Cue-Elicited Craving in Heroin Addicts at Different Abstinent Time: An fMRI Pilot Study

Mingwu Lou,Erlei Wang,Yunxia Shen,Jiping Wang

doi:10.3109/10826084.2011.646381

Abstract

Objective: We evaluated the effect of short-term and long-term heroin abstinence on brain responses to heroin-related cues using functional magnetic resonance imaging (fMRI). Methods: Eighteen male heroin addicts following short-term abstinence and 19 male heroin addicts following long-term abstinence underwent fMRI scanning while viewing heroin-related and neutral images. Cue-elicited craving and withdrawal symptoms in the subjects were measured. Results: Following short-term abstinence, greater activation was found in response to heroin cues compared to neutral cues in bilateral temporal, occipital, posterior cingulate, anterior cingulate, thalamus, cerebellum, and left hippocampus. In contrast, activations in bilateral temporal and occipital and deactivations in bilateral frontal, bilateral parietal, left posterior cingulate, insula, thalamus, dorsal striatum, and bilateral cerebellum were observed following long-term abstinence. Direct comparisons between conditions showed greater brain reactivity in response to smoking cues following short-term abstinence. In addition, short-term abstinence had more serious withdrawal symptoms than the long-term. Conclusion: The present findings indicate that compared to short-term, long-term abstinence manifests less serious withdrawal symptoms and significantly decreases neural responses to heroin-related cues in brain regions subserving visual sensory processing, attention, memory, and action planning. These findings suggest that long-term abstinence can decrease the salience of conditioned cues, thereby reducing the risk of relapses. The study's limitations are noted.

Highlights

Drug addiction is characterized by compulsive drugtaking behavior and high rates of relapse even after many years of abstinence (O’Brien, Testa, O’Brien, Brady, & Wells, 1977)
We evaluated the effect of short-term and long-term heroin abstinence on brain responses to heroin-related cues using functional magnetic resonance imaging
The reduced functional magnetic resonance imaging (fMRI) reactivity to heroin-related images versus the neutral images was evoked in bilateral frontal (BA 6, 8, 9), bilateral parietal (BA 1, 2, 3, 5, 7, 40), left posterior cingulate (BA 23), insula, thalamus, dorsal striatum, and bilateral cerebellum (Figure 2; Table 3)

Summary

Introduction

Drug addiction is characterized by compulsive drugtaking behavior and high rates of relapse even after many years of abstinence (O’Brien, Testa, O’Brien, Brady, & Wells, 1977). Over the past few decades, numerous functional magnetic resonance imaging (fMRI) studies have documented brain areas activated by drug-related cues These areas include regions known to be involved with reward, craving, emotional processing, memory, visual attention, and impulsivity (Brody et al, 2007; Due, Huettel, Hall, & Rubin, 2002; Franklin et al, 2007; McClernon, Kozink, Lutz, & Rose, 2009; Rubinstein et al, 2011). These findings suggest that exposure to drug-related cues increases attentional resources focused on processing external, drug-related information, and triggers the planning of behaviors aimed at obtaining drugs. In contrast with these findings, two previous fMRI studies did not show that smoking abstinence increased brain reactivity to smoking cues (McClernon, Hiott, Huettel, & Rose, 2005; McBride, Barrett, Kelly, Aw, & Dagher, 2006), while one study found abstinence did decrease reactivity in ventral striatum in male smokers (David et al, 2007)

Methods

Results

Conclusion