Relapse presents a major problem for patients recovering from stimulant dependence. Here we examined the hypothesis that patterns of brain function obtained at an early stage of abstinence differentiates patients who later relapse vs. those who remain abstinent. Forty-five recently abstinent stimulant-dependent patients were tested using a randomized event-related functional MRI (ER-fMRI) design that was developed in order to replicate a previous ERP study of relapse using a selective attention task, and were then monitored until 6 months of verified abstinence or stimulant use occurred. SPM revealed smaller absolute BOLD response amplitude in bilateral ventral posterior cingulate and right insular cortex in 23 patients positive for relapse to stimulant use compared with 22 who remained abstinent. ER-fMRI data was compared with psychiatric, neuropsychological, demographic, personal- and family- history of drug use in order to form predictive models, and was found to predict abstinence with higher accuracy than any other single measure obtained in this study. Logistic regression using fMRI amplitude in right posterior cingulate and insular cortex predicted abstinence with 77.8% accuracy, which increased to 89.9% accuracy when history of mania was included. Using 10-fold cross-validation, Bayesian logistic regression and multilayer perceptron algorithms provided the highest accuracy of 84.4%. These results, combined with previous studies, suggest that the functional organization of paralimbic brain regions including ventral anterior and posterior cingulate and right insula are related to patients’ ability to maintain abstinence. Novel therapies designed to target these paralimbic regions identified using ER-fMRI may improve treatment outcome.
Children exposed to substantial amounts of alcohol prenatally are known to display a range of physical and cognitive anomalies, referred to as fetal alcohol spectrum disorders (FASDs). Animal models and neuroimaging studies of FASDs have consistently demonstrated that specific regions of the brain (e.g., midline structures) are more vulnerable to the teratogenic effects of alcohol than other regions. The main aim of this article is to assess whether findings from cognitive–behavioral studies of FASDs yield a profile that maps onto the pattern of damage revealed by neuroanatomical investigations. To achieve this aim, the findings from studies that have investigated elementary functions (e.g., associative learning), general functions (e.g., intellectual abilities), specific functions (e.g., language and memory) and behavior in children and adults with FASDs are examined. The cognitive–behavioral profile emerging from the data is defined as a generalized deficit in processing and integrating complex information. It is proposed that slow processing of information mainly contributes to this deficit. The clinical implications of the above characterization of the cognitive–behavioral profile in FASDs are discussed.
ABSTRACT. Objective:The primary aim of this study was to advance understanding of the effi cacy of 12-step programs by determining the temporal relationships between alcohol and illicit drug use among 12-step program affi liates. Method: A total of 253 early 12-step affi liates without extensive histories of Alcoholics Anonymous (AA) attendance were recruited from substance use treatment and community-based AA. A majority of the sample met criteria for a diagnosis of alcohol dependence, reported lifetime use of illicit drugs, and reported illicit drug use in the 90-day period before recruitment. After informed consent, participants were interviewed at intake and in 3-month increments for 1 year. Results: Preliminary analyses indicated that 12-step attendance was predictive of reductions in substance use and that such reductions were not moderated by illicit substance use disorder diagnosis or alcohol problem severity. Lagged hierarchical linear models indicated that illicit drug use was a robust predictor of later use of alcohol, although the frequency and intensity of drinking were contingent on whether participants sustained 12-step program affi liation. Alcohol use did not predict later illicit drug use among participants who sustained 12-step program participation. Conclusions: Findings suggest that 12-step participation may serve as a protective factor after substance use occurs. Although our results suggest that the initiation of illicit drug use may undermine efforts to achieve and sustain abstinence from alcohol, our fi ndings do not suggest that alcohol use necessarily mobilizes relapse across different substances among 12-step program affi liates. (J. Stud. Alcohol Drugs, 72, 864-871, 2011)
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.