Abstract
Background: Craving is the predictor of relapse, and insula cortex (IC) is a critical neural substrate for craving and drug seeking. This study investigated whether IC abnormalities among MA users can detect craving state and predict relapse susceptibility.Methods: A total of 142 subjects with a history of MA dependence completed structural MRI (sMRI) scans, and 30 subjects (10 subjects relapsed) completed 4-month follow-up scans. MA craving was measured by the Visual Analog Scale for Craving. Abnormalities of IC gray matter volume (GMV) between the subjects with and without craving were investigated by voxel-based morphometry (VBM). The receiver operating characteristic (ROC) analysis was performed for the region-of-interest (ROI) of IC GMV to assess the diagnostic accuracy.Results: By comparing whole-brain volume maps, this study found that subjects without craving (n = 64) had a significantly extensive decrease in IC GMV (family-wise error correction, p < 0.05) than subjects with craving group (n = 78). The ROI of IC GMV had a significantly positive correlation with the craving scores reported by MA users. The ROC analysis showed a good discrimination (area under curve is 0.82/0.80 left/right) for IC GMV between the subjects with and without craving. By selecting Youden index cut-off point from whole model group, calculated sensitivity/specificity was equal to 78/70% and 70/75% for left and right IC, respectively. By applying the above optimal cut-off values to 30 follow-up subjects as validations, the results showed a similar sensitivity (73–80%) and specificity (73–80%) for detecting craving state as model group. For predicting relapse susceptibility, the sensitivity (50–55%) was low and the specificity (80–90%) was high.Conclusions: Our study provides the first evidence that sMRI may be used to diagnosis the craving state in MA users based on optimal cut-off values, which could be served as MRI bio-markers and an objective measure of craving state.
Highlights
Drug addiction is a chronic brain disease marked by high rates of relapse even after months or years of abstinence, long after self-reported craving and withdrawal have abated [1,2,3]
The MA craving group had an average of 4.5 ± 1.84 scores in MA craving by Visual Analog Scale for Craving (VASc) from 1 to 10
The current study provides the first preliminary evidence that structural MRI could be used to diagnosis the craving state in subjects with methamphetamine dependence (MAD)
Summary
Drug addiction is a chronic brain disease marked by high rates of relapse even after months or years of abstinence, long after self-reported craving and withdrawal have abated [1,2,3]. A core challenge for treating MA and other drug addiction is the high propensity for relapse. Reliable and valid biomarkers that accurately predict relapse and developmental processes in craving are still not available. These facts highlight the need for further insight into the neurobiology of drug craving might be gained by exploiting variations in the magnitude of cravings, which will facilitate appropriated medical interventions to prevent relapse among drug dependent individuals. This study investigated whether IC abnormalities among MA users can detect craving state and predict relapse susceptibility
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