Neural Correlates of Stress-Induced and Cue-Induced Drug Craving: Influences of Sex and Cocaine Dependence

Marc N. Potenza, M.D., Ph.D., Kwang-ik Adam Hong, Cheryl M. Lacadie, B.S., Robert K. Fulbright, M.D., Keri L. Tuit, Psy.D., and Rajita Sinha, Ph.D.Authors Info & Affiliations

Publication: American Journal of Psychiatry

Volume 169, Number 4

https://doi.org/10.1176/appi.ajp.2011.11020289

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Abstract

Activity in brain regions linked to substance abuse was greater in cocaine-dependent women than in non-substance-abusing women after stress but not after exposure to drug-related cues. For men with cocaine dependence, the pattern was reversed: more widespread hyperactivation after drug-related cues than after stress. Clinical possibilities include targeted treatment for cocaine dependence: stress reduction for women and 12-step or cognitive-behavioral approaches for men.

Abstract

Objective:

Although stress and drug cue exposure each increase drug craving and contribute to relapse in cocaine dependence, no previous research has directly examined the neural correlates of stress-induced and drug cue-induced craving in cocaine-dependent women and men relative to comparison subjects.

Method:

Functional MRI was used to assess responses to individualized scripts for stress, drug/alcohol cue and neutral-relaxing-imagery conditions in 30 abstinent cocaine-dependent individuals (16 women, 14 men) and 36 healthy recreational-drinking comparison subjects (18 women, 18 men).

Results:

Significant three-way interactions between diagnostic group, sex, and script condition were observed in multiple brain regions including the striatum, insula, and anterior and posterior cingulate. Within women, group-by-condition interactions were observed involving these regions and were attributable to relatively increased regional activations in cocaine-dependent women during the stress and, to a lesser extent, neutral-relaxing conditions. Within men, group main effects were observed involving these same regions, with cocaine-dependent men demonstrating relatively increased activation across conditions, with the main contributions from the drug and neutral-relaxing conditions. In men and women, subjective drug-induced craving measures correlated positively with corticostriatal-limbic activations.

Conclusions:

In cocaine dependence, corticostriatal-limbic hyperactivity appears to be linked to stress cues in women, drug cues in men, and neutral-relaxing conditions in both. These findings suggest that sex should be taken into account in the selection of therapies in the treatment of addiction, particularly those targeting stress reduction.

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Information & Authors

Information

Published In

American Journal of Psychiatry

Volume 169 • Number 4 • April 2012

Pages: 406 - 414

PubMed: 22294257

History

Received: 20 February 2011

Revision received: 18 August 2011

Revision received: 31 October 2011

Accepted: 8 November 2011

Published online: 1 April 2012

Published in print: April 2012