Beyond cue reactivity: blunted brain responses to pleasant stimuli predict long‐term smoking abstinence

Abstract

Identifying addicts with higher risk of relapse would provide the opportunity to implement individualized interventions and increase cessation success rates. Unfortunately, the ability to predict the long-term success of drug-cessation treatments continues to elude researchers. We tested whether brain responses to emotional and cigarette-related pictures were predictive of the ability to abstain from smoking. Smokers interested in quitting (n=180) participated in a smoking cessation clinical trial. Before the initiation of any treatment we recorded event-related potentials (ERPs) evoked by emotional (both pleasant and unpleasant), neutral, and cigarette-related images. Cluster analysis was used to assign smokers to two groups based on the amplitude of the late positive potential (LPP) to the experimental stimuli. While both groups showed enhanced responses to cigarette-related cues, one group (n=81) also showed blunted brain responses to intrinsically pleasant stimuli. Smokers in the latter group were significantly less likely to be abstinent at 10, 12, and 24 weeks after their quit date. In conclusion, using event-related potentials, a direct measure of brain activity, we found that smokers with blunted brain responses to intrinsically pleasant stimuli had lower rates of long-term smoking abstinence. This response offers a new biomarker for identifying smokers at higher risk of relapse and for testing the efficacy of new interventions aimed at normalizing brain reward systems’ responses to intrinsically pleasant stimuli.

Abstinence reverses EEG-indexed attention bias between drug-related and pleasant stimuli in cocaine-addicted individuals

“…Prior studies reported associations between increased attention bias toward drug-related cues and susceptibility to relapse. 11,12,[29][30][31][32][33] That relapse status did not have a significant impact on our results is not surprising because in the present study all individuals with CUD showed a significant reduction of drug use (in both abstinent and relapsed subgroups); however, additional longitudinal studies with longer follow-up are required.…”

“…Although these studies are highly informative, many have been limited to the cross-sectional effects of shorter-term 19 or longer-term abstinence 25,31 relying mostly on self-reported follow-up assessments. 12,[28][29][30]32,33 An exception is a longitudinal behavioural study that reported reduced attention bias to drug-related cues (assessed via an emotional Stroop task) in heroin-addicted individuals after 3 weeks of heroin abstinence. 11 Thus, a systematic withinsubjects longer-term longitudinal investigation that examines the effects of drug use reduction/abstinence on attention bias to drug-related compared with non-drug-related reinforcers is lacking.…”

“…Moreover, prospective neuroimaging studies modelling relapse vulnerability and future drug use have shown that reduced attention toward drug-related cues 11,12,[28][29][30] and increased attention toward non-drug-related reinforcers [31][32][33] predicted longer abstinence durations in individuals with substance use disorders. Although these studies are highly informative, many have been limited to the cross-sectional Background: Increased attention bias toward drug-related cues over non-drug-related intrinsically pleasant reinforcers is a hallmark of drug addiction.…”

“…24 Importantly, cross-sectional studies have shown that the LPP amplitude to drug-related cues is decreased 25,26 while that to non-drug-related cues is increased 19,27 after a period of reduced drug use (3 d to about 1 yr). Moreover, prospective neuroimaging studies modelling relapse vulnerability and future drug use have shown that reduced attention toward drug-related cues 11,12,[28][29][30] and increased attention toward non-drug-related reinforcers [31][32][33] predicted longer abstinence durations in individuals with substance use disorders. Although these studies are highly informative, many have been limited to the cross-sectional effects of shorter-term 19 or longer-term abstinence 25,31 relying mostly on self-reported follow-up assessments.…”

Do reward-processing deficits in schizophrenia-spectrum disorders promote cannabis use? An investigation of physiological response to natural rewards and drug cues

“…13 Electrophysiological studies of brain activity using event-related potentials (ERP), which allow direct measurement of the magnitude and time course of neural activity following stimulus presentation, have shown that deficient response to natural rewards predicts higher J Psychiatry Neurosci 2014;39(5) subsequent use of nicotine 14 and opiates. 12 The former study examined the late positive potential (LPP), a long-lasting posi tivity indicative of sustained attention toward motivationally salient images, which is associated with memory encoding.…”