Neuroimaging the Effectiveness of Substance Use Disorder Treatments

Abstract

Neuroimaging techniques to measure the function and biochemistry of the human brain such as positron emission tomography (PET), proton magnetic resonance spectroscopy ((1)H MRS), and functional magnetic resonance imaging (fMRI), are powerful tools for assessing neurobiological mechanisms underlying the response to treatments in substance use disorders. Here, we review the neuroimaging literature on pharmacological and behavioral treatment in substance use disorder. We focus on neural effects of medications that reduce craving (e.g., naltrexone, bupropion hydrochloride, baclofen, methadone, varenicline) and that improve cognitive control (e.g., modafinil, N-acetylcysteine), of behavioral treatments for substance use disorders (e.g., cognitive bias modification training, virtual reality, motivational interventions) and neuromodulatory interventions such as neurofeedback and transcranial magnetic stimulation. A consistent finding for the effectiveness of therapeutic interventions identifies the improvement of executive control networks and the dampening of limbic activation, highlighting their values as targets for therapeutic interventions in substance use disorders.

Pramipexole Increases Go Timeouts but Not No-go Errors in Healthy Volunteers

“…Further, in patients with addiction, modafinil reduces impulsive decision-making (Schmaal et al, 2014 ) and increases response inhibition (Schmaal et al, 2013 ). In line with the interpretation that pramipexole might reduce motor impulsivity through activation of DS, using fMRI in substance abusers, modafinil and other medications that have dopaminergic properties, enhance activation of DS (Goudriaan et al, 2013 ; for a review see Cabrera et al, 2016 ) and cortical regions to which DS is reciprocally connected such as fronto-parietal cortex (Schmaal et al, 2014 ), anterior cingulate cortex (Ghahremani et al, 2011 ; Goudriaan et al, 2013 ) and supplementary motor cortex (Schmaal et al, 2013 ). Analogously, using PET in a pre- and post-test design relative to an untreated substance abuser control group, modafinil reduces dopamine ligand binding in bilateral caudate and putamen, reflecting increased endogenous dopamine in these regions related to treatment (Karila et al, 2016 ).…”

“…These findings are consistent with the PD literature in that dopaminergic therapy decreases activation and reduces functions of VS and other VTA-innervated brain regions and increases activity and improves functions of SN-innervated DS and its cortical partners. Indeed, in a recent review of imaging in substance abuse, Cabrera et al ( 2016 ) summarized that therapies that reduce craving tend to decrease or normalize activation in reward and motivation brain centers (e.g., VS, VTA, amygdala, orbitofrontal cortex), whereas those that correlated with increased sober days and greater self-control, increase activation in cognitive and response control centers (e.g., DS, supplementary motor area, dorsolateral prefrontal cortex).…”

Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again.

“…Unlike many other therapies, CBT seeks to convey strategies for achieving and maintaining cognitive and behavioral control, and new technologies may help us do so more effectively. Neuroimaging, EEG, and advances in cognitive assessment should be harnessed in order to demonstrate how CBT changes cognition, behavior and the brain (Cabrera et al, 2016; Verdejo-Garcia, 2016; Weingarten & Strauman, 2015). As noted by Garland and Howard (2009), “Neuroplasticity represents a plausible biological mechanism through which psychological interventions may exert some of their therapeutic effects”.…”

Can neuroimaging help combat the opioid epidemic? A systematic review of clinical and pharmacological challenge fMRI studies with recommendations for future research

“…Despite this potential, effective translation of research findings into the clinical realm remains elusive [35]. To synthesize existing knowledge and facilitate effective translation of findings to real-world clinical settings, we aim to build upon recent reviews focused more broadly on fMRI findings across different substance use disorders [36,37] and others focused more narrowly on resting-state fMRI in OUD [38][39][40] by examining published fMRI literature (both task-based and resting-state) relevant to OUD, with an emphasis on findings related to opioid medications and treatment outcomes, as well as proposing areas for further research. By delineating common and distinct neural mechanisms of OUD pathophysiology and treatment response, it may be possible to identify which individuals are most likely to benefit from different treatments, optimize existing therapeutic approaches to target neural and clinical features of OUD, and unveil novel neuroscience-informed interventions to combat the nationwide opioid epidemic [32,35,41].…”