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Gilman JM, Kaur J, Tervo-Clemmens B, Potter K, Sanzo BT, Schuster RM, Bjork JM, Evins AE, Roffman JL, Lee PH. Associations between behavioral and self-reported impulsivity, brain structure, and genetic influences in middle childhood. Dev Cogn Neurosci 2024; 67:101389. [PMID: 38749217 PMCID: PMC11112269 DOI: 10.1016/j.dcn.2024.101389] [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] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/29/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Impulsivity undergoes a normative developmental trajectory from childhood to adulthood and is thought to be driven by maturation of brain structure. However, few large-scale studies have assessed associations between impulsivity, brain structure, and genetic susceptibility in children. In 9112 children ages 9-10 from the ABCD study, we explored relationships among impulsivity (UPPS-P impulsive behavior scale; delay discounting), brain structure (cortical thickness (CT), cortical volume (CV), and cortical area (CA)), and polygenic scores for externalizing behavior (PGSEXT). Both higher UPPS-P total scores and more severe delay-discounting had widespread, low-magnitude associations with smaller CA in frontal and temporal regions. No associations were seen between impulsivity and CV or CT. Additionally, higher PGSEXT was associated with both higher UPPS-P scores and with smaller CA and CV in frontal and temporal regions, but in non-overlapping cortical regions, underscoring the complex interplay between genetics and brain structure in influencing impulsivity. These findings indicate that, within large-scale population data, CA is significantly yet weakly associated with each of these impulsivity measures and with polygenic risk for externalizing behaviors, but in distinct brain regions. Future work should longitudinally assess these associations through adolescence, and examine associated functional outcomes, such as future substance use and psychopathology.
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Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Jasmeen Kaur
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
| | - Brenden Tervo-Clemmens
- Department of Psychiatry & Behavioral Science, Masonic Institute for the Developing Brain, Institute for Translational Neuroscience, University of Minnesota, USA
| | - Kevin Potter
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
| | - Brandon T Sanzo
- Massachusetts General Hospital (MGH) Psychiatric and Neurodevelopmental Genetics Unit Center for Genomic Medicine, Massachusetts General Hospital (MGH), MA, USA
| | - Randi M Schuster
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - James M Bjork
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, VA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Joshua L Roffman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Phil H Lee
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital (MGH) Psychiatric and Neurodevelopmental Genetics Unit Center for Genomic Medicine, Massachusetts General Hospital (MGH), MA, USA
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Karunakaran KD, Pascale M, Ozana N, Potter K, Pachas GN, Evins AE, Gilman JM. Intoxication due to Δ9-tetrahydrocannabinol is characterized by disrupted prefrontal cortex activity. Neuropsychopharmacology 2024:10.1038/s41386-024-01876-5. [PMID: 38714786 DOI: 10.1038/s41386-024-01876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 05/10/2024]
Abstract
Neural states of impairment from intoxicating substances, including cannabis, are poorly understood. Cannabinoid 1 receptors, the main target of Δ9-tetrahydrocannabinol (THC), the primary intoxicating cannabinoid in cannabis, are densely localized within prefrontal cortex; therefore, prefrontal brain regions are key locations to examine brain changes that characterize acute intoxication. We conducted a double-blind, randomized, cross-over study in adults, aged 18-55 years, who use cannabis regularly, to determine the effects of acute intoxication on prefrontal cortex resting-state measures, assessed with portable functional near-infrared spectroscopy. Participants received oral THC (10-80 mg, individually dosed to overcome tolerance and achieve acute intoxication) and identical placebo, randomized for order; 185 adults were randomized and 128 completed both study days and had usable data. THC was associated with expected increases in subjective intoxication ratings (ES = 35.30, p < 0.001) and heart rate (ES = 11.15, p = 0.001). THC was associated with decreased correlations and anticorrelations in static resting-state functional connectivity within the prefrontal cortex relative to placebo, with weakest correlations and anticorrelations among those who reported greater severity of intoxication (RSFC between medial PFC-ventromedial PFC and DEQ scores, r = 0.32, p < 0.001; RSFC between bilateral mPFC and DEQ scores, r = -0.28, p = 0.001). Relative to placebo, THC was associated with increased variability (or reduced stability) in dynamic resting-state functional connectivity of the prefrontal cortex at p = 0.001, consistent across a range of window sizes. Finally, using frequency power spectrum analyses, we observed that relative to placebo, THC was associated with widespread reduced spectral power within the prefrontal cortex across the 0.073-0.1 Hz frequency range at p < 0.039. These neural features suggest a disruptive influence of THC on the neural dynamics of the prefrontal cortex and may underlie cognitive impairing effects of THC that are detectable with portable imaging. This study is registered in Clinicaltrials.gov (NCT03655717).
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Affiliation(s)
- Keerthana Deepti Karunakaran
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael Pascale
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
| | - Nisan Ozana
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Faculty of Engineering and The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, 52900, Israel
| | - Kevin Potter
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gladys N Pachas
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jodi M Gilman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
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Cooke ME, Knoll SJ, Streck JM, Potter K, Lamberth E, Rychik N, Gilman JM, Evins AE, Schuster RM. Contingency management is associated with positive changes in attitudes and reductions in cannabis use even after discontinuation of incentives among non-treatment seeking youth. Drug Alcohol Depend 2024; 256:111096. [PMID: 38277735 PMCID: PMC10923125 DOI: 10.1016/j.drugalcdep.2024.111096] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND It is important to identify interventions that reduce harm in youth not motivated to change their cannabis use. This study evaluated how short-duration contingency management (CM) impacts cannabis use attitudes and behavior after abstinence incentives are discontinued among non-treatment seeking youth. METHODS Participants (N=220) were randomized to 4 weeks of abstinence-based CM (CB-Abst; n=126) or monitoring (CB-Mon; n=94). Participants completed self-report and provided biochemical measures of cannabis exposure at baseline, end-of-intervention, and 4-week follow-up. Changes in self-reported cannabis use frequency (days/week; times/week) and biochemically verified creatinine-adjusted 11-nor-9-carboxy-tetrahydrocannabinol concentrations (CN-THCCOOH) were analyzed between groups from baseline to follow-up. In CB-Abst, cannabis use goals at end-of-intervention were described and changes in cannabis use at follow-up were explored by goals and cannabis use disorder (CUD) diagnosis. RESULTS There was a group by visit interaction on cannabis use (days: beta=0.93, p=0.005; times: beta=0.71, p<0.001; CN-THCCOOH: beta=0.26, p=0.004), with reductions at follow-up detected only in CB-Abst. Following 4 weeks of abstinence, 68.4% of CB-Abst participants wanted to reduce or abstain from cannabis use following completion of CM. Those in CB-Abst who set end-of-intervention reduction goals and were without CUD had greater decreases in cannabis use frequency at follow-up (Goals*time on days/week: beta=-2.27, p<0.001; CUD*time on times/week: beta=0.48, SE=0.24, t=2.01, p=0.048). CONCLUSIONS Findings support the utility of brief incentivized abstinence for generating motivation to reduce cannabis use and behavior change even after incentives end. This study supports CM as a potentially viable harm reduction strategy for those not yet ready to quit.
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Affiliation(s)
- Megan E Cooke
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Sarah J Knoll
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Kevin Potter
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Erin Lamberth
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Natali Rychik
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Jodi M Gilman
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Randi M Schuster
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA.
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Tervo-Clemmens B, Gilman JM, Evins AE, Bentley KH, Nock MK, Smoller JW, Schuster RM. Substance Use, Suicidal Thoughts, and Psychiatric Comorbidities Among High School Students. JAMA Pediatr 2024; 178:310-313. [PMID: 38285470 PMCID: PMC10825781 DOI: 10.1001/jamapediatrics.2023.6263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 01/30/2024]
Abstract
This cross-sectional study evaluates the dose-dependent association between alcohol, cannabis, and nicotine use and psychiatric symptoms among participants in the Substance Use and Risk Factor Survey and the Youth Risk Behavior Survey.
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Affiliation(s)
| | - Jodi M. Gilman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kate H. Bentley
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Boston, Massachusetts
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Randi M. Schuster
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
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Tervo-Clemmens B, Karim ZA, Khan SZ, Ravindranath O, Somerville LH, Schuster RM, Gilman JM, Evins AE. The Developmental Timing but Not Magnitude of Adolescent Risk-Taking Propensity Is Consistent Across Social, Environmental, and Psychological Factors. J Adolesc Health 2024; 74:613-616. [PMID: 38085210 DOI: 10.1016/j.jadohealth.2023.11.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Risk-taking is thought to peak during adolescence, but most prior studies have relied on small convenience samples lacking participant diversity. This study tested the generalizability of adolescent self-reported risk-taking propensity across a comprehensive set of participant-level social, environmental, and psychological factors. METHODS Data (N = 1,005,421) from the National Survey on Drug Use and Health were used to test the developmental timing and magnitude of risk-taking propensity and its link to alcohol and cannabis use across 19 subgroups defined via sex, race/ethnicity, socioeconomic status, population density, religious affiliation, and mental health. RESULTS The developmental timing of a lifespan peak in risk-taking propensity during adolescence (15-18 years old) generalized across nearly all levels of social, environmental, and psychological factors, whereas the magnitude of this peak widely varied. Nearly all adolescents with regular substance use reported higher levels of risk-taking propensity. DISCUSSION Results support a broad generalizability of adolescence as the peak lifespan period of self-reported risk-taking but emphasize the importance of participant-level factors in determining the specific magnitude of reported risk-taking.
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Affiliation(s)
- Brenden Tervo-Clemmens
- Department of Psychiatry, Masssachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota.
| | | | | | - Orma Ravindranath
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leah H Somerville
- Department of Psychology and Center for Brain Science, Harvard University, Cambridge, Massachusetts
| | - Randi M Schuster
- Department of Psychiatry, Masssachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jodi M Gilman
- Department of Psychiatry, Masssachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Eden Evins
- Department of Psychiatry, Masssachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Gilman JM, Iyer MT, Pottinger EG, Klugman EM, Hughes D, Potter K, Tervo-Clemmens B, Roffman JL, Evins AE. State-Level Recreational Cannabis Legalization Is Not Differentially Associated with Cannabis Risk Perception Among Children: A Multilevel Regression Analysis. Cannabis Cannabinoid Res 2024; 9:343-352. [PMID: 36301559 PMCID: PMC10874817 DOI: 10.1089/can.2022.0162] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: As more states pass recreational cannabis laws (RCLs) for adults, there is concern that increasing (and state-sanctioned) cannabis acceptance will result in a reduced perception of risk of harm from cannabis among children. We aimed to discover whether children in states with RCLs had decreased perception of risk from cannabis compared with children in states with illicit cannabis. Methods: We analyzed data from the multisite multistate Adolescent Brain and Cognitive Development Study to determine how the perception of cannabis harm among children (age at baseline: 9-10; N=10,395) changes over time in states with and without RCLs. Using multilevel modeling, we assessed survey responses from children longitudinally across 3 years, adjusting for state-, family-, and participant-level clustering and child-level factors, including demographics (sex, race, and socioeconomic status), religiosity, and trait impulsivity. Results: There was no significant main effect of state RCLs on perceived risk of cannabis use, and no differences in change over time by state RCLs, even after controlling for demographic factors and other risk (e.g., impulsivity) and protective (e.g., religiosity) factors. Conclusions: This analysis indicates that state-level RCLs are not associated with differential perception of cannabis risk among children, even after controlling for demographics, trait impulsivity, and religiosity. Future studies could assess how perception of risk from cannabis changes as children and adolescents continue to mature in states with and without RCLs.
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Affiliation(s)
- Jodi M. Gilman
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Mallika T. Iyer
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | | | - Emma M. Klugman
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Dylan Hughes
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Kevin Potter
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Brenden Tervo-Clemmens
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Joshua L. Roffman
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - A. Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Cooke ME, Edwards RR, Wheeler GL, Schmitt WA, Nielsen LV, Streck JM, Schuster RM, Potter K, Evins AE, Gilman JM. Pain catastrophizing is associated with reduced neural response to monetary reward. Front Pain Res (Lausanne) 2023; 4:1129353. [PMID: 37745802 PMCID: PMC10512714 DOI: 10.3389/fpain.2023.1129353] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Pain catastrophizing, a measure of an individual's negative emotional and cognitive appraisals of pain, has been included as a key treatment target in many psychological interventions for pain. However, the neural correlates of pain catastrophizing have been understudied. Prior neuroimaging evidence suggests that adults with pain show altered reward processing throughout the mesocorticolimbic reward circuitry. Methods In this study, we tested the association between Pain Catastrophizing Scale (PCS) scores and neural activation to the Monetary Incentive Delay (MID) reward neuroimaging task in 94 adults reporting a range of pain, insomnia, and mood symptoms. Results Results indicated that PCS score but not pain intensity was significantly associated with blunted activation in the caudate and putamen in response to feedback of successful vs. unsuccessful trials on the MID task. Mediation analyses indicated that PCS score fully mediated the relationship between depression symptoms and reward activation. Discussion These findings provide evidence that pain catastrophizing is independently associated with altered striatal function apart from depression symptoms and pain intensity. Thus, in individuals experiencing pain and/or co- morbid conditions, reward dysfunction is directly related to pain catastrophizing.
