24-h smoking abstinence potentiates fMRI-BOLD activation to smoking cues in cerebral cortex and dorsal striatum

Duke University Medical Center Box 2701 Durham NC 27708 USA
Psychopharmacology (Impact Factor: 4.06). 05/2009; 204(1):25-35. DOI: 10.1007/s00213-008-1436-9

ABSTRACT RationaleExposure to smoking-related cues can trigger relapse in smokers attempting to maintain abstinence.

ObjectivesIn the present study, we evaluated the effect of 24-h smoking abstinence on brain responses to smoking-related cues using
functional magnetic resonance imaging (fMRI).

Materials and methodsEighteen adult smokers underwent fMRI scanning following smoking as usual (satiated condition) and following 24-h abstinence
(abstinent condition). During scanning, they viewed blocks of photographic smoking and control cues.

ResultsFollowing abstinence, greater activation was found in response to smoking cues compared to control cues in parietal (BA 7/31),
frontal (BA 8/9), occipital (BA 19), and central (BA 4) cortical regions and in dorsal striatum (putamen) and thalamus. In
contrast, no smoking cue greater than control cue activations were observed following smoking as usual. Direct comparisons
between conditions (satiated vs. abstinent) showed greater brain reactivity in response to smoking cues following abstinence.
In addition, positive correlations between pre-scan craving in the abstinent condition and smoking cue activation were observed
in right dorsomedial prefrontal cortex (dmPFC) including superior frontal gyrus (BA 6/10), anterior cingulate gyrus (BA 32),
and supplementary motor area (BA 6).

ConclusionsThe present findings indicate that smoking abstinence significantly potentiates neural responses to smoking-related cues in
brain regions subserving visual sensory processing, attention, and action planning. Moreover, greater abstinence-induced craving
was significantly correlated with increased smoking cue activation in dmPFC areas involved in action planning and decision
making. These findings suggest that drug abstinence can increase the salience of conditioned cues, which is consistent with
incentive-motivation models of addiction.

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    ABSTRACT: Craving is recognized as an important diagnosis criterion for substance use disorders (SUDs) and a predictive factor of relapse. Various methods to study craving exist; however, suppressing craving to successfully promote abstinence remains an unmet clinical need in SUDs. One reason is that social and environmental contexts recalling drug and alcohol consumption in the everyday life of patients suffering from SUDs often initiate craving and provoke relapse. Current behavioral therapies for SUDs use the cue-exposure approach to suppress salience of social and environmental contexts that may induce craving.They facil- itate learning and cognitive reinforcement of new behavior and entrain craving suppression in the presence of cues related to drug and alcohol consumption. Unfortunately, craving often overweighs behavioral training especially in real social and environmental contexts with peer pressure encouraging the use of substance, such as parties and bars. In this perspective, virtual reality (VR) is gaining interest in the development of cue-reactivity par- adigms and practices new skills in treatment. VR enhances ecological validity of traditional craving-induction measurement. In this review, we discuss results from (1) studies using VR and alternative virtual agents in the induction of craving and (2) studies combining cue- exposure therapy with VR in the promotion of abstinence from drugs and alcohol use. They used virtual environments, displaying alcohol and drugs to SUD patients. Moreover, some environments included avatars. Hence, some studies have focused on the social interac- tions that are associated with drug-seeking behaviors and peer pressure. Findings indicate that VR can successfully increase craving. Studies combining cue–exposure therapy with virtual environment, however, reported mitigated success so far.
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    ABSTRACT: Background The temporo-spatial dynamics of risk assessment and reward processing in problem gamblers with a focus on an ecologically valid design has not been examined previously.Methods We investigated risk assessment and reward processing in 12 healthy male occasional gamblers (OG) and in 12 male problem gamblers (PG) with a combined EEG and fMRI approach to identify group-differences in successively activated brain regions during two stages within a quasi-realistic blackjack game.ResultsBoth groups did not differ in reaction times but event-related potentials in PG and OG produced significantly different amplitudes in middle and late time-windows during high-risk vs. low-risk decisions. Applying an fMRI-constrained regional source model during risk assessment resulted in larger source moments in PG in the high-risk vs. low-risk comparison in thalamic, orbitofrontal and superior frontal activations within the 600-800 ms time window. During reward processing, PG showed a trend to enhanced negativity in an early time window (100-150 ms) potentially related to higher rostral anterior cingulate activity and a trend to centro-parietal group-differences in a later time window (390-440 ms) accompanied by increased superior-frontal (i.e., premotor-related) source moments in PG vs. OG.Conclusions We suggest that problem gambling is characterized by stronger cue-related craving during risk assessment. Reward processing is associated with early affective modulation followed by increased action preparation for ongoing gambling in PG.
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