Subtypes in addiction and their neurobehavioral profiles across three functional domains

Abstract

Rates of return to use in addiction treatment remain high. We argue that the development of improved treatment options will require advanced understanding of individual heterogeneity in Substance Use Disorders (SUDs). We hypothesized that considerable individual differences exist in the three functional domains underlying addiction—approach-related behavior, executive function, and negative emotionality. We included N = 593 participants from the enhanced Nathan Kline Institute-Rockland Sample community sample (ages 18–59, 67% female) that included N = 420 Controls and N = 173 with past SUDs [54% female; N = 75 Alcohol Use Disorder (AUD) only, N = 30 Cannabis Use Disorder (CUD) only, and N = 68 Multiple SUDs]. To test our a priori hypothesis that distinct neuro-behavioral subtypes exist within individuals with past SUDs, we conducted a latent profile analysis with all available phenotypic data as input (74 subscales from 18 measures), and then characterized resting-state brain function for each discovered subtype. Three subtypes with distinct neurobehavioral profiles were recovered (p < 0.05, Cohen’s D: 0.4–2.8): a “Reward type” with higher approach-related behavior (N = 69); a “Cognitive type” with lower executive function (N = 70); and a “Relief type” with high negative emotionality (N = 34). For those in the Reward type, substance use mapped onto resting-state connectivity in the Value/Reward, Ventral-Frontoparietal and Salience networks; for the Cognitive type in the Auditory, Parietal Association, Frontoparietal and Salience networks; and for the Relief type in the Parietal Association, Higher Visual and Salience networks (pFDR < 0.05). Subtypes were equally distributed amongst individuals with different primary SUDs (χ2 = 4.71, p = 0.32) and gender (χ2 = 3.44, p = 0.18). Results support functionally derived subtypes, demonstrating considerable individual heterogeneity in the multi-dimensional impairments in addiction. This confirms the need for mechanism-based subtyping to inform the development of personalized addiction medicine approaches.

Data-driven connectivity profiles relate to smoking cessation outcomes

“…Recently, Drossel et al found that distinct subtypes of individuals with SUDs were linked to different patterns of rs-FC. In “reward-type” individuals (i.e., higher approach-related behavior), substance use was related to decreased connectivity in the FPN and SN, while in “cognitive-type” (i.e., lower executive function), substance use was related to increased connectivity in the FPN and SN [ 36 ]. This suggests that different individuals have distinct neurobiological pathways contributing to their craving.…”

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

“…Individuals with deficits in working memory may include adults characterized by inattention or distractibility. This differs from individuals who have response inhibition difficulties, who are typically characterized as more impulsive (Drossel et al, 2023). Similarly, distractible or impulsive individuals often differ from those with set shifting difficulties, who are often characterized as perseverative and exhibiting a 'stickier' personality style (Alexopoulos et al, 2015;Voon, 2015).…”

Editorial: Individual differences in addictive behaviors

“…This takes into account different theoretical perspectives including for example genetics and social environmental variables which clearly have a significant role in explaining, understanding and treating addiction (Volkow et al, 2016 ). As well as this more inclusive approach, the scientific literature has shifted its focus toward the individual both in respect to understanding addiction and to treating addiction (Drossel et al, 2023 ). Further to this, as clearly expressed in this Research Topic, understanding addiction is evolving.…”