Brain mu-opioid receptor binding predicts treatment outcome in cocaine-abusing outpatients - PubMed (original) (raw)

Brain mu-opioid receptor binding predicts treatment outcome in cocaine-abusing outpatients

Udi E Ghitza et al. Biol Psychiatry. 2010.

Abstract

Background: Cocaine users not seeking treatment have increased regional brain mu-opioid receptor (mOR) binding that correlates with cocaine craving and tendency to relapse. In cocaine-abusing outpatients in treatment, the relationship of mOR binding and treatment outcome is unknown.

Methods: We determined whether regional brain mOR binding before treatment correlates with outcome and compared it with standard clinical predictors of outcome. Twenty-five individuals seeking outpatient treatment for cocaine abuse or dependence (DSM-IV) received up to 12 weeks of cognitive-behavioral therapy and cocaine abstinence reinforcement, whereby each cocaine-free urine was reinforced with vouchers redeemable for goods. Regional brain mOR binding was measured before treatment using positron emission tomography with [¹¹C]]-carfentanil (a selective mOR agonist). Main outcome measures were: 1) overall percentage of urines positive for cocaine during first month of treatment; and 2) longest duration (weeks) of abstinence from cocaine during treatment, all verified by urine toxicology.

Results: Elevated mOR binding in the medial frontal and middle frontal gyri before treatment correlated with greater cocaine use during treatment. Elevated mOR binding in the anterior cingulate, medial frontal, middle frontal, middle temporal, and sublobar insular gyri correlated with shorter duration of cocaine abstinence during treatment. Regional mOR binding contributed significant predictive power for treatment outcome beyond that of standard clinical variables such as baseline drug and alcohol use.

Conclusions: Elevated mOR binding in brain regions associated with reward sensitivity is a significant independent predictor of treatment outcome in cocaine-abusing outpatients, suggesting a key role for the brain endogenous opioid system in cocaine addiction.

Published by Elsevier Inc.

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Figures

Figure 1

Figure 1

Association of regional mOR binding before treatment and overall percentage of urine specimens positive for cocaine during the first month of treatment. Pre-treatment mOR binding in the (A) right middle frontal gyrus, and (B) left medial frontal gyrus shows a significant positive correlation with percentage of urine specimens positive for cocaine. See Table 2 for statistics. Lines are least squares best fit to data points. Display threshold for mOR binding is p<0.005 (uncorrected); cluster size k>50.

Figure 2

Figure 2

Association of regional mOR binding before treatment and duration (weeks) of longest abstinence from cocaine achieved during treatment. Pre-treatment mOR binding in the (A) left middle temporal gyrus extending to the left sub-lobar insular gyrus, (B) right middle temporal gyrus, (C) left medial frontal gyrus, (D) right middle temporal gyrus, (E) left middle frontal gyrus, (F) left anterior cingulate gyrus, and (G) right middle frontal gyrus shows a significant negative correlation with the duration of longest abstinence achieved during treatment. See Table 3 for statistics. Lines are least squares best fit to data points. Display threshold for mOR binding is p<0.001 (uncorrected); cluster size k>50.

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