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Affiliation(s)
- Megan E. Cooke
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Robert R. Edwards
- Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Grace L. Wheeler
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - William A. Schmitt
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Lindsay V. Nielsen
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Joanna M. Streck
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Randi M. Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kevin Potter
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jodi M. Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
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Ramaekers JG, Vinckenbosch F, Gilman JM. High Traffic-The Quest for a Reliable Test of Cannabis Impairment. JAMA Psychiatry 2023; 80:871-872. [PMID: 37531119 DOI: 10.1001/jamapsychiatry.2023.2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
| | | | - Jodi M Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Harvard Medical School, Boston, Massachusetts
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9
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Livne O, Potter KW, Schuster RM, Gilman JM. Longitudinal Associations Between Cannabis Use and Cognitive Impairment in a Clinical Sample of Middle-Aged Adults Using Cannabis for Medical Symptoms. Cannabis Cannabinoid Res 2023. [PMID: 37625034 DOI: 10.1089/can.2022.0310] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Introduction: Cannabis use to alleviate medical symptoms is increasing in middle-aged and older adults. Cognitive impairment associated with cannabis use may be especially detrimental to these understudied age groups. We hypothesized that among middle-aged and older adults who used cannabis for 12 months, frequent (≥3 days/week) compared with nonfrequent (≤2 days/week) use will be associated with cognitive impairment. Materials and Methods: We performed secondary analysis on data from a clinical trial of cannabis use for medical symptoms. Participants (n=62) were ≥45 years, and completed a baseline and at least one postbaseline visit. Cognitive domains were assessed through the Cambridge Neuropsychological Test Automated Battery. Cannabis use was assessed prospectively through daily smartphone diaries. Frequency of cannabis use was a binary predictor in a mixed-effects logistic regression model predicting cognitive impairment adjusted for baseline cognitive functioning. Results: At baseline, participants were primarily nonfrequent cannabis users; however, in all other time periods, most participants were frequent users (range: 55-58%). Cognitive outcomes did not differ between frequent and nonfrequent cannabis users. However, in sensitivity analyses, respondents with problematic cannabis use scored significantly worse on one cognitive domain compared to those without problematic cannabis use. Conclusions: In a clinical sample of adults aged ≥45 years, no longitudinal associations were found between cannabis use and cognitive functioning. However, a few significant associations were observed between problematic use and cognitive functioning. Further research is needed to assess the impact of cannabis use on adults, particularly those aged ≥65 years, and to investigate potential subtler influences of cannabis use on cognition. ClinicalTrials.gov ID: NCT03224468.
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Affiliation(s)
- Ofir Livne
- New York State Psychiatric Institute, New York, New York, USA
| | - Kevin W Potter
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Randi M Schuster
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jodi M Gilman
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Weiss JH, Tervo-Clemmens B, Potter KW, Evins AE, Gilman JM. The Cannabis Effects Expectancy Questionnaire-Medical (CEEQ-M): Preliminary psychometric properties and longitudinal validation within a clinical trial. Psychol Assess 2023; 35:659-673. [PMID: 37289502 PMCID: PMC10527809 DOI: 10.1037/pas0001244] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The use of cannabis for medical symptoms is increasing despite limited evidence for its efficacy. Expectancies-prior beliefs about a substance or medicine-can modulate use patterns and effects of medicines on target symptoms. To our knowledge, cannabis expectancies have not been studied for their predictive value for symptom relief. The 21-item Cannabis Effects Expectancy Questionnaire-Medical (CEEQ-M) is the first longitudinally validated measure of expectancies for cannabis used for medical symptoms. The questionnaire was developed for a randomized clinical trial of the effect of state cannabis registration (SCR) card ownership on symptoms of pain, insomnia, anxiety, and depression in adults (N = 269 across six questionnaire administrations). Item-level analyses (n = 188) demonstrated between-person stability of expectancies and no aggregate, within-person expectancy changes 3 months after individuals gained access to SCR cards. Exploratory factor analysis (n = 269) indicated a two-factor structure. Confirmatory factor analysis at a later timepoint (n = 193) demonstrated good fit and scalar invariance of the measurement model. Cross-lagged panel models across 3 and 12 months (n = 187 and 161, respectively) indicated that CEEQ-M-measured expectancies did not predict changes in self-reported cannabis use; symptoms of pain, insomnia, anxiety, and depression; and well-being. However, greater baseline cannabis use predicted more positive expectancy changes. The findings suggest that the CEEQ-M is psychometrically sound. Future work should clarify at what timescales cannabis expectancies have predictive value and how cannabis expectancies for medical symptoms are maintained and diverge from other substance use expectancies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jakob H. Weiss
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
| | - Brenden Tervo-Clemmens
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kevin W. Potter
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jodi M. Gilman
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard Medical School, Charlestown
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Hughes DE, Kunitoki K, Elyounssi S, Luo M, Bazer OM, Hopkinson CE, Dowling KF, Doyle AE, Dunn EC, Eryilmaz H, Gilman JM, Holt DJ, Valera EM, Smoller JW, Cecil CAM, Tiemeier H, Lee PH, Roffman JL. Genetic patterning for child psychopathology is distinct from that for adults and implicates fetal cerebellar development. Nat Neurosci 2023; 26:959-969. [PMID: 37202553 PMCID: PMC7614744 DOI: 10.1038/s41593-023-01321-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
Childhood psychiatric symptoms are often diffuse but can coalesce into discrete mental illnesses during late adolescence. We leveraged polygenic scores (PGSs) to parse genomic risk for childhood symptoms and to uncover related neurodevelopmental mechanisms with transcriptomic and neuroimaging data. In independent samples (Adolescent Brain Cognitive Development, Generation R) a narrow cross-disorder neurodevelopmental PGS, reflecting risk for attention deficit hyperactivity disorder, autism, depression and Tourette syndrome, predicted psychiatric symptoms through early adolescence with greater sensitivity than broad cross-disorder PGSs reflecting shared risk across eight psychiatric disorders, the disorder-specific PGS individually or two other narrow cross-disorder (Compulsive, Mood-Psychotic) scores. Neurodevelopmental PGS-associated genes were preferentially expressed in the cerebellum, where their expression peaked prenatally. Further, lower gray matter volumes in cerebellum and functionally coupled cortical regions associated with psychiatric symptoms in mid-childhood. These findings demonstrate that the genetic underpinnings of pediatric psychiatric symptoms differ from those of adult illness, and implicate fetal cerebellar developmental processes that endure through childhood.
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Affiliation(s)
- Dylan E Hughes
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Keiko Kunitoki
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Safia Elyounssi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mannan Luo
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Oren M Bazer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Casey E Hopkinson
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin F Dowling
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
| | - Alysa E Doyle
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erin C Dunn
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Center on the Developing Child at Harvard University, Cambridge, MA, USA
| | - Hamdi Eryilmaz
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jodi M Gilman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Daphne J Holt
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Eve M Valera
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jordan W Smoller
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Charlotte A M Cecil
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia, Rotterdam, the Netherlands
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Phil H Lee
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Joshua L Roffman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
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Gilman JM, Potter K, Schuster RM, Hoeppner BB, Eden Evins A. Cannabis use for medical symptoms: Patterns over the first year of use. Addict Behav 2023; 144:107719. [PMID: 37068366 DOI: 10.1016/j.addbeh.2023.107719] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND As greater numbers of states in the United States and countries in the world continue to legalize cannabis for medical use, it has become increasingly important to assess patterns of cannabis use in individuals using cannabis for medical symptoms over time. A public health concern is that, like recreational cannabis, some individuals using cannabis for medical reasons may develop detrimental patterns of use, leading to the development of a cannabis use disorder (CUD). METHODS In a 9-month longitudinal cohort study following a 12-week randomized, waitlist-controlled trial in 149 adults who used cannabis to alleviate insomnia, pain, depressed mood, or anxiety (RCT: NCT03224468), we assessed whether patterns of cannabis use for the 9 months following the RCT were associated with the development of CUD. RESULTS We identified five unique trajectories of use; 31 participants (21%) had low stable or no use, 50 (34%) had medium stable use, 19 (13%) had high stable use, 26 (17%) showed de-escalating and 23 (15%) showed escalating use over 9 months following the RCT. Of 149 participants enrolled, 19 (13%) met diagnostic criteria for CUD at 12 months. Only the escalating cannabis use pattern predicted significantly higher rates of CUD compared to the low or no use category (OR = 4.29, 95% CI = 1.21 to 10.87, p = 0.02). CONCLUSIONS These data indicate that most individuals using cannabis for medical symptoms have a stable pattern of use over the first year. Escalation of use may be a detrimental pattern that warrants further concern.
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Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Kevin Potter
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Randi M Schuster
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Bettina B Hoeppner
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH) Department of Psychiatry, Center for Addiction Medicine, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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13
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Cooke ME, Potter KW, Jashinski J, Pascale M, Schuster RM, Tervo-Clemmens B, Hoeppner BB, Pachas GN, Evins AE, Gilman JM. Development of cannabis use disorder in medical cannabis users: A 9-month follow-up of a randomized clinical trial testing effects of medical cannabis card ownership. Front Psychiatry 2023; 14:1083334. [PMID: 36960460 PMCID: PMC10027723 DOI: 10.3389/fpsyt.2023.1083334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background Evidence for long-term effectiveness of commercial cannabis products used to treat medical symptoms is inconsistent, despite increasingly widespread use. Objective To prospectively evaluate the effects of using cannabis on self-reported symptoms of pain, insomnia, anxiety, depression, and cannabis use disorder (CUD) after 12 months of use. Methods This observational cohort study describes outcomes over 9 months following a 12-week randomized, waitlist-controlled trial (RCT: NCT03224468) in which adults (N = 163) who wished to use cannabis to alleviate insomnia, pain, depression, or anxiety symptoms were randomly assigned to obtain a medical marijuana card immediately (immediate card acquisition group) or to delay obtaining a card for 12 weeks delay (delayed card acquisition group). During the 9-month post-randomization period, all participants could use cannabis as they wished and choose their cannabis products, doses, and frequency of use. Insomnia, pain, depression, anxiety, and CUD symptoms were assessed over the 9-month post-randomization period. Results After 12 months of using cannabis for medical symptoms, 11.7% of all participants (n = 19), and 17.1% of those using cannabis daily or near-daily (n = 6) developed CUD. Frequency of cannabis use was positively correlated with pain severity and number of CUD symptoms, but not significantly associated with severity of self-reported insomnia, depression, or anxiety symptoms. Depression scores improved throughout the 9 months in all participants, regardless of cannabis use frequency. Conclusions Frequency of cannabis use was not associated with improved pain, anxiety, or depression symptoms but was associated with new-onset cannabis use disorder in a significant minority of participants. Daily or near-daily cannabis use appears to have little benefit for these symptoms after 12 months of use.
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Affiliation(s)
- Megan E. Cooke
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Kevin W. Potter
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Julia Jashinski
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Michael Pascale
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Randi M. Schuster
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Brenden Tervo-Clemmens
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
| | - Bettina B. Hoeppner
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Gladys N. Pachas
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - A. Eden Evins
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jodi M. Gilman
- Department of Psychiatry, Center for Addiction Medicine (CAM), Massachusetts General Hospital (MGH), Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, United States
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Tervo-Clemmens B, Schmitt W, Wheeler G, Cooke ME, Schuster RM, Hickey S, Pachas GN, Evins AE, Gilman JM. Cannabis use and sleep quality in daily life: An electronic daily diary study of adults starting cannabis for health concerns. Drug Alcohol Depend 2023; 243:109760. [PMID: 36638745 PMCID: PMC10015315 DOI: 10.1016/j.drugalcdep.2022.109760] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/07/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Real world patterns of cannabis use for health concerns are highly variable and rarely overseen by a physician. Pragmatic effectiveness studies with electronic daily diaries that capture person-specific patterns of cannabis use and health symptoms may help clarify risks and benefits. METHODS As part of a larger, randomized trial (NCT03224468), adults (N = 181) seeking cannabis for insomnia, pain, or anxiety or depressive symptoms were randomized to obtain a medical cannabis card immediately (MCC) or a waitlist control (WLC) and completed 12-weeks of daily web-based surveys on cannabis use and sleep, pain, and depressive symptoms. RESULTS Completion rates of daily surveys were moderate to high (median completed: 72 out of 90 days). Daily reports of cannabis use were consistent with monthly interview assessments and urinalysis. The MCC group increased cannabis use frequency in the 12 weeks following randomization, while WLC did not. Among the MCC group, self-reported sleep quality was significantly higher on cannabis use days, compared to nonuse days. The MCC group displayed long-term sleep improvements, consistent with increasing cannabis frequency. No improvements were found for pain or depressive symptoms. CONCLUSION Cannabis use is associated with same day improvements in self-reported sleep quality, but not pain or depressive symptoms, although sleep improvements occurred in the context of increased frequency of cannabis use, raising the risk for cannabis use disorder. Daily web-based assessments of cannabis appear valid and feasible in adults seeking cannabis for health concerns, providing a flexible, complementary method for future real-world effectiveness studies with expanded and objective measures.
