Sustained incentive value of heroin-related cues in short- and long-term abstinent heroin users

Abstract

Models of addiction and addiction memory propose that drug-associated cues elicit incentive effects in drug users, which play an important role in maintenance of drug use and relapse. Incentive effects have been demonstrated for smoking and alcohol-related cues but evidence for heroin-related cues has been inconclusive. Furthermore, it is unknown whether appetitive effects of heroin-related cues persist after prolonged abstinence, although heroin addiction is known to have high relapse rates. Therefore, we investigated implicit and explicit valence of heroin-related cues in dependent users at different stages of abstinence using affective startle modulation. In Study I, 15 current heroin users were measured before and after detoxification. Correspondingly, 15 healthy control participants were tested twice at an interval of 14 days. In Study II, 14 long-term abstinent heroin users were additionally measured in a single session. Implicit processing of drug-related stimuli was assessed using affective startle modulation by pictures of heroin and smoking scenes. Explicit reactions were measured using ratings of valence and craving. In contrast to controls, heroin-dependent participants showed a clear reduction of startle response during heroin-related pictures (p<0.05). Detoxification did not significantly change their startle responses to heroin-cues. No difference between non-detoxified current and long-term abstinent heroin users was found in implicit reactions to heroin-cues, whereas explicit measures differed between both groups (all p<0.05). After detoxification and even after prolonged abstinence, heroin cues still exert implicit appetitive effects in heroin users. This implies that drug-induced adaptations of reward circuits are long-lasting, resulting in a highly stable addiction memory. AbstractModels of addiction and addiction memory propose that drug-associated cues elicit incentive effects in drug users, which play an important role in maintenance of drug use and relapse.Incentive effects have been demonstrated for smoking and alcohol-related cues but evidence for heroin-related cues has been inconclusive. Furthermore, it is unknown whether appetitive effects of heroin-related cues persist after prolonged abstinence, although heroin addiction is known to have high relapse rates. Therefore, we investigated implicit and explicit valence of heroin-related cues in dependent users at different stages of abstinence using affective startle modulation. In Study I, 15 current heroin users were measured before and after detoxification.Correspondingly, 15 healthy control participants were tested twice at an interval of 14 days.In Study II, 14 long-term abstinent heroin users were additionally measured in a single session. Implicit processing of drug-related stimuli was assessed using affective startle modulation by pictures of heroin and smoking scenes. Explicit reactions were measured using ratings of valence and craving. In contrast to controls, heroin-dependent participants showed a clear reduction o...

Deep brain stimulation of the nucleus accumbens core but not shell reduces motivational components of heroin taking and seeking in rats

“…Heroin-associated cues are shown to play an important role in the maintenance of drug use and relapse (Carter and Tiffany, 1999;Preller et al, 2013), also after a long period of abstinence (Preller et al, 2013). In line with this, it has been reported that cue-reactivity as measured with intracranial electroencephalography (EEG) recordings was related to NA DBS effectiveness for heroin dependence at the same contact points of the DBS electrodes (Valencia-Alfonso et al, 2012).…”

Abstinence reverses EEG-indexed attention bias between drug-related and pleasant stimuli in cocaine-addicted individuals

“…The lack of attention modulation in response to drugrelated cues has been reported in studies comparing treatment-seeking and non-treatment-seeking individuals with CUD, 50 satiated and abstinent chronic smokers, 51 and short-and long-term abstinent heroin users. 52 These studies suggest that even after longer durations of reduced drug use, responsiveness to drug-related cues stays elevated perhaps owing to longterm pairing of the cues (i.e., pipes of crack-cocaine, other paraphernalia) with the actual drugs. This inability to divert attention away from drug-related cues has been interpreted to mark enhanced personal relevance and could reflect a strong desire to avoid drug-related cues, 53 potentially suggesting an increased motivation to quit/remain abstinent in the present study.…”

Using cognitive modelling to investigate the psychological processes of the Go/NoGo discrimination task in male abstinent heroin misusers

“…The incentive value of heroin-related cues has been reported to be sustained in heroin misusers even after prolonged abstinence [48]. The results of our study have practical implications; they point to the importance of including cognitive strategy training to reduce the impact of heroin-related cues as part of relapse prevention programmes [48,49]. Assisting heroin misusers in identifying the negative consequences of drugs may help to devalue the expected drug effects.…”

“…This study also suggests that the incentive value of heroin-related cues strongly influences the AHMs' decision-making, even though they may exhibit intact decision-making performance. The incentive value of heroin-related cues has been reported to be sustained in heroin misusers even after prolonged abstinence [48]. The results of our study have practical implications; they point to the importance of including cognitive strategy training to reduce the impact of heroin-related cues as part of relapse prevention programmes [48,49].…”