Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
Biol Psychiatry. 2011 Jun 1;69(11):1060-6. doi: 10.1016/j.biopsych.2010.12.016. Epub 2011 Feb 3.
In alcohol-dependent patients, alcohol-associated cues elicit brain activation in mesocorticolimbic networks involved in relapse mechanisms. Cue-exposure based extinction training (CET) has been shown to be efficacious in the treatment of alcoholism; however, it has remained unexplored whether CET mediates its therapeutic effects via changes of activity in mesolimbic networks in response to alcohol cues. In this study, we assessed CET treatment effects on cue-induced responses using functional magnetic resonance imaging (fMRI).
In a randomized controlled trial, abstinent alcohol-dependent patients were randomly assigned to a CET group (n = 15) or a control group (n = 15). All patients underwent an extended detoxification treatment comprising medically supervised detoxification, health education, and supportive therapy. The CET patients additionally received nine CET sessions over 3 weeks, exposing the patient to his/her preferred alcoholic beverage. Cue-induced fMRI activation to alcohol cues was measured at pretreatment and posttreatment.
Compared with pretreatment, fMRI cue-reactivity reduction was greater in the CET relative to the control group, especially in the anterior cingulate gyrus and the insula, as well as limbic and frontal regions. Before treatment, increased cue-induced fMRI activation was found in limbic and reward-related brain regions and in visual areas. After treatment, the CET group showed less activation than the control group in the left ventral striatum.
The study provides first evidence that an exposure-based psychotherapeutic intervention in the treatment of alcoholism impacts on brain areas relevant for addiction memory and attentional focus to alcohol-associated cues and affects mesocorticolimbic reward pathways suggested to be pathophysiologically involved in addiction.
在酒精依赖患者中，与酒精相关的线索会引发涉及复发机制的中脑边缘奖赏网络的大脑激活。基于线索暴露的消退训练（CET）已被证明在治疗酗酒方面是有效的；然而，CET 是否通过中脑边缘奖赏网络对酒精线索的反应活性变化来介导其治疗效果仍未得到探索。在这项研究中，我们使用功能磁共振成像（fMRI）评估了 CET 治疗对线索诱导反应的影响。
在一项随机对照试验中，酒精依赖的戒酒患者被随机分配到 CET 组（n = 15）或对照组（n = 15）。所有患者都接受了为期 3 周的扩展戒毒治疗，包括医学监督下的戒毒、健康教育和支持性治疗。CET 患者还接受了 9 次 CET 治疗，使患者接触到他/她喜欢的酒精饮料。在治疗前和治疗后测量了对酒精线索的 fMRI 激活。
与治疗前相比，CET 组的 fMRI 线索反应性降低幅度大于对照组，尤其是在前扣带皮层和脑岛，以及边缘和额叶区域。治疗前，在边缘和奖赏相关的大脑区域以及视觉区域发现了增加的线索诱导 fMRI 激活。治疗后，CET 组的左腹侧纹状体的激活低于对照组。
该研究首次提供了证据，表明暴露为基础的心理治疗干预在治疗酗酒方面会影响到与成瘾记忆和对酒精相关线索的注意力有关的大脑区域，并影响到被认为与成瘾的病理生理过程有关的中脑边缘奖赏通路。