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Affiliation(s)
- Brenden Tervo-Clemmens
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - William Schmitt
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Wheeler
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Megan E Cooke
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Randi M Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Hickey
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gladys N Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jodi M Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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15
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Paul RH, Cho K, Belden A, Carrico AW, Martin E, Bolzenius J, Luckett P, Cooley SA, Mannarino J, Gilman JM, Miano M, Ances BM. Cognitive Phenotypes of HIV Defined Using a Novel Data-driven Approach. J Neuroimmune Pharmacol 2022; 17:515-525. [PMID: 34981318 PMCID: PMC10364465 DOI: 10.1007/s11481-021-10045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 01/13/2023]
Abstract
The current study applied data-driven methods to identify and explain novel cognitive phenotypes of HIV. Methods: 388 people with HIV (PWH) with an average age of 46 (15.8) and median plasma CD4+ T-cell count of 555 copies/mL (79% virally suppressed) underwent cognitive testing and 3T neuroimaging. Demographics, HIV disease variables, and health comorbidities were recorded within three months of cognitive testing/neuroimaging. Hierarchical clustering was employed to identify cognitive phenotypes followed by ensemble machine learning to delineate the features that determined membership in the cognitive phenotypes. Hierarchical clustering identified five cognitive phenotypes. Cluster 1 (n=97) was comprised of individuals with normative performance on all cognitive tests. The remaining clusters were defined by impairment on action fluency (Cluster 2; n=46); verbal learning/memory (Cluster 3; n=73); action fluency and verbal learning/memory (Cluster 4; n=56); and action fluency, verbal learning/memory, and tests of executive function (Cluster 5; n=114). HIV detectability was most common in Cluster 5. Machine learning revealed that polysubstance use, race, educational attainment, and volumes of the precuneus, cingulate, nucleus accumbens, and thalamus differentiated membership in the normal vs. impaired clusters. The determinants of persistent cognitive impairment among PWH receiving suppressive treatment are multifactorial nature. Viral replication after ART plays a role in the causal pathway, but psychosocial factors (race inequities, substance use) merit increased attention as critical determinants of cognitive impairment in the context of ART. Results underscore the need for comprehensive person-centered interventions that go beyond adherence to patient care to achieve optimal cognitive health among PWH.
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Affiliation(s)
- Robert H Paul
- Department of Psychological Sciences, University of Missouri Saint Louis, Missouri, Saint Louis, US. .,Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US.
| | - Kyu Cho
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Andrew Belden
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Adam W Carrico
- Department of Public Health, University of Miami School of Medicine, Coral Gables, Florida, US
| | - Eileen Martin
- Department of Psychiatry, Rush University School of Medicine, Chicago, Illinois, US
| | - Jacob Bolzenius
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Patrick Luckett
- Department of Neurology, Washington University, Saint Louis, Missouri, US
| | - Sarah A Cooley
- Department of Neurology, Washington University, Saint Louis, Missouri, US
| | - Julie Mannarino
- Missouri Institute of Mental Health, University of Missouri Saint Louis, Missouri, Saint Louis, US
| | - Jodi M Gilman
- Center for Addiction Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, US
| | - Mariah Miano
- Department of Communication Sciences and Disorders, Northern Arizona University, Flagstaff, Arizona, US
| | - Beau M Ances
- Department of Neurology, Washington University, Saint Louis, Missouri, US
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Pike CK, Kim M, Schnitzer K, Mercaldo N, Edwards R, Napadow V, Zhang Y, Morrissey EJ, Alshelh Z, Evins AE, Loggia ML, Gilman JM. Study protocol for a phase II, double-blind, randomised controlled trial of cannabidiol (CBD) compared with placebo for reduction of brain neuroinflammation in adults with chronic low back pain. BMJ Open 2022; 12:e063613. [PMID: 36123113 PMCID: PMC9486315 DOI: 10.1136/bmjopen-2022-063613] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Chronic pain is a debilitating medical problem that is difficult to treat. Neuroinflammatory pathways have emerged as a potential therapeutic target, as preclinical studies have demonstrated that glial cells and neuroglial interactions play a role in the establishment and maintenance of pain. Recently, we used positron emission tomography (PET) to demonstrate increased levels of 18 kDa translocator protein (TSPO) binding, a marker of glial activation, in patients with chronic low back pain (cLBP). Cannabidiol (CBD) is a glial inhibitor in animal models, but studies have not assessed whether CBD reduces neuroinflammation in humans. The principal aim of this trial is to evaluate whether CBD, compared with placebo, affects neuroinflammation, as measured by TSPO levels. METHODS AND ANALYSIS This is a double-blind, randomised, placebo-controlled, phase II clinical trial. Eighty adults (aged 18-75) with cLBP for >6 months will be randomised to either an FDA-approved CBD medication (Epidiolex) or matching placebo for 4 weeks using a dose-escalation design. All participants will undergo integrated PET/MRI at baseline and after 4 weeks of treatment to evaluate neuroinflammation using [11C]PBR28, a second-generation radioligand for TSPO. Our primary hypothesis is that participants randomised to CBD will demonstrate larger reductions in thalamic [11C]PBR28 signal compared with those receiving placebo. We will also assess the effect of CBD on (1) [11C]PBR28 signal from limbic regions, which our prior work has linked to depressive symptoms and (2) striatal activation in response to a reward task. Additionally, we will evaluate self-report measures of cLBP intensity and bothersomeness, depression and quality of life at baseline and 4 weeks. ETHICS AND DISSEMINATION This protocol is approved by the Massachusetts General Brigham Human Research Committee (protocol number: 2021P002617) and FDA (IND number: 143861) and registered with ClinicalTrials.gov. Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT05066308; ClinicalTrials.gov.
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Affiliation(s)
- Chelsea K Pike
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Minhae Kim
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Kristina Schnitzer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Edwards
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vitaly Napadow
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Yi Zhang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin Janas Morrissey
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Zeynab Alshelh
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco L Loggia
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jodi M Gilman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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17
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Jashinski J, Grossman E, Quaye A, Cather C, Potter K, Schoenfeld DA, Evins AE, Gilman JM. Randomised, pragmatic, waitlist controlled trial of cannabis added to prescription opioid support on opioid dose reduction and pain in adults with chronic non-cancer pain: study protocol. BMJ Open 2022; 12:e064457. [PMID: 35680252 PMCID: PMC9185656 DOI: 10.1136/bmjopen-2022-064457] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Chronic, non-cancer pain impacts approximately 50 million adults in the USA (20%), approximately 25% of whom receive chronic prescription opioids for pain despite limited empirical efficacy data and strong dose-related risk for opioid use disorder and opioid overdose. Also despite lack of efficacy data, there are many reports of people using cannabis products to manage chronic pain and replace or reduce chronic opioids. Here we describe the protocol for a randomised trial of the effect of cannabis, when added to a behavioural pain management and prescription opioid taper support programme, on opioid utilisation, pain intensity and pain interference. METHODS This is a pragmatic, single-blind, randomised, wait-list controlled trial that aims to enrol 250 adults taking prescription opioids at stable doses of ≥25 morphine milligram equivalents per day for chronic non-cancer pain who express interest in using cannabis to reduce their pain, their opioid dose or both. All participants will be offered a weekly, 24-session Prescription Opioid Taper Support group behavioural pain management intervention. Participants will be randomly assigned in 1:1 ratio to use cannabis products, primarily from commercial cannabis dispensaries or to abstain from cannabis use for 6 months. Coprimary outcomes are change in prescription monitoring programme-verified opioid dose and change in Pain, Enjoyment, General Activity scale scores. Secondary outcomes include quality of life, depression, anxiety, self-reported opioid dose and opioid and cannabis use disorder symptoms. All other outcomes will be exploratory. We will record adverse events. ETHICS AND DISSEMINATION This study has ethical approval by the Massachusetts General Brigham Institutional Review Board (#2021P000871). Results will be published in peer-reviewed journals and presented at national conferences. TRIAL REGISTRATION NUMBER NCT04827992.
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Affiliation(s)
- Julia Jashinski
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ellie Grossman
- Department of Medicine, Cambridge Health Alliance, Somerville, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Aurora Quaye
- Department of Anesthesiology, MaineHealth, Portland, Maine, USA
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Potter
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Schoenfeld
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jodi M Gilman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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18
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Cooke ME, Clifford JS, Do EK, Gilman JM, Maes HH, Peterson RE, Prom-Wormley EC, Evins AE, Schuster RM. Polygenic score for cigarette smoking is associated with ever electronic-cigarette use in a college-aged sample. Addiction 2022; 117:1071-1078. [PMID: 34636095 PMCID: PMC9875558 DOI: 10.1111/add.15716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/03/2021] [Accepted: 09/23/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Electronic cigarette use has escalated rapidly in recent years, particularly among youth. Little is known about the genetic influences on e-cigarette use. This study aimed to determine whether genetic risk for regular use of combustible cigarettes or for number of cigarettes smoked per day confers risk for ever e-cigarette use or frequency of e-cigarette use. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We used data from 9541 young adults from the Spit for Science longitudinal cohort study (2011-2019). Polygenic scores (PGS) of regular combustible cigarette use (PGS-RCU) and cigarettes per day (PGS-CPD) were constructed using summary statistics from the two largest available genome-wide association study (GWAS) meta-analysis of European ancestry and East Asian ancestry of combustible cigarette use and used to test whether the PGS of RCU or CPD predicted lifetime e-cigarette use and frequency of past 30-day e-cigarette use in a diverse sample of young adults of African (AFR), Admixed American (AMR), East Asian (EAS), European (EUR), and South Asian (SAS) ancestry. FINDINGS The PGS-RCU was associated with lifetime e-cigarette use in the EUR sample (OR = 1.27, 95% CI = 1.19-1.36, P = 7.53 × 10-12 ), but not in the other subsamples (ps > 0.12). This association remained significant after excluding regular combustible cigarette smokers (OR = 1.21, 95% CI = 1.12-1.31, P = 3.36 × 10-6 ). There was no statistically significant association between PGS-CPD and lifetime e-cigarette use and neither the PGS-RCU nor the PGS-CPD were associated with frequency of e-cigarette use in the past 30 days in any of the subsamples. CONCLUSIONS Genetic factors associated with regular combustible cigarette use appear to be associated with ever e-cigarette use in young adults. We did not find evidence for shared genetic factors influencing heaviness of use of combustible cigarettes and current e-cigarette use frequency.
