Competing neurobehavioral decision systems and the neuroeconomics of craving in opioid addiction

Abstract

Abstract:Craving is typically thought of as a classically conditioned response characterized by an elevated mesolimbic dopamine response to drug-related stimuli. Although this definition has spurred considerable research, the clinical impact of the research conducted has been less robust. The current review takes a more contemporary approach by conceptualizing craving as the breakdown of executive function and relative strengthening of the limbic system, occurring in the presence of conditioned cues, leading to a maladaptive craving response (ie, an increased likelihood of drug consumption). Working from this framework, the present review focuses on four issues in drug craving research: pivotal findings and limitations of cue-reactivity and neurocognitive tasks; two main processes of craving that include self-control and reward-based explanations; integration of neuroeconomic approaches to craving; and the theoretical implications and future directions of drug craving research.

Buprenorphine-Naloxone Treatment of Prescription Opioid Abuse: Does Past Performance Predict Future Results?

“…[40][41][42][43] To some extent, this is analogous to a cardiac stress test or a glucose tolerance test in medicine. Although craving and its peripheral nervous system correlates (eg, electrodermal skin response) have not produced effects robust enough for clinical applications, 44,45 neuroimaging indices of brain function, such as brain activity at rest, in response to cognitive tasks, or brain response to drug-related cues, have shown promise as pretreatment predictors of outcomes. 35,46,47 For example, prospective studies of the brain response to heroin-related cues in recently detoxified heroin addicts suggest that time to relapse may be getting longer with continued abstinence, 48,49 lending support to the feasibility of time-limited pharmacotherapy followed by abstinence as the treatment goal in prescription opioid dependence.…”