Chen Yu, Li Chiang-Shan R
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06520, USA.
Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06520, USA.
Addict Neurosci. 2023 Sep;7. doi: 10.1016/j.addicn.2023.100089. Epub 2023 Apr 8.
Craving reflects the subjective urge to use drugs and can be triggered by both positive and negative emotional states. No studies have systematically investigated the relative roles of these mechanisms in the pathophysiology of substance misuse. Here, we performed meta-analyses of drug cue-elicited reactivity and win and loss processing in the monetary incentive delay task to identify distinct neural correlates of appetitive and aversive responses to drug cues. We then characterized the appetitive and aversive cue responses in seventy-six alcohol drinkers performing a cue craving task during fMRI. Imaging data were processed according to published routines. The appetitive circuit involved medial cortical regions and the ventral striatum, and the aversive circuit involved the insula, caudate and mid-cingulate cortex. We observed a significant correlation of cue-elicited activity ( estimates) of the appetitive and aversive circuit. However, individuals varied in appetitive and aversive cue responses. From the regression of appetitive (y) vs. aversive (x) , we identified participants in the top 1/3 each of those with positive and negative residuals as "approach" ( = 15) and "avoidance" ( = 11) and the others as the "mixed" ( = 50) subtype. In clinical characteristics, the avoidance subtype showed higher sensitivity to punishment and, in contrast, the approach subtype showed higher levels of sensation seeking and alcohol expectancy for social and physical pressure. The findings highlighted distinct neural underpinnings of appetitive and aversive components of cue-elicited reactivity and provided evidence for potential subtypes of alcohol drinkers.
渴求反映了使用毒品的主观冲动，可由积极和消极情绪状态引发。尚无研究系统地探究这些机制在物质滥用病理生理学中的相对作用。在此，我们对货币奖励延迟任务中药物线索引发的反应性以及输赢处理进行了荟萃分析，以确定对药物线索的奖赏性和厌恶性反应的不同神经关联。然后，我们对76名在功能磁共振成像（fMRI）期间执行线索渴求任务的饮酒者的奖赏性和厌恶性线索反应进行了特征描述。成像数据按照已发表的程序进行处理。奖赏性回路涉及内侧皮质区域和腹侧纹状体，厌恶性回路涉及脑岛、尾状核和扣带中部皮质。我们观察到奖赏性和厌恶性回路的线索引发活动（估计值）之间存在显著相关性。然而，个体在奖赏性和厌恶性线索反应方面存在差异。通过对奖赏性（y）与厌恶性（x）的回归分析，我们将正残差和负残差前1/3的参与者分别确定为“趋近型”（n = 15）和“回避型”（n = 11），其他参与者为“混合型”（n = 50）亚型。在临床特征方面，回避型亚型对惩罚更敏感，相反，趋近型亚型在寻求刺激以及对社交和身体压力的酒精预期方面水平更高。这些发现突出了线索引发反应的奖赏性和厌恶性成分的不同神经基础，并为饮酒者的潜在亚型提供了证据。