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Affiliation(s)
- Megan E. Cooke
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, 101 Merrimac St., Boston MA 02114, USA
| | - James S. Clifford
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond VA, USA
| | - Elizabeth K. Do
- Department of Health Behavior & Policy, Virginia Commonwealth University, Richmond VA, USA
| | - Jodi M. Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, 101 Merrimac St., Boston MA 02114, USA
| | | | - Hermine H. Maes
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, School of Medicine, Virginia Commonwealth University Richmond VA, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University Richmond VA, USA,Massey Cancer Center, Virginia Commonwealth University, Richmond VA, USA
| | - Roseann E. Peterson
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, School of Medicine, Virginia Commonwealth University Richmond VA, USA
| | - Elizabeth C. Prom-Wormley
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond VA, USA,Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, School of Medicine, Virginia Commonwealth University Richmond VA, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University Richmond VA, USA
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, 101 Merrimac St., Boston MA 02114, USA
| | - Randi M. Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, 101 Merrimac St., Boston MA 02114, USA
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Gilman JM, Schuster RM, Potter KW, Schmitt W, Wheeler G, Pachas GN, Hickey S, Cooke ME, Dechert A, Plummer R, Tervo-Clemmens B, Schoenfeld DA, Evins AE. Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e222106. [PMID: 35302633 PMCID: PMC8933735 DOI: 10.1001/jamanetworkopen.2022.2106] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 01/30/2023] Open
Abstract
Importance Despite the legalization and widespread use of cannabis products for a variety of medical concerns in the US, there is not yet a strong clinical literature to support such use. The risks and benefits of obtaining a medical marijuana card for common clinical outcomes are largely unknown. Objective To evaluate the effect of obtaining a medical marijuana card on target clinical and cannabis use disorder (CUD) symptoms in adults with a chief concern of chronic pain, insomnia, or anxiety or depressive symptoms. Design, Setting, and Participants This pragmatic, single-site, single-blind randomized clinical trial was conducted in the Greater Boston area from July 1, 2017, to July 31, 2020. Participants were adults aged 18 to 65 years with a chief concern of pain, insomnia, or anxiety or depressive symptoms. Participants were randomized 2:1 to either the immediate card acquisition group (n = 105) or the delayed card acquisition group (n = 81). Randomization was stratified by chief concern, age, and sex. The statistical analysis followed an evaluable population approach. Interventions The immediate card acquisition group was allowed to obtain a medical marijuana card immediately after randomization. The delayed card acquisition group was asked to wait 12 weeks before obtaining a medical marijuana card. All participants could choose cannabis products from a dispensary, the dose, and the frequency of use. Participants could continue their usual medical or psychiatric care. Main Outcomes and Measures Primary outcomes were changes in CUD symptoms, anxiety and depressive symptoms, pain severity, and insomnia symptoms during the trial. A logistic regression model was used to estimate the odds ratio (OR) for CUD diagnosis, and linear models were used for continuous outcomes to estimate the mean difference (MD) in symptom scores. Results A total of 186 participants (mean [SD] age 37.2 [14.4] years; 122 women [65.6%]) were randomized and included in the analyses. Compared with the delayed card acquisition group, the immediate card acquisition group had more CUD symptoms (MD, 0.28; 95% CI, 0.15-0.40; P < .001); fewer self-rated insomnia symptoms (MD, -2.90; 95% CI, -4.31 to -1.51; P < .001); and reported no significant changes in pain severity or anxiety or depressive symptoms. Participants in the immediate card acquisition group also had a higher incidence of CUD during the intervention (17.1% [n = 18] in the immediate card acquisition group vs 8.6% [n = 7] in the delayed card acquisition group; adjusted odds ratio, 2.88; 95% CI, 1.17-7.07; P = .02), particularly those with a chief concern of anxiety or depressive symptoms. Conclusions and Relevance This randomized clinical trial found that immediate acquisition of a medical marijuana card led to a higher incidence and severity of CUD; resulted in no significant improvement in pain, anxiety, or depressive symptoms; and improved self-rating of insomnia symptoms. Further investigation of the benefits of medical marijuana card ownership for insomnia and the risk of CUD are needed, particularly for individuals with anxiety or depressive symptoms. Trial Registration ClinicalTrials.gov Identifier: NCT03224468.
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Affiliation(s)
- Jodi M. Gilman
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard Medical School, Charlestown
| | - Randi M. Schuster
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kevin W. Potter
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - William Schmitt
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard Medical School, Charlestown
| | - Grace Wheeler
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard Medical School, Charlestown
| | - Gladys N. Pachas
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sarah Hickey
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
| | - Megan E. Cooke
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alyson Dechert
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard Medical School, Charlestown
| | - Rachel Plummer
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard Medical School, Charlestown
| | - Brenden Tervo-Clemmens
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - David A. Schoenfeld
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, MGH, Boston
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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20
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Gilman JM, Schmitt WA, Potter K, Kendzior B, Pachas GN, Hickey S, Makary M, Huestis MA, Evins AE. Identification of ∆9-tetrahydrocannabinol (THC) impairment using functional brain imaging. Neuropsychopharmacology 2022; 47:944-952. [PMID: 34999737 PMCID: PMC8882180 DOI: 10.1038/s41386-021-01259-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/01/2021] [Accepted: 12/17/2021] [Indexed: 01/01/2023]
Abstract
The primary cannabinoid in cannabis, Δ9-tetrahydrocannabinol (THC), causes intoxication and impaired function, with implications for traffic, workplace, and other situational safety risks. There are currently no evidence-based methods to detect cannabis-impaired driving, and current field sobriety tests with gold-standard, drug recognition evaluations are resource-intensive and may be prone to bias. This study evaluated the capability of a simple, portable imaging method to accurately detect individuals with THC impairment. In this double-blind, randomized, cross-over study, 169 cannabis users, aged 18-55 years, underwent functional near-infrared spectroscopy (fNIRS) before and after receiving oral THC and placebo, at study visits one week apart. Impairment was defined by convergent classification by consensus clinical ratings and an algorithm based on post-dose tachycardia and self-rated "high." Our primary outcome, prefrontal cortex (PFC) oxygenated hemoglobin concentration (HbO), was increased after THC only in participants operationalized as impaired, independent of THC dose. ML models using fNIRS time course features and connectivity matrices identified impairment with 76.4% accuracy, 69.8% positive predictive value (PPV), and 10% false-positive rate using convergent classification as ground truth, which exceeded Drug Recognition Evaluator-conducted expanded field sobriety examination (67.8% accuracy, 35.4% PPV, and 35.4% false-positive rate). These findings demonstrate that PFC response activation patterns and connectivity produce a neural signature of impairment, and that PFC signal, measured with fNIRS, can be used as a sole input to ML models to objectively determine impairment from THC intoxication at the individual level. Future work is warranted to determine the specificity of this classifier to acute THC impairment.ClinicalTrials.gov Identifier: NCT03655717.
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Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - William A Schmitt
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Kevin Potter
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Gladys N Pachas
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah Hickey
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
| | - Meena Makary
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Faculty of Engineering, Cairo University, Cairo, Egypt
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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21
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Gilman JM, Schmitt WA, Wheeler G, Schuster RM, Klawitter J, Sempio C, Evins AE. Variation in Cannabinoid Metabolites Present in the Urine of Adults Using Medical Cannabis Products in Massachusetts. JAMA Netw Open 2021; 4:e215490. [PMID: 33844003 PMCID: PMC8042519 DOI: 10.1001/jamanetworkopen.2021.5490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/21/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jodi M. Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts
| | - William A. Schmitt
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Grace Wheeler
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Randi M. Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Jost Klawitter
- Department of Anesthesiology, University of Colorado, Aurora
| | - Cristina Sempio
- Department of Anesthesiology, University of Colorado, Aurora
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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22
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Cooke ME, Gilman JM, Lamberth E, Rychik N, Tervo-Clemmens B, Evins AE, Schuster RM. Assessing Changes in Symptoms of Depression and Anxiety During Four Weeks of Cannabis Abstinence Among Adolescents. Front Psychiatry 2021; 12:689957. [PMID: 34276449 PMCID: PMC8280499 DOI: 10.3389/fpsyt.2021.689957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/01/2021] [Accepted: 06/07/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Cannabis use is prevalent among adolescents, and many report using in attempts to alleviate negative mood and anxiety. Abstinence from substances such as alcohol and tobacco has been reported to improve symptoms of anxiety and depression. Few studies have examined the effect of cannabis abstinence on symptoms of anxiety and depression. Objective: To test the effect of 4 weeks of continuous cannabis abstinence on depressive and anxious symptoms. Methods: Healthy, non-treatment seeking adolescents who used cannabis at least weekly (n = 179) were randomized to either 4 weeks of cannabis abstinence achieved through a contingency management paradigm (CB-Abst) or cannabis use monitoring without an abstinence requirement (CB-Mon). Abstinence was assessed by self-report verified with quantitative assay of urine for cannabinoids. Anxiety and depressive symptoms were assessed weekly with the Mood and Anxiety Symptom Questionnaire (MASQ). Results: Symptoms of depression and anxiety decreased throughout the study for all participants (MASQ-AA: stnd beta = -0.08, p = 0.01, MASQ-GDA: stnd beta = -0.11, p = 0.003, MASQ-GDD: stnd beta = -0.08, p = 0.02) and did not differ significantly between randomization groups (p's > 0.46). Exploratory analyses revealed a trend that abstinence may be associated with greater improvement in symptoms of anxiety and depression among those using cannabis to cope with negative affect and those with potentially hazardous levels of cannabis use. Conclusions: Among adolescents who use cannabis at least weekly, 4 weeks of cannabis abstinence was not associated with a significant change in anxiety or depressive symptoms compared to continued use. For recreational cannabis users who may be concerned about reducing their use for fear of increased symptoms of anxiety and depression, findings suggest that significant symptom worsening may not occur within the first 4 weeks of abstinence. Further studies are needed in clinical populations where anxiety and depression symptoms are measured more frequently and for a longer period of abstinence. Future studies are also needed to determine whether there are subgroups of adolescents who are uniquely impacted by sustained cannabis abstinence.
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Affiliation(s)
- Megan E Cooke
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Jodi M Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Erin Lamberth
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Natali Rychik
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Brenden Tervo-Clemmens
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Randi M Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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23
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Schuster RM, Potter K, Lamberth E, Rychik N, Hareli M, Allen S, Broos HC, Mustoe A, Gilman JM, Pachas G, Evins AE. Alcohol substitution during one month of cannabis abstinence among non-treatment seeking youth. Prog Neuropsychopharmacol Biol Psychiatry 2020; 107:110205. [PMID: 33309538 PMCID: PMC7882030 DOI: 10.1016/j.pnpbp.2020.110205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Cannabis and alcohol use are correlated behaviors among youth. It is not known whether discontinuation of cannabis use is associated with changes in alcohol use. This study assessed alcohol use in youth before, during, and after 4 weeks of paid cannabis abstinence. METHODS Healthy, non-treatment seeking, cannabis users (n = 160), aged 14-25 years, 84% of whom used alcohol in the last month, were enrolled for a 4-week study with a 2-4 week follow-up. Participants were randomly assigned to 4 weeks of either biochemically-verified cannabis abstinence achieved through a contingency management framework (CB-Abst) or monitoring with no abstinence requirement (CB-Mon). Participants were assessed at baseline and approximately 4, 6, 10, 17, 24, and 31 days after enrollment. A follow-up visit with no cannabis abstinence requirement for CB-Abst was conducted after 2-4 weeks. RESULTS Sixty percent of individuals assigned to the CB-Abst condition increased in frequency and quantity of alcohol consumption during the 4-week period of incentivized cannabis abstinence. As a whole, CB-Abst increased by a mean of 0.6 drinking days and 0.2 drinks per day in the initial week of abstinence (p's < 0.006). There was no evidence for further increases in drinking frequency or quantity during the 30-day abstinence period (p's > 0.53). There was no change in drinking frequency or quantity during the 4-week monitoring or follow-up periods among CB-Mon. CONCLUSIONS On average, 4 weeks of incentivized (i.e., paid) cannabis abstinence among non-treatment seeking youth was associated with increased frequency and amount of alcohol use in week 1 that was sustained over 4 weeks and resolved with resumption of cannabis use. However, there was notable variability in individual-level response, with 60% increasing in alcohol use and 23% actually decreasing in alcohol use during cannabis abstinence. Findings suggest that increased alcohol use during cannabis abstinence among youth merits further study to determine whether this behavior occurs among treatment seeking youth and its clinical significance.
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Affiliation(s)
- Randi Melissa Schuster
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Kevin Potter
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Erin Lamberth
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Natali Rychik
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Maya Hareli
- Department of Psychology, Loyola University Chicago, United States of America
| | - Sophia Allen
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Hannah C Broos
- Department of Psychology, University of Miami, United States of America
| | - Audrey Mustoe
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Jodi M Gilman
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Gladys Pachas
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America
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Yeh CL, Levar N, Broos HC, Dechert A, Potter K, Evins AE, Gilman JM. White matter integrity differences associated with post-traumatic stress disorder are not normalized by concurrent marijuana use. Psychiatry Res Neuroimaging 2020; 295:111017. [PMID: 31760337 PMCID: PMC7730843 DOI: 10.1016/j.pscychresns.2019.111017] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/22/2022]
Abstract
Marijuana (MJ) use and post-traumatic stress disorder (PTSD) have both been associated with abnormalities in brain white matter tracts, including the cingulum and the anterior thalamic radiations (ATR), which project from subcortical regions to frontal cortex. Studies have not assessed the integrity of these tracts in patients with comorbid PTSD and MJ use. To examine effects of PTSD and MJ use on brain structure, we performed diffusion tensor imaging scans on seventy-two trauma-exposed participants, categorized into four groups: those with PTSD who used MJ at least weekly (PTSD+MJ; n = 20), those with PTSD with no regular MJ use (PTSD; n = 19), trauma-exposed controls without PTSD who used MJ (TEC+MJ; n = 14) and trauma-exposed controls with no PTSD or MJ use (TEC; n = 19). White matter integrity was evaluated by calculating fractional anisotropy (FA). Results showed that while FA values in the right ATR and the cingulum differed across groups, there were no significant interactions between PTSD and MJ in any white matter tracts, indicating that MJ exposure neither normalizes nor worsens white matter abnormalities in those with PTSD. Further study is needed to evaluate the impact of MJ use on other neurobiological markers of PTSD.
