Association of Cortico-Striatal Engagement During Cue Reactivity, Reappraisal, and Savoring of Drug and Non-Drug Stimuli With Craving in Heroin Addiction.
Association of Cortico-Striatal Engagement During Cue Reactivity, Reappraisal, and Savoring of Drug and Non-Drug Stimuli With Craving in Heroin Addiction.
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DOI：
10.1176/appi.ajp.20220759
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发表时间：
2023-07
期刊：
影响因子：
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通讯作者：
Yuefeng Huang;A. Ceceli;G. Kronberg;S. King;P. Malaker;M. Parvaz;N. Alia-Klein;E. Garland;Rita Z. Goldstein
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文献类型：
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作者：
Yuefeng Huang;A. Ceceli;G. Kronberg;S. King;P. Malaker;M. Parvaz;N. Alia-Klein;E. Garland;Rita Z. Goldstein
目的研究海洛因使用障碍患者皮质-纹状体对药物线索的反应性（与中性线索和食物线索相比）、药物线索再评价、食物线索品味及其与海洛因渴求的相关性。方法在32名海洛因使用障碍患者（平均年龄40.3岁; 7名女性）和21名年龄和性别匹配的健康对照者（平均年龄40.6岁; 8名女性）中评估了功能性MRI血氧水平依赖信号在新线索反应任务中的横截面变化。结果与对照组相比，海洛因使用障碍组中脑核的药物线索反应性（与中性线索相比）显著升高，眶额皮质（OFC）的药物线索反应性显著升高;腹内侧前额叶皮质（vmPFC）的活性与药物渴求呈正相关。与对照组相比，海洛因使用障碍组的额下回（IFG）的药物线索反应性（与突出的食物线索相比）也更高。药物重新评价和食物品尝（与被动观看）显示增加IFG和补充运动区活动在所有参与者中，在海洛因使用障碍组，较高的IFG/背外侧PFC（dlPFC）活动在药物重新评价和喙前扣带皮层（ACC）活动在食物品尝与较低的药物线索诱导的渴望和较长的治疗，分别。对两种突出线索的反应性调节的直接比较揭示了广泛的组间差异，例如海洛因使用障碍组的药物重新评价活动较高，对照组的食物品尝活动较高，在两个皮层（例如，OFC、IFG、ACC、vmPFC和VMC）和皮质下（例如，背侧纹状体和海马）区域。在海洛因使用障碍组中，更高的药物再评价与食物品味与更高的自我报告美沙酮剂量相关。结论：海洛因使用障碍组在药物线索暴露过程中皮质-纹状体上调，在处理替代性非药物奖励过程中反应性受损。通过降低药物线索反应性和增强自然奖赏评价来使皮质-纹状体功能正常化，可以为减少海洛因成瘾者的药物渴求和寻求提供治疗机制。
OBJECTIVE The authors investigated cortico-striatal reactivity to drug cues (as compared with neutral and food cues), drug cue reappraisal, food cue savoring, and their correlations with heroin craving in individuals with heroin use disorder compared with healthy control subjects. METHODS Cross-sectional changes in functional MRI blood-oxygen-level-dependent signal during a novel cue reactivity task were assessed in 32 individuals with heroin use disorder (mean age, 40.3 years; seven women) and 21 age- and sex-matched healthy control subjects (mean age, 40.6 years; eight women). RESULTS Drug cue reactivity (vs. neutral cues) was significantly higher in the nucleus accumbens in the heroin use disorder group compared with the control group and nominally significantly higher in the orbitofrontal cortex (OFC); ventromedial prefrontal cortex (vmPFC) activity positively correlated with drug craving. Drug cue reactivity (vs. salient food cues) was also higher in the inferior frontal gyrus (IFG) in the heroin use disorder group compared with the control group. Drug reappraisal and food savoring (vs. passive viewing) showed increased IFG and supplementary motor area activity in all participants; in the heroin use disorder group, higher IFG/dorsolateral PFC (dlPFC) activity during drug reappraisal and rostral anterior cingulate cortex (ACC) activity during food savoring were associated with lower drug cue-induced craving and longer treatment, respectively. A direct comparison of regulation of reactivity to both salient cues revealed widespread group differences such that drug reappraisal activity was higher in the heroin use disorder group and food savoring activity was higher in the control group in both cortical (e.g., OFC, IFG, ACC, vmPFC, and insula) and subcortical (e.g., dorsal striatum and hippocampus) regions. Higher drug reappraisal versus food savoring in the dlPFC was associated with higher self-reported methadone dosage in the heroin use disorder group. CONCLUSIONS The results demonstrate cortico-striatal upregulation during drug cue exposure and impaired reactivity during processing of alternative non-drug rewards in the heroin use disorder group. Normalizing cortico-striatal function by reducing drug cue reactivity and enhancing natural reward valuation may inform therapeutic mechanisms for reducing drug craving and seeking in heroin addiction.