Evidence of anhedonia and differential reward processing in prefrontal cortex among post-withdrawal patients with prescription opiate dependence

Abstract

Anhedonia is an important but understudied element of a neuroadaptive model underlying vulnerability to relapse in opioid dependence. Previous research using fMRI has shown reduced activation to pleasant stimuli in rostral prefrontal cortex among heroin-dependent patients in early recovery. This study evaluated the presence of anhedonia among recently withdrawn prescription opiate dependent patients (PODP) in residential treatment compared to control subjects. Anhedonia was assessed using self-report, affect-modulated startle response (AMSR), and a cue reactivity task during which participant’s rostral prefrontal cortex (RPFC) and ventrolateral prefrontal cortex (VLPFC) was monitored with functional near infrared spectroscopy (fNIRS). The cue reactivity task included three distinct categories of natural reward stimuli: highly palatable food, positive social situations, and intimate (nonerotic) interactions. PODP reported greater anhedonia on self-report (Snaith-Hamilton Pleasure Scale), and showed reduced hedonic response to positive stimuli in the AMSR task relative to controls. PODP also exhibited reduced neural activation in bilateral RPFC and left VLPFC in response to food images and reduced left VLPFC in response to images depicting positive social situations relative to controls. No differences were found for emotionally intimate stimuli. When patients were divided into groups based on the Snaith-Hamilton criteria for the presence or absence of anhedonia, patients endorsing anhedonia showed reduced neural responses to images depicting positive social stimuli and food relative to patients who did not endorse anhedonia. Activations were in areas of RPFC that support the retrieval of episodic memories. The results suggest the presence of anhedonia in a subsample of PODP.

Daily sleep quality affects drug craving, partially through indirect associations with positive affect, in patients in treatment for nonmedical use of prescription drugs

“…The focus on composite positive and negative affective states in the present study is in line with previous studies examining the association between affect and craving in NMUPD (e.g., Huhn et al, 2016), as well as studies that have examined the association between affect and drug craving more generally(e.g., McHugh et al, 2013; Schlauch et al, 2013). Future studies might gain further insight into the association between affect and craving by focusing on discrete affective states (e.g., Epstein et al, 2010).…”

“…Previous analyses have shown high inter-item reliability for the PA and NA factors (standardized Chronbach’s alpha for NA=0.93, and PA=0.95; Huhn et al, 2016). The Pearson’s r correlation between the PA and NA factors was r = −0.13.…”

“…When perceived, drug cues engender an incentive motivation for drugs (Robinson & Berridge, 2008), even after up to 30-days of abstinence (Childress et al, 1986). Cue-induced craving has a long history (Carter & Tiffany, 1999; Drummond, 2000) but internal states, including affective states (Baker et al, 2004; Otto et al, 2007), also constitute powerful cues or contexts for drug desire (Huhn et al, 2016). …”

“…Laboratory studies have demonstrated a positive association between NA and drug craving for a number substances, including opiates (Childress et al, 1994), alcohol, cocaine, and cigarettes (Conklin & Perkins, 2005; Litt et al, 1990; Sinha et al, 2000). Studies employing ecological momentary assessment (EMA) have also observed a positive association between NA and craving (Delfino et al, 2001; Epstein et al, 2009; Huhn et al, 2016). …”

“…Low PA has been associated with greater craving (Huhn et al, 2016; McHugh et al, 2013), and high levels of PA have been associated with both higher and lower levels of craving in the laboratory (Mason et al, 2008; Maude-Griffin & Tiffany, 1996; Schlauch et al, 2013; Tiffany & Drobes, 1990) and in the EMA (Bujarski et al, 2015; Epstein & Preston, 2010) literature. Emotional states that produce high PA might place individuals in a celebratory mood, encouraging drug use for hedonic reasons (Baker, Morse, & Sherman, 1987; Robinson & Berridge, 1993).…”