Predicting Subsequent Relapse by Drug-Related Cue-Induced Brain Activation in Heroin Addiction: An Event-Related Functional Magnetic Resonance Imaging Study

Addict Biol. 2015 Sep;20(5):968-78. doi: 10.1111/adb.12182. Epub 2014 Sep 11.

Abstract

Abnormal salience attribution is implicated in heroin addiction. Previously, combining functional magnetic resonance imaging (fMRI) and a drug cue-reactivity task, we demonstrated abnormal patterns of subjective response and brain reactivity in heroin-dependent individuals. However, whether the changes in cue-induced brain response were related to relapse was unknown. In a prospective study, we recruited 49 heroin-dependent patients under methadone maintenance treatment, a gold standard treatment (average daily dose 41.8 ± 16.0 mg), and 20 healthy subjects to perform the heroin cue-reactivity task during fMRI. The patients' subjective craving was evaluated. They participated in a follow-up assessment for 3 months, during which heroin use was assessed and relapse was confirmed by self-reported relapse or urine toxicology. Differences between relapsers and non-relapsers were analyzed with respect to the results from heroin-cue responses. Compared with healthy subjects, relapsers and non-relapsers commonly demonstrated significantly increased brain responses during the processing of heroin cues in the mesolimbic system, prefrontal regions and visuospatial-attention regions. However, compared with non-relapsers, relapsers demonstrated significantly greater cue-induced craving and the brain response mainly in the bilateral nucleus accumbens/subcallosal cortex and cerebellum. Although the cue-induced heroin craving was low in absolute measures, the change in craving positively correlated with the activation of the nucleus accumbens/subcallosal cortex among the patients. These findings suggest that in treatment-seeking heroin-dependent individuals, greater cue-induced craving and greater specific regional activations might be related to reward/craving and memory retrieval processes. These responses may predict relapse and represent important targets for the development of new treatment for heroin addiction.

Keywords: Craving; fMRI; heroin addiction; relapse.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brain / drug effects*
  • Brain / physiopathology*
  • Brain Mapping*
  • China
  • Cues*
  • Female
  • Follow-Up Studies
  • Heroin Dependence / physiopathology*
  • Heroin Dependence / rehabilitation
  • History, Ancient
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Methadone / therapeutic use
  • Opiate Substitution Treatment
  • Predictive Value of Tests
  • Prospective Studies
  • Recurrence
  • Reproducibility of Results

Substances

  • Methadone