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An fMRI Study of the Interaction of Stress and Cocaine Cues on Cocaine Craving in Cocaine-Dependent Men
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Cocaine addiction tough to treat because many patients show chronic relapse Relapse is often preceded by 1) Negative emotions 2) Stressful life events
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Limbic areas - Motivation and emotion Areas linked to dopamine system - reward Anterior cingulate cortex Amygdala Nucleus accumbens Insula Amygdala Bed nucleus of stria terminalis
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Script-guided imagery of stressful situations Found that female cocaine users had increased frontal and cingulate activation How stress influences cocaine craving to better understand relapse process About relationship between stress and craving in the brain
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Stressful stimuli would enhance the activation of craving related neural pathways. IVs: Stressor and Script-Type DV: subjective measure of emotion OR fMRI activation
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Participants Ten right-handed African American males Age range: 37-49 Administration method: smoking crack In early stage of drug abstinence (on avg 8) Met DSM-IV criteria for cocaine dependence but no other disorders Unless substance-induced mood disorder
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Procedure Baseline assessments of: cocaine craving the week before testing ADHD Psychopathology Mental imagery ability Script-guided mental imagery Listened to and mentally re-enacted scripts One drug-related One drug-neutral Stressor: threat of mild electric shock to wrist Told which part of testing would occur
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fMRI scanning BOLD fMRI Data analysis done with statistical parametric mapping software Based on probability of areas being activated due solely to chance
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MeasureMean (SD)Range CCS—cocaine craving 4.85 (2.4)1–10 QMI59.4 (31)35–116 CAARS-SL12.11 (8.4)2–24 BPRS26.2 (6.6)19–38 Baseline assessments
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Within-Subjects ANOVA for: Shock condition – not significant Timepoint – Cocaine script resulted in significantly higher craving than neutral script and baseline Shock*Timepoint interaction – not significant No significant changes at any timepoint during the session in subjective ratings of sadness, anxiety, or anger
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Cocaine Scripts to Neutral Scripts 1) Early: Early Significant activation of: Anterior cingulate cortex Insula Posterior cingulate cortex 2) Late: Late Significant activation of: Anterior cingulate cortex Insula 3) Entire cocaine script minus entire neutral Activation of: Anterior cingulate cortex Insula Posterior cingulate cortex
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Cocaine (no stress): Cocaine (stress) Right thalamus Precuneus/posterior cingulate cortex → Not significant Cocaine (stress, late): Neutral (stress, late) Left insula → Not significant No activation differences when no stress: no stress
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Effects seen in parietal lobes For “Early” these effects were significant in the posterior cingulate cortex and right parietal (For Cocaine*Stress)
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1 st Main Finding: Cocaine compared to neutral showed activation of: Posterior cingulate cortex Linked to anterior cingulate and amygdala; reward Left insula Integration of internal body state associated with emotions Right thalamus Information relaying
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2 nd Main Finding Stressor in cocaine condition resulted in activation of: Left insula Anterior cingulate cortex Evaluation of incentive cues and decision-making regarding reward
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Results seen for stress situation not surprising as they are areas previously associated with conditioned cocaine craving. → Responses not as strong as in prior studies Results for reward make sense but areas missing Nucleus accumbens Prefrontal cortex Orbitofrontal cortex
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Limitations fMRI loud – harder to fully immerse self in script Used PET in past Imagery skills were not the same across all participants Desired responding Not stressful enough
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Cocaine scripts elicited responses in areas associated with rewards Presence of cocaine script and stressor enhanced cocaine-induced reward activation Also attentional areas Implications? Relaxation training for recovering addicts Future studies: More participants
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Duncan, E., Boshoven, W., Harenski, K., Fiallos, A., Tracy, H., Jovanovic, T., Hu, X., Drexler, K. & Kilts, C. (2007). An fMRI study of the interaction of stress and cocaine cues on cocaine craving in cocaine-dependent men. The American Journal on Addictions, 16, 174-182.
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