Naturalistic drug cue reactivity in heroin use disorder: orbitofrontal synchronization as a marker of craving and recovery

Kronberg, Greg; Ceceli, Ahmet O.; Huang, Yuefeng; Gaudreault, Pierre-Olivier; King, Sarah G.; McClain, Natalie; Alia-Klein, Nelly; Goldstein, Rita Z.

doi:10.1101/2023.11.02.23297937

Cited by 2 publications

(1 citation statement)

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“…In addition to those measures, assessment of baseline drug craving was conducted at both timepoints at the start of a drug cue reactivity fMRI task (“Please rate how strong your desire for heroin is currently on a scale of 0-9”), reported elsewhere 9 . Following this baseline craving assessment, three stimulus ratings were measured after the MRI procedures to assess specific aspects of dynamic, cue-induced craving: picture-induced drug arousal (“ How emotional do you feel about the picture ”, a 5-point scale ranging from “calm, no emotion” to “extremely emotional”) and picture-induced drug craving (“ How strong is your desire to use the substance ”, a 5-point scale ranging from “no desire” to “extreme desire”) ratings of the same drug pictures used in the cue-reactivity fMRI task, and scene-induced drug craving intensity ratings in response to 34 3-sec clips of a naturalistic drug-related movie presented during an fMRI task 31 .…”

Section: Methodsmentioning

confidence: 99%

Frontal White Matter Changes Indicate Recovery With Inpatient Treatment in Heroin Addiction

Gaudreault,

King,

Huang

et al. 2024

Preprint

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ImportanceAmidst an unprecedented opioid epidemic, identifying neurobiological correlates of change with medication-assisted treatment of heroin use disorder is imperative. Distributed white matter (WM) impairments in individuals with heroin use disorder (iHUD) have been associated with increased drug craving, a reliable predictor of treatment outcomes. However, little is known about the extent of whole-brain structural connectivity changes with inpatient treatment and abstinence in iHUD.ObjectiveTo assess WM microstructure and associations with drug craving changes with inpatient treatment in iHUD (effects of time/re-scan compared to controls; CTL).DesignLongitudinal cohort study (12/2020-09/2022) where iHUD and CTL underwent baseline magnetic resonance imaging (MRI#1) and follow-up (MRI#2) scans, (mean interval of 13.9 weeks in all participants combined).SettingThe iHUD and CTL were recruited from urban inpatient treatment facilities and surrounding communities, respectively.ParticipantsThirty-four iHUD (42.1yo; 7 women), 25 age-/sex-matched CTL (40.5yo; 9 women).InterventionBetween scans, inpatient iHUD continued their medically-assisted treatment and related clinical interventions. CTL participants were scanned at similar time intervals.Main Outcomes and MeasuresChanges in white matter diffusion metrics [fractional anisotropy (FA), mean (MD), axial (AD), and radial diffusivities (RD)] in addition to baseline and cue-induced drug craving, and other clinical outcome variables (mood, sleep, affect, perceived stress, and therapy attendance).ResultsMain findings showed HUD-specific WM microstructure changes encompassing mostly frontal major callosal, projection, and association tracts, characterized by increased FA (.949<1- p<.986) and decreased MD (.949<1-p<.997) and RD (.949<1-p<.999). The increased FA (r=- 0.72, p<.00001) and decreased MD (r=0.69, p<.00001) and RD (r=0.67, p<.0001) in the genu and body of the corpus callosum and the left anterior corona radiata in iHUD were correlated with a reduction in baseline craving (.949<1-p<.999). No other WM correlations with outcome variables reached significance.Conclusions and RelevanceOur findings suggest whole-brain normalization of structural connectivity with inpatient medically-assisted treatment in iHUD encompassing recovery in frontal WM pathways implicated in emotional regulation and top-down executive control. The association with decreases in baseline craving further supports the relevance of these WM markers to a major symptom in drug addiction, with implications for monitoring clinical outcomes.Key pointsQuestionDoes white matter (WM) microstructure change with medication-assisted treatment in individuals with heroin use disorder (iHUD)?FindingsIn this longitudinal cohort study, diffusion MRI was acquired in 34 inpatient iHUD and 25 healthy controls (CTL) twice, separated by a mean of 13.9 weeks. We found HUD- specific WM microstructure changes with time, characterized by increased anisotropy and decreased diffusivity in fronto-striatal WM pathways. These changes were correlated with decreased baseline drug craving with treatment.MeaningFrontal WM changes and associated drug craving decreases suggest brain-behavior recovery with inpatient treatment in iHUD, potentially contributing to reduced drug use and sustained abstinence.

