大麻依赖中脑结构和奖赏处理脑功能的预处理措施：一项关于行为治疗期间与戒断关系的探索性研究。
Pretreatment measures of brain structure and reward-processing brain function in cannabis dependence: an exploratory study of relationships with abstinence during behavioral treatment.
作者信息
Yip Sarah W, DeVito Elise E, Kober Hedy, Worhunsky Patrick D, Carroll Kathleen M, Potenza Marc N
机构信息
Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
出版信息
Drug Alcohol Depend. 2014 Jul 1;140:33-41. doi: 10.1016/j.drugalcdep.2014.03.031. Epub 2014 Apr 13.
BACKGROUND
Cannabis is widely abused, and efficacies of therapeutics for cannabis dependence remain suboptimal. Magnetic resonance imaging (MRI) may aid in the identification of biological markers for successful treatment outcomes (i.e., abstinence).
METHODS
Twenty men with cannabis dependence and twenty non-substance-using healthy comparison (HC) men underwent MRI scanning. Cannabis-dependent individuals then participated in a 12-week randomized clinical trial of behavioral treatments (contingency management (CM), cognitive behavioral therapy (CBT) or both). Pretreatment functional and structural data were compared between the cannabis-dependent and HC participants. In addition, individuals with cannabis dependence were subdivided based on the successful achievement of 21 days of consecutive abstinence during treatment to assess whether abstinent versus non-abstinent cannabis-dependent participants displayed different pretreatment functional and structural characteristics when compared to HC participants.
RESULTS
In comparison to HC participants, cannabis-dependent participants demonstrated greater ventral striatal activation during the receipt of losing outcomes and smaller putamenal volumes. Cannabis-dependent participants who did not subsequently achieve 21 days of consecutive abstinence had increased activity within the striatum during the receipt of losing outcomes, relative to HC participants. Cannabis-dependent participants who did not achieve 21 days of abstinence had decreased bilateral putamen volumes prior to treatment, relative to HC participants.
CONCLUSIONS
Individual differences in pretreatment striatal function and structure may relate to individual differences in treatment responses for cannabis dependence. While mechanisms underlying these associations require further exploration, the striatum might mediate treatment responses via its role in associative reward-learning (e.g., through skills training in CBT or reinforcement of abstinence in CM).
背景
大麻被广泛滥用，用于治疗大麻依赖的疗法效果仍不尽人意。磁共振成像（MRI）可能有助于识别成功治疗结果（即戒断）的生物标志物。
方法
20名大麻依赖男性和20名非物质使用健康对照（HC）男性接受了MRI扫描。大麻依赖个体随后参加了一项为期12周的行为治疗随机临床试验（应急管理（CM）、认知行为疗法（CBT）或两者结合）。比较了大麻依赖参与者和HC参与者的治疗前功能和结构数据。此外，根据治疗期间连续21天成功戒断情况，将大麻依赖个体进行细分，以评估与HC参与者相比，戒断与未戒断的大麻依赖参与者在治疗前是否表现出不同的功能和结构特征。
结果
与HC参与者相比，大麻依赖参与者在接受失败结果时腹侧纹状体激活更强，壳核体积更小。相对于HC参与者，随后未连续21天戒断的大麻依赖参与者在接受失败结果时纹状体内活动增加。相对于HC参与者，未达到21天戒断的大麻依赖参与者在治疗前双侧壳核体积减小。
结论
治疗前纹状体功能和结构的个体差异可能与大麻依赖治疗反应的个体差异有关。虽然这些关联背后的机制需要进一步探索，但纹状体可能通过其在联想奖励学习中的作用（例如，通过CBT中的技能训练或CM中的戒断强化）来介导治疗反应。
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