Summary: Study concludes the most intense periods for cocaine cravings often coincides with a patient’s release from addiction treatment programs.
Source: Mount Sinai Hospital.
Findings offer new promise for addiction treatment.
New research from the Icahn School of Medicine at Mount Sinai using electroencephalography, or EEG, indicates that adults addicted to cocaine may be increasingly vulnerable to relapse from day two to one month of abstinence and most vulnerable between one and six months. The findings, published online today in JAMA Psychiatry, suggest that the most intense periods of craving for illicit substances often coincide with patients’ release from addiction treatment programs and facilities.
It is not known why individuals with substance use disorders relapse even after remaining abstinent from illicit substances for long periods of time. However, it is clear that cue-induced craving–craving elicited by the exposure to cues previously associated with drug use–plays a major role in relapse. Until now, studies have used self-reported measures to assess cue-induced craving. This is the first study that uses EEG to quantify cue-induced craving in humans with cocaine use disorder, showing a similar trajectory of craving demonstrated in previous studies using animal models. In this study and in contrast to the EEG measures, self-reported craving showed a gradual decline with increasing abstinence duration, underscoring a potential disconnect between the physiological response to drug-related cues in addicted individuals and their perception of this response.
“Our results are important because they identify an objectively ascertained period of high vulnerability to relapse,” says Muhammad Parvaz, PhD, Assistant Professor of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, and the study’s lead author. “Unfortunately, this period of vulnerability coincides with the window of discharge from most treatment programs, perhaps increasing a person’s propensity to relapse.”
Over five and a half years, the research team collected data from EEG recordings in 76 adults addicted to cocaine with varying durations of abstinence (two days, one week, one month, six months, and one year). EEG was recorded while participants looked at different types of pictures, including pictures that depicted cocaine and individuals preparing, using, and simulating use of cocaine. After EEG, participants also self-rated their level of craving for each cocaine-related picture.
“Results of this study are alarming in that they suggest that many people struggling with drug addiction are being released from treatment programs at the time they need the most support,” said Rita Goldstein, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine and Principal Investigator of the study. “Our results could help guide the implementation of alternative, individually tailored and optimally timed intervention, prevention, and treatment strategies.”
About this addiction research article
Scott J. Moeller, PhD, Assistant Professor of Psychiatry and Neuroscience at the Icahn School of Medicine, also collaborated in the study. The entire Neuropsychoimaging of Addiction and Related Conditions (NARC) group also provided the needed support.
Funding: The research was supported by multiple grants from the National Institute on Drug Abuse (NIDA): F32DA033088, 1K01DA037453, 1R21DA40046, R01DA023579, 1R21DA034954-01, and R01DA041528-01.
Source: Sasha Walek – Mount Sinai Hospital Image Source: This NeuroscienceNews.com image is in the public domain. Original Research:Abstract for “Incubation of Cue-Induced Craving in Adults Addicted to Cocaine Measured by Electroencephalography” by Muhammad A. Parvaz, PhD; Scott J. Moeller, PhD; and Rita Z. Goldstein, PhD in JAMA Psychiatry. Published online September 7 2016 doi:10.1001/jamapsychiatry.2016.2181
Cite This NeuroscienceNews.com Article
[cbtabs][cbtab title=”MLA”]Mount Sinai Hospital. “Researchers Pinpoint When Cocaine Addicts Are Most Vulnerable to Relapse.” NeuroscienceNews. NeuroscienceNews, 7 September 2016. <https://neurosciencenews.com/cocaine-relapse-psychology-4984/>.[/cbtab][cbtab title=”APA”]Mount Sinai Hospital. (2016, September 7). Researchers Pinpoint When Cocaine Addicts Are Most Vulnerable to Relapse. NeuroscienceNews. Retrieved September 7, 2016 from https://neurosciencenews.com/cocaine-relapse-psychology-4984/[/cbtab][cbtab title=”Chicago”]Mount Sinai Hospital. “Researchers Pinpoint When Cocaine Addicts Are Most Vulnerable to Relapse.” https://neurosciencenews.com/cocaine-relapse-psychology-4984/ (accessed September 7, 2016).[/cbtab][/cbtabs]
Incubation of Cue-Induced Craving in Adults Addicted to Cocaine Measured by Electroencephalography
Importance A common trigger for relapse in drug addiction is the experience of craving via exposure to cues previously associated with drug use. Preclinical studies have consistently demonstrated incubation of cue-induced drug-seeking during the initial phase of abstinence, followed by a decline over time. In humans, the incubation effect has been shown for alcohol, nicotine, and methamphetamine addictions, but not for heroin or cocaine addiction. Understanding the trajectory of cue-induced craving during abstinence in humans is of importance for addiction medicine.