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Affiliation(s)
- Chien-Lin Yeh
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Nina Levar
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Hannah C Broos
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alyson Dechert
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin Potter
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jodi M Gilman
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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25
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Stangl BL, Schuster RM, Schneider A, Dechert A, Potter KW, Hareli M, Mahmud F, Yalin ER, Ramchandani VA, Gilman JM. Suggestibility is associated with alcohol self-administration, subjective alcohol effects, and self-reported drinking behavior. J Psychopharmacol 2019; 33:769-778. [PMID: 30829118 PMCID: PMC6936214 DOI: 10.1177/0269881119827813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Suggestibility, defined as an individual's inclination to accept and internalize messages, has not been studied in relation to alcohol use. Peer conformity, a component of suggestibility, may be related to alcohol use, as peer groups show similarities in patterns of alcohol use. Few studies have assessed how suggestibility and peer conformity relate to alcohol self-administration or to reinforcing effects of alcohol. AIMS This study assessed whether suggestibility and peer conformity were associated with drinking behavior, alcohol self-administration, subjective response to alcohol, and drinking motives and expectancies. METHODS Study 1 participants were alcohol drinkers (n=20), who completed a laboratory study of free-access intravenous alcohol self-administration. Study 2 participants were adolescents and young adults, age 14-25 (n=150), with lifetime alcohol use. Participants completed surveys of suggestibility and drinking patterns (Study 1 and 2), subjective alcohol effects (Study 1 only), and alcohol motives and expectancies (Study 2 only). RESULTS/OUTCOMES In Study 1, participants with higher levels of suggestiblity self-administered more alcohol, and reported greater subjective alcohol effects. Peer conformity, though correlated with suggestibility, was not related to these measures. In Study 2, participants with higher suggestiblity reported more alcohol consumption, higher drinking motives and alcohol expectancies. Peer conformity was not related to alcohol consumption, but was related to coping and enhancement drinking motives, and all expectancies measures. CONCLUSIONS/INTERPRETATION Results indicate that suggestibility, beyond peer conformity, may be a critical factor to study when examining alcohol consumption behavior, and may provide insight into the development of alcohol use disorder.
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Affiliation(s)
- Bethany L Stangl
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Randi M Schuster
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Alyssa Schneider
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Alyson Dechert
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin W Potter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Maya Hareli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Fahim Mahmud
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Elgin R Yalin
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Jodi M Gilman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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Gilman JM, Yücel MA, Pachas GN, Potter K, Levar N, Broos H, Manghis EM, Schuster RM, Evins AE. Delta-9-tetrahydrocannabinol intoxication is associated with increased prefrontal activation as assessed with functional near-infrared spectroscopy: A report of a potential biomarker of intoxication. Neuroimage 2019; 197:575-585. [PMID: 31075393 DOI: 10.1016/j.neuroimage.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/23/2018] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 11/17/2022] Open
Abstract
The primary psychoactive compound in cannabis, Δ9-tetrahydrocannabinol (THC), binds to cannabinoid receptors (CB1) present in high concentrations in the prefrontal cortex (PFC). It is unknown whether the PFC hemodynamic response changes with THC intoxication. We conducted the first double-blind, placebo-controlled, cross-over study of the effect of THC intoxication on functional near infrared spectroscopy (fNIRS) measures of PFC activation. Fifty-four adult, regular (at least weekly) cannabis users received a single oral dose of synthetic THC (dronabinol; 5-50 mg, dose individually tailored to produce intoxication) and identical placebo on two visits at least one week apart. fNIRS recordings were obtained during a working memory task (N-Back) at three timepoints: before THC/placebo, at 100 min (when peak effects were expected), and at 200 min after THC/placebo administration. Functional data were collected using a continuous-wave NIRS device, with 8 sources and 7 detectors arrayed over the forehead, resulting in 20 channels covering PFC regions. Participants also completed frequent heart rate measures and subjective ratings of intoxication. Approximately half of participants reported significant intoxication. Intoxication ratings were not correlated with dose of THC. Increases in heart rate significantly correlated with intoxication ratings after THC dosing. Results indicated that 100 min after THC administration, oxygenated hemoglobin (HbO) response significantly increased from pre-dose HbO levels throughout the PFC in participants who reported significant intoxication. Changes in HbO response significantly correlated with self-reported intoxication at 100 min after THC administration. Among those who reported intoxication, HbO response decreased at 200 min after THC, when intoxication had largely resolved, compared to the peak THC time point. This study demonstrates that THC intoxication causes increased PFC activity, and fNIRS of the PFC can measure this effect. Increased neural activation in PFC represents a potential biomarker for cannabis intoxication.
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Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Meryem A Yücel
- MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Neurophotonics Center, Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Gladys N Pachas
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Kevin Potter
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Nina Levar
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Hannah Broos
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
| | - Eve M Manghis
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
| | - Randi M Schuster
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Gilman JM. What Can Neuroimaging of Human Alcohol Drinkers Tell Us About Compulsive Alcohol Use? Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 3:983-984. [PMID: 30526944 DOI: 10.1016/j.bpsc.2018.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital Center for Addiction Medicine, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
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Levar N, Francis AN, Smith MJ, Ho WC, Gilman JM. Verbal Memory Performance and Reduced Cortical Thickness of Brain Regions Along the Uncinate Fasciculus in Young Adult Cannabis Users. Cannabis Cannabinoid Res 2018; 3:56-65. [PMID: 29607411 PMCID: PMC5870060 DOI: 10.1089/can.2017.0030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction: Memory impairment is one of the most commonly reported effects of cannabis use, especially among those who initiate use earlier, perhaps due to the effects of delta-9- tetrahydrocannabinol on cannabinoid (CB1) receptors in the brain. Studies have increasingly investigated whether cannabis use is associated with impairments in verbal memory, and with alterations in brain structures underlying verbal memory. The uncinate fasciculus (UF), a long-range white matter tract, connects regions with densely localized CB1 receptors that are important in verbal memory. This study investigated the impact of cannabis use on UF structures and its association with memory performance in young adult cannabis users (CU) and non-using controls (CON). Materials and Methods: Nineteen CU and 22 CON completed a verbal memory task and a neuroimaging protocol, in which diffusion tensor imaging and structural scans were collected. We compared memory performance, diffusion and tractography measures of the UF, and cortical thickness of regions connected by the UF, between CU and CON. In regions showing a significant group effect, we also examined associations between verbal memory performance, cortical thickness, and age of onset of cannabis use. Results: Compared to non-users, CU had worse memory performance, decreased fiber bundle length in the UF, and decreased cortical thickness of brain regions along the UF such as the entorhinal cortex and fusiform gyrus. Verbal memory performance was significantly associated with age of onset of cannabis use, indicating that those who initiated cannabis use at an earlier age performed worse. Cortical thickness of the entorhinal cortex was significantly correlated with age of first use and memory performance. Conclusion: This study provides evidence that cannabis use, especially when initiated at a young age, may be associated with worse verbal memory and altered neural development along the UF. Reductions in cortical thickness in regions implicated in memory processes may underlie weaknesses in verbal memory performance.
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Affiliation(s)
- Nina Levar
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Alan N Francis
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,McLean Imaging Center, McLean Hospital, Belmont, Massachusetts
| | - Matthew J Smith
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Wilson C Ho
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jodi M Gilman
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Gilman JM, Radoman M, Schuster RM, Pachas G, Azzouz N, Fava M, Evins AE. Anterior insula activation during inhibition to smoking cues is associated with ability to maintain tobacco abstinence. Addict Behav Rep 2018; 7:40-46. [PMID: 29450255 PMCID: PMC5805503 DOI: 10.1016/j.abrep.2018.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/28/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 11/04/2022] Open
Abstract
Relapse to smoking after initial abstinence is a major clinical challenge with significant public health consequences. At the brain and behavioral level, those who relapse to tobacco smoking have both greater cue-reactivity and lower inhibitory control than those who remain abstinent. Little is known about neural activation during inhibitory control tasks in the presence of drug-related cues. In the current study, tobacco smokers (SMK; n = 22) and non-smoking controls (CON; n = 19) completed a Go/NoGo task involving smoking cues during a functional magnetic resonance imaging (fMRI) scan. Following the scan session, smokers were required to quit smoking, and maintenance of abstinence was evaluated as part of a 12-week smoking cessation trial. We evaluated pre-cessation brain activity during NoGo trials in smokers who were versus were not able to quit smoking. We then compared fMRI and inhibitory control measures between smokers and non-smokers. We did not find differences between SMK and CON in performance or activation to smoking or neutral cues. However, compared to SMK who relapsed, SMK who attained biochemically-validated abstinence at the end of the smoking cessation trial had greater neural activation in the anterior insula during NoGo trials specifically with smoking-related cues. Results indicate that within SMK, decreased inhibitory control activation during direct exposure to drug-related stimuli may be a marker of difficulty quitting and relapse vulnerability. Smokers and controls showed no differences in performance or activation to smoking or neutral cues. Abstinent smokers compared to relapsers had greater activation in the insula during NoGo trials with smoking-related cues. Within smokers, decreased NoGo activation during exposure to drug-related cues may be a marker of relapse vulnerability.
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Affiliation(s)
- Jodi M Gilman
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, MGH, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Milena Radoman
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Randi M Schuster
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gladys Pachas
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Nour Azzouz
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA
| | - Maurizio Fava
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Massachusetts General Hospital (MGH), Department of Psychiatry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Janes AC, Gilman JM, Frederick BB, Radoman M, Pachas G, Fava M, Evins AE. Salience network coupling is linked to both tobacco smoking and symptoms of attention deficit hyperactivity disorder (ADHD). Drug Alcohol Depend 2018; 182:93-97. [PMID: 29175464 PMCID: PMC6585943 DOI: 10.1016/j.drugalcdep.2017.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) symptoms, even those below diagnostic threshold, enhance the likelihood of nicotine dependence, suggesting a neurobiological link between disorders. Of particular interest is the salience network (SN), which mediates attention to salient internal/external stimuli to guide behavior and is anchored by the dorsal anterior cingulate cortex (dACC) and bilateral anterior insula (AI). Disrupted interactions between the SN and the default mode (DMN) and central executive networks (CEN) have been noted in both ADHD and nicotine dependence. Further, enhanced intra-SN coupling between the dACC-AI influences aspects of nicotine dependence such as reactivity to smoking cues. METHODS To identify links between SN functional connectivity and ADHD symptoms in nicotine dependence, we compared 21 nicotine dependent individuals with 17 non-smokers on ADHD symptoms as measured by the ADHD self-report scale (ASRS) and resting state intra and inter-SN functional connectivity. RESULTS Relative to healthy controls, nicotine dependent individuals had significantly higher ASRS scores and greater dACC-AI coupling. No group differences were noted on inter-SN network coupling. A significant association was found between ASRS and dACC-AI coupling both in the entire cohort and specifically when evaluating nicotine dependent individuals alone. CONCLUSIONS The greater ASRS scores in nicotine dependent individuals is in line with existent literature and the stronger dACC-AI coupling in smokers further supports the role of this network in nicotine dependence. The significant association between dACC-AI coupling and ASRS suggests that intra-SN coupling strength may impact neurocognitive functioning associated with both ADHD symptoms and nicotine dependence.
