural regions involved in the processes of delay discounting and demand for snack foods in a prediabetic sample. Fifty-four participants completed both of these tasks. Conjunction between delay discounting and purchasing task results indicates substantial common neural substrates recruited during these two tasks, consistent with interpretations of executive control, interoception, and attention, in the prefrontal cortex, insula, and frontoparietal cortex (superior/middle frontal cortex and superior/inferior parietal lobules), respectively. Collectively, these results suggest possible neural substrates in which the two behavioral risk factors of reinforcer pathology may interact during real-world decision-making in prediabetes.
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Affiliation(s)
| | - Alexandra M Mellis
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - Jonathan M Lisinski
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - Jeffrey S Stein
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - Mikhail N Koffarnus
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - Rocco Paluch
- University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Stephen M LaConte
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA
| | - Leonard H Epstein
- University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, USA.
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Snider SE, Deshpande HU, Lisinski JM, Koffarnus MN, LaConte SM, Bickel WK. Working Memory Training Improves Alcohol Users' Episodic Future Thinking: A Rate-Dependent Analysis. Biol Psychiatry Cogn Neurosci Neuroimaging 2017. [PMID: 29529411 DOI: 10.1016/j.bpsc.2017.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Episodic thinking, whether past or future, uses similar neural machinery, and individuals with alcohol dependence have clear challenges with both. Moreover, alcohol-dependent individuals' narrowed temporal window likely gives rise to greater valuation of immediate rewards. We aimed to strengthen working memory (WM) in alcohol-dependent individuals and measure performance on near-transfer (novel WM) and far-transfer delay discounting (DD) tasks, including episodic future thinking (EFT) performance. Importantly, heterogeneous intervention responses could obscure a treatment effect due to individuals' baseline differences. Therefore, we considered WM, DD, and EFT DD scores using rate-dependent analyses. METHODS A total of 50 alcohol-dependent individuals received either 20 active (Trained) or sham (Control) WM training sessions using the Cogmed adaptive WM training program. Participants completed a near-transfer novel WM task and far-transfer DD and EFT DD tasks before and after training. RESULTS Active WM training improved performance on the near-transfer task. As determined by Oldham's correlation [rmean(x,y),y-x], initially low near-transfer task scores improved more than initially high scores (i.e., rate dependence) in the Trained group only. Moreover, Trained group individuals with the highest rates of EFT DD at baseline rate-dependently decreased following training, whereas WM training had no effect on DD alone. CONCLUSIONS These data support the notion that WM training improves near-transfer task performance and may enhance the effects of EFT DD in a subset of alcohol-dependent individuals trapped within the narrowest temporal window. Rate-dependent changes highlight that we should attend to baseline performance to better identify individuals who would most benefit from an intervention.
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Affiliation(s)
- Sarah E Snider
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Harshawardhan U Deshpande
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Jonathan M Lisinski
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Mikhail N Koffarnus
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Stephen M LaConte
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Warren K Bickel
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia.
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