Cannabis Abstinence During Treatment and One-Year Follow-up: Relationship to Neural Activity in Men.
ABSTRACT Cannabis is among the most frequently-abused substances in the United States. Cognitive control is a contributory factor in the maintenance of substance use disorders and may relate to treatment response. Therefore, we assessed whether cognitive-control-related neural activity prior to treatment differs between treatment-seeking cannabis-dependent and healthy individuals and relates to cannabis-abstinence measures during treatment and one-year follow-up. Cannabis-dependent males (N=20) completed a functional magnetic resonance imaging (fMRI) cognitive-control (Stroop) task prior to a 12-week randomized controlled trial of cognitive behavioral therapy and/or contingency management. A healthy-comparison group (N=20) also completed the fMRI task. Cannabis-use was assessed by urine toxicology and self-report during treatment, and by self-report across a 1-year follow-up period (N=18). The cannabis-dependent group displayed diminished Stroop-related neural activity relative to the healthy-comparison group in multiple regions including those strongly implicated in cognitive control and addiction-related processes (e.g. dorsolateral prefrontal cortex and ventral striatum). The groups did not significantly differ in response times (cannabis-dependent N=12; healthy-comparison N=14). Within the cannabis-dependent group, greater Stroop-related activity in regions including the dorsal anterior cingulate cortex was associated with less cannabis use during treatment. Greater activity in regions including the ventral striatum was associated with less cannabis use during one-year post-treatment follow-up. These data suggest that lower cognitive-control-related neural activity in classic "control" regions (e.g., dorsolateral prefrontal cortex, dorsal anterior cingulate) and classic "salience/reward/learning" regions (e.g., ventral striatum) differentiates cannabis-dependent from healthy individuals and relates to less abstinence within-treatment and during long-term follow-up. Clinically, results suggest that treatment development efforts that focus on enhancing cognitive control in addition to abstinence may improve treatment outcomes in cannabis dependence.Neuropsychopharmacology accepted article peview online, 07 April 2014; doi:10.1038/npp.2014.82.
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ABSTRACT: Cannabis use disorders (CUDs) are the most prevalent substance use disorders among adolescents in treatment. Yet, little is known about the neuropsychological mechanisms underlying adolescent CUDs. Studies in adult cannabis users suggest a significant role for cognitive control and cannabis-oriented motivational processes, such as attentional bias, approach bias, and craving in CUDs. The current 6-month prospective study investigated the relationships between attentional bias, approach bias, craving, cognitive control, and cannabis use in adolescent patients in treatment for a primary or secondary CUD. Moreover, we investigated if these motivational processes and cognitive control could predict treatment progression after 6 months. Adolescents with a CUD had an attentional but no approach bias towards cannabis. In contrast to adult findings on the role of attentional bias, approach bias and cognitive control, only cannabis craving significantly correlated with current cannabis use and predicted cannabis use-related problems and abstinence from cannabis 6 months later. These findings identify craving as a predictor of treatment outcome, thereby supporting an important role for craving in the course of adolescent cannabis use and dependence. This prospective study is among the first to investigate neuropsychological mechanisms underlying adolescent CUDs, warranting future longitudinal studies. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.Developmental Cognitive Neuroscience 04/2015; 22. DOI:10.1016/j.dcn.2015.04.001 · 3.71 Impact Factor