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Affiliation(s)
- A C Janes
- McLean Imaging Center, McLean Hospital, Belmont, MA, 02478, USA; Harvard Medical School, Boston, MA, USA.
| | - J M Gilman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, MGH, Charlestown, MA, USA,; Harvard Medical School, Boston, MA, USA
| | - B B Frederick
- McLean Imaging Center, McLean Hospital, Belmont, MA, 02478, USA; Harvard Medical School, Boston, MA, USA
| | - M Radoman
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA
| | - G Pachas
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - M Fava
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - A E Evins
- Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Keles HO, Radoman M, Pachas GN, Evins AE, Gilman JM. Using Functional Near-Infrared Spectroscopy to Measure Effects of Delta 9-Tetrahydrocannabinol on Prefrontal Activity and Working Memory in Cannabis Users. Front Hum Neurosci 2017; 11:488. [PMID: 29066964 PMCID: PMC5641318 DOI: 10.3389/fnhum.2017.00488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 07/06/2017] [Accepted: 09/22/2017] [Indexed: 11/13/2022] Open
Abstract
Intoxication from cannabis impairs cognitive performance, in part due to the effects of Δ9-tetrahydrocannabinol (THC, the primary psychoactive compound in cannabis) on prefrontal cortex (PFC) function. However, a relationship between impairment in cognitive functioning with THC administration and THC-induced change in hemodynamic response has not been demonstrated. We explored the feasibility of using functional near-infrared spectroscopy (fNIRS) to examine the functional changes of the human PFC associated with cannabis intoxication and cognitive impairment. Eighteen adult regular cannabis users (final sample, n = 13) performed a working memory task (n-back) during fNIRS recordings, before and after receiving a single dose of oral synthetic THC (dronabinol; 20–50 mg). Functional data were collected using a continuous-wave NIRS device, in which 8 Sources and 7 detectors were placed on the forehead, resulting in 20 channels covering PFC regions. Physiological changes and subjective intoxication measures were collected. We found a significant increase in the oxygenated hemoglobin (HbO) concentration after THC administration in several channels on the PFC during both the high working memory load (2-back) and the low working memory load (0-back) condition. The increased HbO response was accompanied by a trend toward an increased number of omission errors after THC administration. The current study suggests that cannabis intoxication is associated with increases in hemodynamic blood flow to the PFC, and that this increase can be detected with fNIRS.
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Affiliation(s)
- Hasan O Keles
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Milena Radoman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Gladys N Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, United States
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Jodi M Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, United States
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Gilman JM, Lee S, Kuster JK, Lee MJ, Kim BW, van der Kouwe A, Blood AJ, Breiter HC. Variable activation in striatal subregions across components of a social influence task in young adult cannabis users. Brain Behav 2016; 6:e00459. [PMID: 27257518 PMCID: PMC4873656 DOI: 10.1002/brb3.459] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 07/29/2015] [Revised: 01/27/2016] [Accepted: 02/28/2016] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Decades of research have demonstrated the importance of social influence in initiation and maintenance of drug use, but little is known about neural mechanisms underlying social influence in young adults who use recreational drugs. METHODS To better understand whether the neural and/or behavioral response to social influence differs in young adults using illicit drugs, 20 marijuana-using young adults (MJ) aged 18-25, and 20 controls (CON) performed a decision-making task in the context of social influence, while they underwent functional magnetic resonance imaging scans. A priori analyses focused on the nucleus accumbens (NAc), with post hoc analyses in the rest of the striatum. In this task, participants could choose to either follow or go against group influence. RESULTS When subjects applied social information to response choice selection (independent of following or going against group influence), we observed activation in the middle striatum (caudate), in the MJ group only, that extended ventrally into the NAc. MJ users but not CON showed greater activation in the NAc but not the caudate while making choices congruent with group influence as opposed to choices going against group influence. Activation in the NAc when following social influence was associated with amount of drug use reported. In contrast, during the feedback phase of the task we observed significant NAc activation in both MJ and CON, along with dorsal caudate activation only in MJ participants. This NAc activation did not correlate with drug use. CONCLUSIONS This study shows that MJ users, but not CON, show differential brain activation across striatal subregions when applying social information to make a decision, following versus going against a group of peers, or receiving positive feedback. The current work suggests that differential neural sensitivity to social influence in regions such as the striatum may contribute to the development and/or maintenance of marijuana use.
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Affiliation(s)
- Jodi M Gilman
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Athinoula A. Martinos Center in Biomedical Imaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129; Harvard Medical School Boston Massachusetts 02115
| | - Sang Lee
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129
| | - John K Kuster
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Mood and Motor Control Laboratory Massachusetts General Hospital Charlestown Massachusetts 02129
| | - Myung Joo Lee
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences Northwestern University Feinberg School of Medicine Chicago Illinois 06011
| | - Byoung Woo Kim
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences Northwestern University Feinberg School of Medicine Chicago Illinois 06011
| | - Andre van der Kouwe
- Athinoula A. Martinos Center in Biomedical Imaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129; Harvard Medical School Boston Massachusetts 02115; Laboratory for Computational Neuroimaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129
| | - Anne J Blood
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Athinoula A. Martinos Center in Biomedical Imaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129; Harvard Medical School Boston Massachusetts 02115; Mood and Motor Control Laboratory Massachusetts General Hospital Charlestown Massachusetts 02129
| | - Hans C Breiter
- Laboratory of Neuroimaging and Genetics Department of Psychiatry Massachusetts General Hospital (MGH) Charlestown Massachusetts 02129; Athinoula A. Martinos Center in Biomedical Imaging Department of Radiology Massachusetts General Hospital Charlestown Massachusetts 02129; Harvard Medical School Boston Massachusetts 02115; Warren Wright Adolescent Center Department of Psychiatry and Behavioral Sciences Northwestern University Feinberg School of Medicine Chicago Illinois 06011; Mood and Motor Control Laboratory Massachusetts General Hospital Charlestown Massachusetts 02129
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Abstract
OBJECTIVE Verbal memory difficulties are the most widely reported and persistent cognitive deficit associated with early onset marijuana use. Yet, it is not known what memory stages are most impaired in those with early marijuana use. METHOD Forty-eight young adults, aged 18-25, who used marijuana at least once per week and 48 matched nonusing controls (CON) completed the California Verbal Learning Test, Second Edition (CVLT-II). Marijuana users were stratified by age of initial use: early onset users (EMJ), who started using marijuana at or before age 16 (n = 27), and late onset marijuana user group (LMJ), who started using marijuana after age 16 (n = 21). Outcome variables included trial immediate recall, total learning, clustering strategies (semantic clustering, serial clustering, ratio of semantic to serial clustering, and total number of strategies used), delayed recall, and percent retention. RESULTS Learning improved with repetition, with no group effect on the learning slope. EMJ learned fewer words overall than LMJ or CON. There was no difference between LMJ and CON in total number of words learned. Reduced overall learning mediated the effect on reduced delayed recall among EMJ, but not CON or LMJ. Learning improved with greater use of semantic versus serial encoding, but this did not vary between groups. EMJ was not related to delayed recall after adjusting for encoding. CONCLUSIONS Young adults reporting early onset marijuana use had learning weaknesses, which accounted for the association between early onset marijuana use and delayed recall. No amnestic effect of marijuana use was observed. (PsycINFO Database Record
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Affiliation(s)
| | - Susanne S Hoeppner
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital
| | - Jodi M Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital
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Gilman JM, Curran MT, Calderon V, Schuster RM, Evins AE. Altered Neural Processing to Social Exclusion in Young Adult Marijuana Users. Biol Psychiatry Cogn Neurosci Neuroimaging 2015; 1:152-159. [PMID: 26977454 DOI: 10.1016/j.bpsc.2015.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies have reported that peer groups are one of the most important predictors of adolescent and young adult marijuana use, and yet the neural correlates of social processing in marijuana users have not yet been studied. In the current study, marijuana-using young adults (n = 20) and non-using controls (n = 22) participated in a neuroimaging social exclusion task called Cyberball, a computerized ball-tossing game in which the participant is excluded from the game after a pre-determined number of ball tosses. Controls, but not marijuana users, demonstrated significant activation in the insula, a region associated with negative emotion, when being excluded from the game. Both groups demonstrated activation of the ventral anterior cingulate cortex (vACC), a region associated with affective monitoring, during peer exclusion. Only the marijuana group showed a correlation between vACC activation and scores on a self-report measure of peer conformity. This study indicates that marijuana users show atypical neural processing of social exclusion, which may be either caused by, or the result of, regular marijuana use.
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Affiliation(s)
- Jodi M Gilman
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA; Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, MGH, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Max T Curran
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA
| | - Vanessa Calderon
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA
| | - Randi M Schuster
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA; Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital (MGH) Department of Psychiatry, Boston, MA; Harvard Medical School, Boston, MA, USA
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Lee S, Lee MJ, Kim BW, Gilman JM, Kuster JK, Blood AJ, Kuhnen CM, Breiter HC. The Commonality of Loss Aversion across Procedures and Stimuli. PLoS One 2015; 10:e0135216. [PMID: 26394306 PMCID: PMC4579072 DOI: 10.1371/journal.pone.0135216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/20/2015] [Indexed: 11/27/2022] Open
Abstract
Individuals tend to give losses approximately 2-fold the weight that they give gains. Such approximations of loss aversion (LA) are almost always measured in the stimulus domain of money, rather than objects or pictures. Recent work on preference-based decision-making with a schedule-less keypress task (relative preference theory, RPT) has provided a mathematical formulation for LA similar to that in prospect theory (PT), but makes no parametric assumptions in the computation of LA, uses a variable tied to communication theory (i.e., the Shannon entropy or information), and works readily with non-monetary stimuli. We evaluated if these distinct frameworks described similar LA in healthy subjects, and found that LA during the anticipation phase of the PT-based task correlated significantly with LA related to the RPT-based task. Given the ease with which non-monetary stimuli can be used on the Internet, or in animal studies, these findings open an extensive range of applications for the study of loss aversion. Furthermore, the emergence of methodology that can be used to measure preference for both social stimuli and money brings a common framework to the evaluation of preference in both social psychology and behavioral economics.
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Affiliation(s)
- Sang Lee
- Warren Wright Adolescent Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA, United States of America
- Massachusetts General Hospital and Northwestern University Phenotype Genotype Project in Addiction and Mood Disorders
| | - Myung J. Lee
- Warren Wright Adolescent Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA, United States of America
- Massachusetts General Hospital and Northwestern University Phenotype Genotype Project in Addiction and Mood Disorders
| | - Byoung W. Kim
- Warren Wright Adolescent Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA, United States of America
- Massachusetts General Hospital and Northwestern University Phenotype Genotype Project in Addiction and Mood Disorders
| | - Jodi M. Gilman
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA, United States of America
- Massachusetts General Hospital and Northwestern University Phenotype Genotype Project in Addiction and Mood Disorders
| | - John K. Kuster
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA, United States of America
- Mood and Motor Control Laboratory, MGH and HMS, Boston, MA, United States of America
- Massachusetts General Hospital and Northwestern University Phenotype Genotype Project in Addiction and Mood Disorders
| | - Anne J. Blood
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA, United States of America
- Mood and Motor Control Laboratory, MGH and HMS, Boston, MA, United States of America
- Massachusetts General Hospital and Northwestern University Phenotype Genotype Project in Addiction and Mood Disorders
| | - Camelia M. Kuhnen
- Kenan-Flagler Business School, University of North Carolina, Chapel Hill, NC, United States of America
| | - Hans C. Breiter
- Warren Wright Adolescent Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA, United States of America
- Mood and Motor Control Laboratory, MGH and HMS, Boston, MA, United States of America
- Massachusetts General Hospital and Northwestern University Phenotype Genotype Project in Addiction and Mood Disorders
- * E-mail:
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Gilman JM, Treadway MT, Curran MT, Calderon V, Evins AE. Effect of social influence on effort-allocation for monetary rewards. PLoS One 2015; 10:e0126656. [PMID: 25961725 PMCID: PMC4427110 DOI: 10.1371/journal.pone.0126656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 04/06/2015] [Indexed: 01/31/2023] Open
Abstract
Though decades of research have shown that people are highly influenced by peers, few studies have directly assessed how the value of social conformity is weighed against other types of costs and benefits. Using an effort-based decision-making paradigm with a novel social influence manipulation, we measured how social influence affected individuals’ decisions to allocate effort for monetary rewards during trials with either high or low probability of receiving a reward. We found that information about the effort-allocation of peers modulated participant choices, specifically during conditions of low probability of obtaining a reward. This suggests that peer influence affects effort-based choices to obtain rewards especially under conditions of risk. This study provides evidence that people value social conformity in addition to other costs and benefits when allocating effort, and suggests that neuroeconomic studies that assess trade-offs between effort and reward should consider social environment as a factor that can influence decision-making.
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Affiliation(s)
- Jodi M. Gilman
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, United States of America
- * E-mail:
| | - Michael T. Treadway
- Emory University, Department of Psychology, Atlanta, Georgia, United States of America
| | - Max T. Curran
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Vanessa Calderon
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - A. Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, United States of America
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Gilman JM, Smith AR, Bjork JM, Ramchandani VA, Momenan R, Hommer DW. Cumulative gains enhance striatal response to reward opportunities in alcohol-dependent patients. Addict Biol 2015; 20:580-93. [PMID: 24754451 DOI: 10.1111/adb.12147] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Substance use disorder is characterized by a transition from volitional to compulsive responding for drug reward. A possible explanation for this transition may be that alcohol-dependent patients (ADP) show a general propensity for a history of rewarded instrumental responses, and these rewarded responses may boost the activation of motivational neurocircuitry for additional reward. Brain imaging studies of decision-making have demonstrated that ADP relative to controls (CON) often show altered neural activation in response to anticipating and receiving rewards, but the majority of studies have not investigated how past performance affects activation. A potential exists for ADP to show increased sensitivity to reward as a function of reward delivery history. In the current study, we used functional magnetic resonance imaging to investigate the neural correlates of risky decision-making in ADP (n = 18) and CON (n = 18) while they played a two-choice monetary risk-taking game. In addition to investigating general neural recruitment by risky decision-making, we also modeled each participant's running total of monetary earnings in order to determine areas of activation that correlated with cumulative reward. We found that ADP and CON showed few differences in behavior or in mesolimbic activation by choice for, and receipt of, risky gains. However, when including a cumulative-earnings covariate, ADP exhibited heightened striatal activation that correlated with total earnings during the choice event in the task. The heightened contextual sensitivity of striatal responses to cumulative earnings in ADP may represent a general neurobiological affective substrate for development of automatized instrumental behavior.
