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Published Online: 12 July 2023

Association of Cortico-Striatal Engagement During Cue Reactivity, Reappraisal, and Savoring of Drug and Non-Drug Stimuli With Craving in Heroin Addiction

Publication: American Journal of Psychiatry

Abstract

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.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 153 - 165
PubMed: 37434487

History

Received: 2 September 2022
Revision received: 10 March 2023
Accepted: 11 April 2023
Published online: 12 July 2023
Published in print: February 01, 2024

Keywords

  1. Addiction Psychiatry
  2. Substance-Related and Addictive Disorders
  3. Opioids

Authors

Details

Yuefeng Huang, Ph.D.
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).
Ahmet O. Ceceli, Ph.D.
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).
Greg Kronberg, Ph.D.
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).
Sarah King, B.S.
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).
Pias Malaker, M.S.
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).
Muhammad A. Parvaz, Ph.D.
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).
Nelly Alia-Klein, Ph.D.
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).
Eric L. Garland, Ph.D.
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).
Rita Z. Goldstein, Ph.D. [email protected]
Department of Psychiatry (Huang, Ceceli, Kronberg, Malaker, Parvaz, Alia-Klein, Goldstein) and Department of Neuroscience, Friedman Brain Institute (King, Parvaz, Alia-Klein, Goldstein), Icahn School of Medicine at Mount Sinai, New York; Center on Mindfulness and Integrative Health Intervention Development and College of Social Work, University of Utah, Salt Lake City (Garland).

Notes

Send correspondence to Dr. Goldstein ([email protected]).

Author Contributions

Drs. Huang and Ceceli contributed equally to this study.

Competing Interests

Dr. Garland is director of the Center on Mindfulness and Integrative Health Intervention Development; he has received honoraria and payment for seminars, lectures, and teaching engagements (related to training clinicians in Mindfulness-Oriented Recovery Enhancement [MORE]), including those sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers; he receives royalties from the sale of books related to MORE; and he is a licensor to BehaVR. The other authors report no financial relationships with commercial interests.

Funding Information

Supported by NIDA grant T32DA053558 to Dr. Ceceli, NIDA grant R01DA048094 to Dr. Garland, and National Center for Complementary and Integrative Health grant R01AT010627 to Dr. Goldstein.

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