Functional neural changes following behavioral therapies and disulfiram for cocaine dependence.

Abstract

A growing literature exists on neural correlates of treatment outcome. However, different types - or components of - treatment have distinct theorized mechanisms of action. And, it is not yet known how changes in neural activity across treatment relate to engagement in different treatment components. Participants with cocaine-use disorders in a randomized clinical trial received cognitive behavioral therapy (CBT) plus, in a 2×2 design, contingency management (CM) or no-CM, and disulfiram or placebo. Participants performed an fMRI Stroop Task, a measure of cognitive-control, at the beginning of and after the 12-week treatment. Analyses assessed changes in Stroop-related neural activity within the sample overall and assessed how changes in Stroop-related activity correlated with measures of treatment process specific to each form of treatment (i.e., participation in CBT sessions, receipt of CM prizes, administration of disulfiram pills). Within the sample overall, compared to beginning-of-treatment, post-treatment Stroop-related neural activity was diminished in hippocampus, thalamus, cingulate, precentral, post/precentral gyrus, and precuneus and culmen regions (pFWE<.05). In separate whole-brain correlation analyses, greater reductions in Stroop-related activity were associated with more treatment engagement: ‘CBT sessions’ with precentral gyrus, inferior parietal lobule, middle and medial frontal gyrus; ‘CM prizes’ with postcentral frontal gyrus. Disulfiram ‘medication days’ were not associated with changes in Stroop-related activity. Findings suggest key process indicators of CBT and CM may be associated with functional changes in cognitive-control-related neurocircuitry.

Computational models of drug use and addiction: A review.

“…Within a VBDM framework, CBT can be understood as enhancing executive control systems, allowing for more deliberative, less-impulsive decision-making. This is consistent with data showing that CBT-based strategies engage executive control systems (Kober, Mende-Siedlecki, et al, 2010) and that CBT leads to lasting changes in these systems (DeVito et al, 2012, 2017). Additionally, recent evidence suggests that mindfulness-based treatments reduce drug-use (Bowen et al, 2009, 2014); they may do so by reducing the likelihood of maintaining a craving state after seeing drug cues, which reduces substance use behavior (e.g., Elwafi, Witkiewitz, Mallik, Thornhill, & Brewer, 2013; Kober, Brewer, Height, & Sinha, 2017).…”

Default mode network mechanisms of repeated transcranial magnetic stimulation in heroin addiction

“…Several studies have implicated the involvement of the IPL during the treatment of addictive disorders. The cocaine dependent individuals under cognitive-behavioral treatment showed a lower activity in the IPL for task-related neural activity(DeVito et al, 2017). Our recent study also found that the HD individuals under protracted abstinence showed lower activity of IPL when exposed to drug related cues in comparison with the HD individuals under MMT(Wei et al, 2020).…”

Neurocognitive predictors of treatment completion and daytime activities at follow-up in multiproblem young adults

“…Previous studies suggest a positive effect of physical activity on cognitive control, through increased neural efficiency (Erickson, Hillman, & Kramer, 2015 ) in the prefrontal cortex and ACC (Voss et al, 2011 ). Furthermore, a reduction in ACC activity is related to better treatment engagement (Devito et al, 2017 ). It is thus possible that interventions targeting ACC activity, for example through physical activity, could potentially increase neural efficiency (thus reducing activity) in cognitive control-related regions, and subsequently improve cognitive control.…”