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Affiliation(s)
- Jodi M. Gilman
- Center for Addiction Medicine; Massachusetts General Hospital; Boston MA USA
| | - Ashley R. Smith
- Department of Psychology; Neurocognition Laboratory; Temple University; Philadelphia PA USA
| | - James M. Bjork
- Clinical Neuroscience Branch; Division of Clinical Neuroscience and Behavioral Research; National Institute on Drug Abuse; Bethesda MD USA
| | - Vijay A. Ramchandani
- Section on Human Psychopharmacology; Laboratory of Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
| | - Reza Momenan
- Section of Brain Electrophysiology and Imaging; Laboratory of Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
| | - Daniel W. Hommer
- Section of Brain Electrophysiology and Imaging; Laboratory of Clinical and Translational Studies; National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health; Bethesda MD USA
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Viswanathan V, Lee S, Gilman JM, Kim BW, Lee N, Chamberlain L, Livengood SL, Raman K, Lee MJ, Kuster J, Stern DB, Calder B, Mulhern FJ, Blood AJ, Breiter HC. Age-related striatal BOLD changes without changes in behavioral loss aversion. Front Hum Neurosci 2015; 9:176. [PMID: 25983682 PMCID: PMC4415398 DOI: 10.3389/fnhum.2015.00176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 04/23/2014] [Accepted: 03/15/2015] [Indexed: 12/21/2022] Open
Abstract
Loss aversion (LA), the idea that negative valuations have a higher psychological impact than positive ones, is considered an important variable in consumer research. The literature on aging and behavior suggests older individuals may show more LA, although it is not clear if this is an effect of aging in general (as in the continuum from age 20 and 50 years), or of the state of older age (e.g., past age 65 years). We also have not yet identified the potential biological effects of aging on the neural processing of LA. In the current study we used a cohort of subjects with a 30 year range of ages, and performed whole brain functional MRI (fMRI) to examine the ventral striatum/nucleus accumbens (VS/NAc) response during a passive viewing of affective faces with model-based fMRI analysis incorporating behavioral data from a validated approach/avoidance task with the same stimuli. Our a priori focus on the VS/NAc was based on (1) the VS/NAc being a central region for reward/aversion processing; (2) its activation to both positive and negative stimuli; (3) its reported involvement with tracking LA. LA from approach/avoidance to affective faces showed excellent fidelity to published measures of LA. Imaging results were then compared to the behavioral measure of LA using the same affective faces. Although there was no relationship between age and LA, we observed increasing neural differential sensitivity (NDS) of the VS/NAc to avoidance responses (negative valuations) relative to approach responses (positive valuations) with increasing age. These findings suggest that a central region for reward/aversion processing changes with age, and may require more activation to produce the same LA behavior as in younger individuals, consistent with the idea of neural efficiency observed with high IQ individuals showing less brain activation to complete the same task.
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Affiliation(s)
- Vijay Viswanathan
- Medill Integrated Marketing Communications, Northwestern University Evanston, IL, USA ; Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA
| | - Sang Lee
- Mood and Motor Control Laboratory or Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA ; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine Chicago, IL, USA ; Northwestern University and Massachusetts General Hospital Phenotype Genotype Project in Addiction and Mood Disorders Chicago, IL, USA
| | - Jodi M Gilman
- Mood and Motor Control Laboratory or Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA
| | - Byoung Woo Kim
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Mood and Motor Control Laboratory or Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA ; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine Chicago, IL, USA ; Northwestern University and Massachusetts General Hospital Phenotype Genotype Project in Addiction and Mood Disorders Chicago, IL, USA
| | - Nick Lee
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Marketing Group, Aston Business School Birmingham, UK
| | - Laura Chamberlain
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Marketing Group, Aston Business School Birmingham, UK
| | - Sherri L Livengood
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine Chicago, IL, USA
| | - Kalyan Raman
- Medill Integrated Marketing Communications, Northwestern University Evanston, IL, USA ; Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine Chicago, IL, USA ; Department of Marketing, Kellogg School of Management, Northwestern University Evanston, IL, USA
| | - Myung Joo Lee
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Mood and Motor Control Laboratory or Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA ; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine Chicago, IL, USA ; Northwestern University and Massachusetts General Hospital Phenotype Genotype Project in Addiction and Mood Disorders Chicago, IL, USA
| | - Jake Kuster
- Mood and Motor Control Laboratory or Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA ; Northwestern University and Massachusetts General Hospital Phenotype Genotype Project in Addiction and Mood Disorders Chicago, IL, USA
| | - Daniel B Stern
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine Chicago, IL, USA
| | - Bobby Calder
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Department of Marketing, Kellogg School of Management, Northwestern University Evanston, IL, USA
| | - Frank J Mulhern
- Medill Integrated Marketing Communications, Northwestern University Evanston, IL, USA ; Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA
| | - Anne J Blood
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Mood and Motor Control Laboratory or Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA ; Northwestern University and Massachusetts General Hospital Phenotype Genotype Project in Addiction and Mood Disorders Chicago, IL, USA
| | - Hans C Breiter
- Applied Neuromarketing Consortium: Northwestern University, Wayne State University, University of Michigan, Loughborough University School of Business and Economics (UK) and Massachusetts General Hospital/Harvard University Chicago, IL, USA ; Mood and Motor Control Laboratory or Laboratory of Neuroimaging and Genetics, Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA ; Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine Chicago, IL, USA ; Northwestern University and Massachusetts General Hospital Phenotype Genotype Project in Addiction and Mood Disorders Chicago, IL, USA
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Smith MJ, Cobia DJ, Reilly JL, Gilman JM, Roberts AG, Alpert KI, Wang L, Breiter HC, Csernansky JG. Cannabis-related episodic memory deficits and hippocampal morphological differences in healthy individuals and schizophrenia subjects. Hippocampus 2015; 25:1042-51. [PMID: 25760303 DOI: 10.1002/hipo.22427] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 11/24/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 11/07/2022]
Abstract
Cannabis use has been associated with episodic memory (EM) impairments and abnormal hippocampus morphology among both healthy individuals and schizophrenia subjects. Considering the hippocampus' role in EM, research is needed to evaluate the relationship between cannabis-related hippocampal morphology and EM among healthy and clinical groups. We examined differences in hippocampus morphology between control and schizophrenia subjects with and without a past (not current) cannabis use disorder (CUD). Subjects group-matched on demographics included 44 healthy controls (CON), 10 subjects with a CUD history (CON-CUD), 28 schizophrenia subjects with no history of substance use disorders (SCZ), and 15 schizophrenia subjects with a CUD history (SCZ-CUD). Large-deformation, high-dimensional brain mapping with MRI produced surface-based representations of the hippocampus that were compared across all four groups and correlated with EM and CUD history. Surface maps of the hippocampus were generated to visualize morphological differences. CON-CUD and SCZ-CUD were characterized by distinct cannabis-related hippocampal shape differences and parametric deficits in EM performance. Shape differences observed in CON-CUD were associated with poorer EM performance, while shape differences observed in SCZ-CUD were associated with a longer duration of CUD and shorter duration of CUD remission. A past history of CUD may be associated with notable differences in hippocampal morphology and EM impairments among adults with and without schizophrenia. Although the results may be compatible with a causal hypothesis, we must consider that the observed cannabis-related shape differences in the hippocampus could also be explained as biomarkers of a neurobiological susceptibility to poor memory or the effects of cannabis.
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Affiliation(s)
- Matthew J Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Warren Wright Adolescent Center, Chicago, Illinois
| | - Derin J Cobia
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Warren Wright Adolescent Center, Chicago, Illinois
| | - James L Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Warren Wright Adolescent Center, Chicago, Illinois
| | - Jodi M Gilman
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrea G Roberts
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Warren Wright Adolescent Center, Chicago, Illinois
| | - Kathryn I Alpert
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hans C Breiter
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Warren Wright Adolescent Center, Chicago, Illinois
| | - John G Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Gilman JM, Calderon V, Curran MT, Evins AE. Young adult cannabis users report greater propensity for risk-taking only in non-monetary domains. Drug Alcohol Depend 2015; 147:26-31. [PMID: 25577478 PMCID: PMC4297698 DOI: 10.1016/j.drugalcdep.2014.12.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/09/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Though substance use is often associated with elevated risk-taking in real-world scenarios, many risk-taking tasks in experimental psychology using financial gambles fail to find significant differences between individuals with substance use disorders and healthy controls. We assessed whether participants using marijuana would show a greater propensity for risk-taking in distinct domains including, but not limited to, financial risk-taking. METHODS In the current study, we assessed risk-taking in young adult (age 18-25) regular marijuana users and in non-using control participants using a domain-specific risk-taking self-report scale (DOSPERT) encompassing five domains of risk-taking (social, financial, recreational, health/safety, and ethical). We also measured behavioral risk-taking using a laboratory monetary risk-taking task. RESULTS Marijuana users and controls reported significant differences on the social, health/safety, and ethical risk-taking scales, but no differences in the propensity to take recreational or financial risks. Complementing the self-report finding, there were no differences between marijuana users and controls in their performance on the laboratory risk-taking task. CONCLUSIONS These findings suggest that financial risk-taking may be less sensitive than other domains of risk-taking in assessing differences in risky behavior between those who use marijuana and those who do not. In order to more consistently determine whether increased risk-taking is a factor in substance use, it may be necessary to use both monetary risk-taking tasks and complementary assessments of non-monetary-based risk-taking measures.
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Bjork JM, Gilman JM. The effects of acute alcohol administration on the human brain: insights from neuroimaging. Neuropharmacology 2014; 84:101-10. [PMID: 23978384 PMCID: PMC3971012 DOI: 10.1016/j.neuropharm.2013.07.039] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [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: 02/21/2013] [Revised: 07/26/2013] [Accepted: 07/29/2013] [Indexed: 02/05/2023]
Abstract
Over the last quarter century, researchers have peered into the living human brain to develop and refine mechanistic accounts of alcohol-induced behavior, as well as neurobiological mechanisms for development and maintenance of addiction. These in vivo neuroimaging studies generally show that acute alcohol administration affects brain structures implicated in motivation and behavior control, and that chronic intoxication is correlated with structural and functional abnormalities in these same structures, where some elements of these decrements normalize with extended sobriety. In this review, we will summarize recent findings about acute human brain responses to alcohol using neuroimaging techniques, and how they might explain behavioral effects of alcohol intoxication. We then briefly address how chronic alcohol intoxication (as inferred from cross-sectional differences between various drinking populations and controls) may yield individual brain differences between drinking subjects that may confound interpretation of acute alcohol administration effects. This article is part of the Special Issue Section entitled 'Neuroimaging in Neuropharmacology'.
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Affiliation(s)
- James M Bjork
- Division of Clinical Neuroscience and Behavioral Research, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd, Room 3163, Bethesda, MD 20892, USA.
| | - Jodi M Gilman
- Laboratory of Neuroimaging and Genetics, MGH Division of Psychiatric Neuroscience, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
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Stoeckel LE, Garrison KA, Ghosh S, Wighton P, Hanlon CA, Gilman JM, Greer S, Turk-Browne NB, deBettencourt MT, Scheinost D, Craddock C, Thompson T, Calderon V, Bauer CC, George M, Breiter HC, Whitfield-Gabrieli S, Gabrieli JD, LaConte SM, Hirshberg L, Brewer JA, Hampson M, Van Der Kouwe A, Mackey S, Evins AE. Optimizing real time fMRI neurofeedback for therapeutic discovery and development. Neuroimage Clin 2014; 5:245-55. [PMID: 25161891 PMCID: PMC4141981 DOI: 10.1016/j.nicl.2014.07.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/20/2014] [Accepted: 07/05/2014] [Indexed: 11/06/2022]
Abstract
While reducing the burden of brain disorders remains a top priority of organizations like the World Health Organization and National Institutes of Health, the development of novel, safe and effective treatments for brain disorders has been slow. In this paper, we describe the state of the science for an emerging technology, real time functional magnetic resonance imaging (rtfMRI) neurofeedback, in clinical neurotherapeutics. We review the scientific potential of rtfMRI and outline research strategies to optimize the development and application of rtfMRI neurofeedback as a next generation therapeutic tool. We propose that rtfMRI can be used to address a broad range of clinical problems by improving our understanding of brain–behavior relationships in order to develop more specific and effective interventions for individuals with brain disorders. We focus on the use of rtfMRI neurofeedback as a clinical neurotherapeutic tool to drive plasticity in brain function, cognition, and behavior. Our overall goal is for rtfMRI to advance personalized assessment and intervention approaches to enhance resilience and reduce morbidity by correcting maladaptive patterns of brain function in those with brain disorders. Guidelines are proposed for studies of rtfMRI neurofeedback for clinical therapeutics. Evidence-based guidelines are needed for clinical trials of rtfMRI neurofeedback. These guidelines will shape the design of future clinical trials.