Objective To assess cue-induced craving for cocaine in humans using both subjective and objective indices of cue-elicited responses.
Design, Setting, and Participants Seventy-six individuals addicted to cocaine with varying durations of abstinence (ie, 2 days, 1 week, 1 month, 6 months, and 1 year) participated in this laboratory-based cross-sectional study from June 19, 2007, to November 26, 2012. The late positive potential component of electroencephalography, a recognized marker of incentive salience, was used to track motivated attention to drug cues across these self-selected groups. Participants also completed subjective ratings of craving for cocaine before presentation of a cue, and ratings of cocaine “liking” (hedonic feelings toward cocaine) and “wanting” (craving for cocaine) after presentation of cocaine-related pictures. Data analysis was conducted from June 5, 2015, to March 30, 2016.
Main Outcomes and Measures The late positive potential amplitudes and ratings of liking and wanting cocaine in response to cocaine-related pictures were quantified and compared across groups.
Results Among the 76 individuals addicted to cocaine, 19 (25%) were abstinent for 2 days, 20 (26%) were abstinent for 1 week, 15 (20%) were abstinent for 1 month, 12 (16%) were abstinent for 6 months, and 10 (13%) were abstinent for 1 year. In response to drug cues, the mean (SD) late positive potential amplitudes showed a parabolic trajectory that was higher at 1 (1.26 [1.36] µV) and 6 (1.17 [1.19] µV) months of abstinence and lower at 2 days (0.17 [1.09] µV), 1 week (0.36 [1.26] µV), and 1 year (–0.27 [1.74] µV) of abstinence (P = .02, partial η2 = 0.16). In contrast, the subjective assessment of baseline craving (mean [SD] rating: 2 days, 26.05 [9.85]; 1 week, 18.70 [11.01]; 1 month, 10.87 [10.70]; 6 months, 6.92 [8.47]; and 1 year, 3.00 [3.77]) and cue-induced liking (mean [SD] rating: 2 days, 3.06 [2.34]; 1 week, 2.33 [2.87]; 1 month, 1.15 [2.03]; 6 months, 1.00 [2.24]; and 1 year, 1.00 [1.26]) and wanting (mean [SD] rating: 2 days, 3.44 [2.62]; 1 week, 2.72 [2.87]; 1 month, 1.46 [2.33]; 6 months, 1.00 [2.16]; and 1 year, 1.00 [1.55]) of cocaine showed a linear decline from 2 days to 1 year of abstinence (P ≤ .001, partial η2 > 0.26).
Conclusions and Relevance The late positive potential responses to drug cues, indicative of motivated attention, showed a trajectory similar to that reported in animal models. In contrast, we did not detect incubation of subjective cue-induced craving. Thus, the objective electroencephalographic measure may possibly be a better indicator of vulnerability to cue-induced relapse than subjective reports of craving, although this hypothesis must be empirically tested. These results suggest the importance of deploying intervention between 1 month and 6 months of abstinence, when addicted individuals may be most vulnerable to, and perhaps least cognizant of, risk of relapse.
“Incubation of Cue-Induced Craving in Adults Addicted to Cocaine Measured by Electroencephalography” by Muhammad A. Parvaz, PhD; Scott J. Moeller, PhD; and Rita Z. Goldstein, PhD in JAMA Psychiatry. Published online September 7 2016