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Section: Methodsmentioning

confidence: 99%

Frontal White Matter Changes Indicate Recovery With Inpatient Treatment in Heroin Addiction

Gaudreault,

King,

Huang

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

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Frontal White Matter Changes and Craving Recovery in Inpatients With Heroin Use Disorder

Gaudreault,

King,

Huang

et al. 2024

JAMA Netw Open

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ImportanceAmidst an unprecedented opioid epidemic, identifying neurobiological correlates of change with medication-assisted treatment of heroin use disorder is imperative. White matter impairments in individuals with heroin use disorder (HUD) have been associated with drug craving, a reliable predictor of treatment outcomes; however, little is known about structural connectivity changes with inpatient treatment and abstinence in individuals with HUD.ObjectiveTo assess white matter microstructure and associations with drug craving changes with inpatient treatment in individuals with HUD (effects of time and rescan compared with controls).Design, Setting, and ParticipantsThis cohort study conducted from December 2020 to September 2022 included individuals recruited from urban inpatient treatment facilities treating HUD and surrounding communities in New York City. Participants with HUD were receiving medication-assisted treatment. Data were analyzed from October 2022 to March 2023.InterventionBetween scans, inpatient individuals with HUD continued treatment and related clinical interventions. Control participants were scanned at similar time intervals.Main Outcomes and MeasuresChanges in white matter diffusion metrics (fractional anisotropy and mean, axial, and radial diffusivities) assessed voxelwise with general linear models in addition to baseline and cue-induced drug craving, and other clinical outcome variables (mood, sleep, affect, perceived stress, and therapy attendance).ResultsThirty-four individuals with HUD (mean [SD] age, 40.5 [11.0] years; 9 women [36%]; 3 Black [9%], 17 White [50%], 14 other race or ethnicity [41%]) and 25 control (mean [SD] age, 42.1 [9.0]; 7 women [21%]; 8 Black [32%], 10 White [40%], 7 other race or ethnicity [28%]) were included. Main voxelwise findings showed HUD-specific white matter microstructure changes (1 − P &gt; .949), including increased fractional anisotropy and decreased mean and radial diffusivities, encompassing mostly frontal major callosal, projection, and association tracts. The increased fractional anisotropy (r = −0.72, P &lt; .001, slope SE = 9.0 × 10−4) and decreased mean diffusivity (r = 0.69, P &lt; .001, slope SE = 1.25 × 10−6) and/or radial diffusivity (r = 0.67, P &lt; .001, slope SE = 1.16 × 10−6) in the genu and body of the corpus callosum and left anterior corona radiata in individuals with HUD correlated with a reduction in baseline craving (voxelwise 1 − P &gt; .949). No other white matter correlations with outcome variables reached significance.Conclusions and RelevanceThis cohort study of inpatients with HUD on medication-assisted treatment found whole-brain normalization of structural connectivity in frontal white matter pathways implicated in emotional regulation and top-down executive control. Observed associations with decreases in baseline craving further support the possibility of recovery, highlighting the relevance of these white matter markers to a major symptom of addiction, with implications for clinical outcome monitoring.

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Naturalistic drug cue reactivity in heroin use disorder: orbitofrontal synchronization as a marker of craving and recovery

Cited by 2 publications

References 75 publications

Frontal White Matter Changes Indicate Recovery With Inpatient Treatment in Heroin Addiction

Frontal White Matter Changes Indicate Recovery With Inpatient Treatment in Heroin Addiction

Frontal White Matter Changes and Craving Recovery in Inpatients With Heroin Use Disorder

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