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Affiliation(s)
- L E Stoeckel
- Massachusetts General Hospital, Department of Psychiatry, USA ; Harvard Medical School, USA ; Athinoula A. Martinos Center, USA ; McGovern Institute for Brain Research, Massachusetts Institute of Technology, USA
| | - K A Garrison
- Yale University School of Medicine, Department of Psychiatry, USA
| | - S Ghosh
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, USA
| | - P Wighton
- Athinoula A. Martinos Center, USA ; Massachusetts General Hospital, Department of Radiology, USA
| | - C A Hanlon
- Department of Psychiatry, Medical University of South Carolina, USA
| | - J M Gilman
- Massachusetts General Hospital, Department of Psychiatry, USA ; Harvard Medical School, USA ; Athinoula A. Martinos Center, USA
| | - S Greer
- Department of Neuroscience, University of California, Berkeley, USA
| | | | | | - D Scheinost
- Department of Diagnostic Radiology, Yale University School of Medicine, USA
| | | | - T Thompson
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, USA
| | - V Calderon
- Massachusetts General Hospital, Department of Psychiatry, USA
| | - C C Bauer
- Universidad Nacional Autonoma de Mexico, Instituto de Neurobiologia, Mexico
| | - M George
- Department of Psychiatry, Medical University of South Carolina, USA
| | - H C Breiter
- Massachusetts General Hospital, Department of Psychiatry, USA ; Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - S Whitfield-Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, USA
| | - J D Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, USA
| | - S M LaConte
- School of Biomedical Engineering and Sciences, Virginia Tech, USA ; Virginia Tech Carilion Research Institute, USA
| | - L Hirshberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, USA
| | - J A Brewer
- Yale University School of Medicine, Department of Psychiatry, USA ; Department of Medicine and Psychiatry, University of Massachusetts Medical School, USA
| | - M Hampson
- Department of Diagnostic Radiology, Yale University School of Medicine, USA
| | - A Van Der Kouwe
- Athinoula A. Martinos Center, USA ; Massachusetts General Hospital, Department of Radiology, USA
| | - S Mackey
- Department of Anesthesia, Stanford University School of Medicine, USA
| | - A E Evins
- Massachusetts General Hospital, Department of Psychiatry, USA ; Harvard Medical School, USA
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Gilman JM, Smith AR, Ramchandani VA, Momenan R, Hommer DW. The effect of intravenous alcohol on the neural correlates of risky decision making in healthy social drinkers. Addict Biol 2012; 17:465-78. [PMID: 21995446 DOI: 10.1111/j.1369-1600.2011.00383.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Alcohol is thought to contribute to an increase in risk-taking behavior, but the neural correlates underlying this effect are not well understood. In this study, participants were given intravenous alcohol or placebo while undergoing functional magnetic resonance imaging (fMRI) and playing a risk-taking game. The game allowed us to examine the neural response to choosing a safe or risky option, anticipating outcome and receiving feedback. We found that alcohol increased risk-taking behavior, particularly among participants who experienced more stimulating effects of alcohol. fMRI scans demonstrated that alcohol increased activation in the striatum to risky compared with safe choices and dampened the neural response to notification of both winning and losing throughout the caudate, thalamus and insula. This study suggests that alcohol may increase risk-taking behavior by both activating brain regions involved in reward when a decision is made, and dampening the response to negative and positive feedback.
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Affiliation(s)
- Jodi M Gilman
- Section of Brain Electrophysiology and Imaging, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
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Gilman JM, Ramchandani VA, Crouss T, Hommer DW. Subjective and neural responses to intravenous alcohol in young adults with light and heavy drinking patterns. Neuropsychopharmacology 2012; 37:467-77. [PMID: 21956438 PMCID: PMC3242308 DOI: 10.1038/npp.2011.206] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [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] [Indexed: 11/09/2022]
Abstract
Heavy alcohol consumption during young adulthood is a risk factor for the development of serious alcohol use disorders. Research has shown that individual differences in subjective responses to alcohol may affect individuals' vulnerability to developing alcoholism. Studies comparing the subjective and objective response to alcohol between light and heavy drinkers (HDs), however, have yielded inconsistent results, and neural responses to alcohol in these groups have not been characterized. We performed a double-blind, placebo-controlled, randomized crossover alcohol challenge study comparing functional magnetic resonance imaging and subjective response to intravenously administered 6% v/v ethanol to a target blood alcohol concentration of 0.08% or placebo between HDs and social drinkers (SDs). During the imaging, we presented emotional cues in order to measure how emotion modulated the effects of alcohol on the brain's reward circuitry. We found that, at equivalent blood alcohol concentrations, HDs reported lower subjective alcohol effects than SDs. Alcohol significantly activated the nucleus accumbens in SDs, but not in HDs. Self-reported ratings of intoxication correlated with striatal activation, suggesting that activation may reflect subjective experience of intoxication. Fearful faces significantly activated the amygdala in the SDs only, and this activation was attenuated by alcohol. This study shows that HDs not only experience reduced subjective effects of alcohol, but also demonstrate a blunted response to alcohol in the brain's reward system. Our findings indicate that reduced subjective and neural response to alcohol in HDs may be suggestive of either the development of tolerance to alcohol, or of pre-existing decreased sensitivity to alcohol's effects.
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Affiliation(s)
- Jodi M Gilman
- Section of Brain Electrophysiology and Imaging, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Vijay A Ramchandani
- Section of Brain Electrophysiology and Imaging, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Tess Crouss
- Section of Brain Electrophysiology and Imaging, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Daniel W Hommer
- Section of Brain Electrophysiology and Imaging, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
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Abstract
We compare the evidence from human neuroimaging studies for and against two of the major hypotheses of how alterations in the brain's reward system underlie addiction. One of these, the impulsivity hypothesis, proposes that addiction is characterized by excessive sensitivity to reward combined with a failure of inhibition. The other, the reward-deficiency hypothesis, proposes that addicted individuals have a reduced response to nondrug rewards that leads them to seek drugs in preference to more socially acceptable goals. Positron emission tomographic (PET) studies of dopamine receptor density and dopamine release strongly support the reward-deficiency hypothesis, while the more recent and numerous functional magnetic resonance imaging (fMRI) studies of goal-directed behavior provide both support and contradiction for each of the hypotheses. Differences in the time scale on which PET and fMRI make measurements probably account for differences in results, at least in part. It is likely that aspects of brain function described by both the impulsivity and reward-deficiency hypotheses contribute to the pathophysiology of addiction.
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Affiliation(s)
- Daniel W Hommer
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892, USA.
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Gilman JM, Davis MB, Hommer DW. Greater activation in left hemisphere language-related regions during simple judgment tasks among substance-dependent patients in treatment for alcoholism. Alcohol Clin Exp Res 2009; 34:331-41. [PMID: 19951293 DOI: 10.1111/j.1530-0277.2009.01095.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcoholism is often associated with impaired emotional control. Alcoholics have also been found to have deficits in frontal lobe executive functions. Recent functional imaging studies have suggested that alcoholics show greater activation than nonalcoholics in circuits involving frontal lobes, as well as more posterior brain regions, when engaged in executive-type tasks. In this study, we compared brain activations of alcohol-dependent patients and healthy nonalcoholics while they performed 2 simple judgment tasks designed to activate frontal circuits involved in a basic form of decision making. Participants completed 1 judgment task that required an emotional judgment and 1 task that did not, which enabled us to study whether alcoholics had greater brain activation while performing executive tasks, and to determine if emotional tasks elicited even greater activation than nonemotional tasks. METHODS We performed functional magnetic resonance imaging scans while alcoholic patients and nonalcoholic controls viewed pictures from the International Affective Picture System. In 3 separate runs, participants viewed the images without making a judgment, determined whether the images were indoor or outdoor scenes, or decided if they liked or disliked the images. RESULTS There was little difference in brain activation between alcoholics and controls when no judgment was required. When participants made judgments about either the location or whether they liked or disliked an image, however, we observed significantly increased activation in frontal, limbic, and temporal regions in the patients relative to the controls. Increases were particularly robust in the frontal lobe and in areas of the brain associated with language. When we compared the emotional to the nonemotional judgment, the alcoholics, but not the controls, showed greater activation in the ventral mesial frontal cortex. CONCLUSIONS Alcoholic patients appear to use brain language areas more than nonalcoholics while making judgments about the setting or liking of emotionally arousing visual images. This increased activation may reflect a compensatory recruitment of brain regions to perform simple decision-making tasks.
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Affiliation(s)
- Jodi M Gilman
- Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892, USA.
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Gilman JM, Ramchandani VA, Crouss TM, Hommer DW. The neural correlates of tolerance to the rewarding and anxiolytic effects of alcohol in heavy drinkers. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71677-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Alcohol is often used to modulate mood states. Alcohol drinkers report that they use alcohol both to enhance positive affect and to reduce dysphoria, and alcohol-dependent patients specifically state reduction of negative affect as a primary reason for drinking. The current study proposes that alcohol cues may reduce negative affect in alcoholics. We used functional magnetic resonance imaging to examine brain activation in response to combination images that juxtaposed negative or positive International Affective Picture System (IAPS) images with an alcohol or non-alcohol-containing beverage. We found that in the absence of the alcohol cue, alcoholics showed more activation to negative than to positive images and greater activation than controls to negative images. When the IAPS images were presented with the alcohol cue, there was a decreased difference in activation between the positive and negative images among the alcoholics, and a decreased difference in response to the negative images between controls and alcoholics. Additionally, in the neutral-beverage conditions, anxiety ratings significantly predicted activation in the right parahippocampal gyrus but did not predict activation when the alcohol cues were presented. In conclusion, the alcohol cues may have modulated cortical networks involved in the processing of emotional stimuli by eliciting a conditioned response in the alcoholics, but not in the controls, which may have decreased responsiveness to the negative images.
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Affiliation(s)
- Jodi M Gilman
- Section of Brain Electrophysiology and Imaging, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, NIH, 10 Center Dr. (10CRC/15330), Bethesda, MD 20892-1108, USA.
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Abstract
BACKGROUND Studies have shown that alcoholics have smaller brain volumes than non-alcoholic cohorts, but an effect of family history (FH) of heavy drinking on brain volume has not been demonstrated. We examined the relationship between an FH of heavy drinking and both brain shrinkage as measured by the ratio of brain volumes to intracranial volume (ICV) as well as maximal brain growth as measured by ICV in early-onset and late-onset alcoholics. METHODS With T1-weighted resonance imaging, we measured ICV, brain volume, and white and gray matter volume in adult treatment-seeking late-onset and early-onset alcoholics with either a positive or a negative FH of heavy alcohol use, and in healthy control subjects. We also calculated brain shrinkage using a ratio of soft tissue volumes to ICV. RESULTS The FH positive alcoholic patients had significantly smaller ICVs than FH negative patients, suggesting smaller premorbid brain growth. Brain shrinkage did not correlate with FH. Late-onset alcoholics showed a greater difference in ICV between FH positive and FH negative patients than early-onset alcoholics. Late-onset FH positive patients also had significantly lower IQ scores than late-onset FH negative patients, and IQ scores were correlated with ICV. CONCLUSIONS These data provide evidence that parental alcohol use might increase risk for alcoholism in offspring in part by a genetic and/or environmental effect that might be related to reduced brain growth.
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Affiliation(s)
- Jodi M Gilman
- Section of Brain Electrophysiology and Imaging, Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
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Gilman JM, Hutton R, Hamnett A, Peter LM. Modeling of electrolyte electroreflectance of heavily doped n-type GaAs. Phys Rev B Condens Matter 1993; 47:13453-13461. [PMID: 10005653 DOI: 10.1103/physrevb.47.13453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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