Functional near infrared spectroscopy as a potential biological assessment of addiction recovery: preliminary findings.

BACKGROUND: Addiction science has primarily utilized self-report, continued substance use, and relapse factors to explore the process of recovery. However, the entry into successful abstinence substantially reduces our assessment abilities. Advances in neuroscience may be the key to objective understanding, treating, and monitoring long-term success in addiction recovery. OBJECTIVES: To explore functional near infrared spectroscopy (fNIR) as a viable technique in the assessment of addiction-cue reactivity. Specifically, prefrontal cortex (PFC) activation to alcohol cues was explored among formally alcohol-dependent individuals, across varying levels of successful abstinence. The aim of the investigation was to identify patterns of PFC activation change consistent with duration of abstinence. METHODS: A total of 15 formally alcohol-dependent individuals, with abstinence durations ranging from 1 month to 10 years, viewed alcohol images during fNIR PFC assessment. Participants also subjectively rated the same images for affect and arousal level. RESULTS: Subjective ratings of alcohol cues did not significantly correlate with duration of abstinence. As expected, days of abstinence did not significantly correlate with neutral cue fNIR reactivity. However, for alcohol cues, fNIR results showed increased days of abstinence was associated with decreased activation within the dorsolateral and dorsomedial prefrontal cortex regions. CONCLUSIONS: The present results suggest that fNIR may be a viable tool in the assessment of addiction-cue reactivity. RESULTS also support previous findings on the importance of dorsolateral and dorsomedial PFC in alcohol-cue activation. The findings build upon these past results suggesting that fNIR-assessed activation may represent a robust biological marker of successful addiction recovery.

The influence of stress on the affective modulation of the startle response to nicotine cues.

Recent research suggesting that nicotine cues are appetitive in nature promotes the affective modulation of the startle reflex (AMSR) paradigm as a potentially valuable psychophysiological tool for elucidating mechanisms involved in nicotine addiction. Despite numerous studies indicating stress as a key factor in nicotine dependence, specific behavioral mechanisms linking stress and smoking have yet to be explicated. The current study aimed to determine the effects of stress, a negative affective state intimately linked with nicotine use, on the psychophysiological responding of nicotine dependent individuals during smoking cues. Twenty-nine nicotine dependent individuals were randomly assigned to the trier social stress test or control condition directly prior to administration of the AMSR paradigm, which examined their physiological responses to appetitive, neutral, aversive, and nicotine cue images. Both groups evinced significantly decreased startle magnitudes in response to nicotine cues as compared to aversive images. However, exposure to stress did not significantly modulate the startle reflex while viewing nicotine cues. Stress induction does not appear to modulate the AMSR paradigm when evaluating responses to nicotine images. These findings suggest that AMSR is robust to effects of acute stress induction in nicotine dependent individuals which may increase its viability as a clinical tool for assessing success in smoking cessation interventions.

Social anxiety impacts willingness to participate in addiction treatment.

Individuals with social anxiety have difficulty participating in group settings. Although it makes intuitive sense that social anxiety could present a challenge in addiction treatment settings, which often involve small groups and encouragement to participate in self-help groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), to our knowledge no study has yet assessed the impact of shyness on the treatment experience. Assessment surveys were given to 110 individuals seeking intensive outpatient substance abuse treatment at three community treatment programs. Established cut-offs for presence of clinically-significant social anxiety indicated a prevalence of 37%. Controlling for depression and worry, social anxiety was a unique predictor of endorsement that shyness interfered with willingness to talk to a therapist, speak up in group therapy, attend AA/NA, and ask somebody to be a sponsor. Socially anxious substance abusers were 4-8 times more likely to endorse that shyness interfered with addiction treatment activities. These findings have clinical and research implications.

Treatment of social anxiety with paroxetine: mediation of changes in anxiety and depression symptoms.

Investigation of relationship patterns between co-occurring symptoms has greatly improved the efficacy of psychiatric care. Depression and anxiety often present together, and identification of primary vs secondary psychiatric symptoms has implications for treatment. Previous psychotherapy research investigating the relationship between social anxiety and depression, across social anxiety treatment, found that severity of social anxiety accounted for most of the change in depression severity across time. Conversely, severity of depression accounted for little variation in severity of social anxiety. The current investigation was conducted to extend these findings by examining this mediational relationship in a pharmacologic trial comparing paroxetine (n = 20) and placebo (n = 22). Social anxiety and depression severity were assessed weekly for 16 weeks. Consistent with the previous study, results indicated that social anxiety severity mediated most of the variance in depression severity, with little variance accounted for by a test of the reverse mediation. Surprisingly, this same pattern was also found in the placebo group. These findings suggest that this pattern of mediational relationships may be fundamental to social anxiety, rather than specific to treatment modality or secondary comorbidity.

The influence of monetary compensation on relapse among addicted participants: empirical vs. anecdotal evidence.

Although common, the use of cash incentives to compensate drug-addicted participants is controversial. This is particularly true given concerns that cash incentives might precipitate relapse, as is commonly believed. The following investigation examined whether cash versus money order compensation differentially influenced drug use among 34 non-treatment-seeking, cocaine-dependent individuals. Consistent with past evidence, results did not suggest that form of compensation was associated with likelihood of continued cocaine use or dollar amount of cocaine consumed after participation. Findings do not support commonly held concerns that cash incentives increase the risk of relapse following research participation.

Smoking prevalence and awareness among undergraduate and health care students.

Approximately 10,000 undergraduates from 12 Texas colleges and universities and 350 health care students completed a Web-based survey assessing the prevalence and awareness of cigarette smoking. There were few differences between health care and undergraduate students on trying smoking or quitting smoking. Health care students reported lower rates of current smoking than undergraduate students, even though both groups demonstrated similar knowledge of tobacco-related health risks. Gender differences are discussed. Findings suggest that tobacco awareness programs should continue to target young adults as an at-risk population, and that health care training programs should place a greater emphasis on tobacco cessation.

Appetitive nature of drug cues re-confirmed with physiological measures and the potential role of stage of change.

RATIONALE: Smokers report pleasant reactions to viewing cigarettes, suggesting that smoking cues may be appetitive in nature. Two studies have investigated this hypothesis through physiological assessment. The first study found that smoking cues were physiologically appetitive in nature, with dampened startle response to smoking pictures in comparison to neutral pictures. The second found that smoking pictures did not modulate the startle response, suggesting such cues may not be physiologically appetitive. OBJECTIVE: The goal of the present study was to further investigate how participants' motivation to quit smoking might modulate responses to smoking cues. MATERIALS AND METHODS: Twenty-two nicotine-dependent smokers viewed standardized pleasant, unpleasant, neutral, and smoking pictures. Eleven of the subjects reported no intent to quit (precontemplators) and 11 reported planning to quit within the next 6 months (contemplators). Acoustic startle probes were randomly administered while subjects viewed the pictures, and eyeblink startle magnitude was measured with electromyography (EMG). RESULTS: As a whole, participants exhibited dampened startle responses during smoking pictures, relative to unpleasant pictures. Precontemplators showed robust startle inhibition to smoking pictures, in comparison to both neutral and unpleasant pictures. Contemplators, however, showed blunted unpleasant picture augmentation and a lack of startle inhibition for pleasant pictures. CONCLUSION: These findings are consistent with the idea that smoking pictures are appetitive in nature. Furthermore, they suggest that smokers at a later stage of change may exhibit a lesser response.