Influence of improved behavioral inhibition on decreased cue-induced craving in heroin use disorder: A preliminary intermittent theta burst stimulation study.

BACKGROUND: Impaired behavioral inhibition is a critical factor in drug addiction and relapse. Repetitive transcranial magnetic stimulation (rTMS) reduces the craving of heroin-addicted individuals for drug-related cues. However, it is unclear whether this technique also improves impaired behavioral inhibition and how improved behavioral inhibition affects craving. OBJECTIVE: The intermittent theta-burst stimulation (iTBS) has been recently shown to be non-inferior relative to rTMS for depression. Here, we aim to investigate the effect of iTBS on heroin-addicted individuals' behavioral inhibition and cue-induced craving and the relationship between the alteration of behavioral inhibition and craving. METHOD: 42 of 56 initially recruited individuals with the heroin-use disorder in the abstinent-course treatment were randomized to undergo active or sham iTBS to the left dorsolateral prefrontal cortex and received three daily iTBS treatments for 10 consecutive days. We measured participants' performance during a two-choice oddball task (80% standard and 20% deviant trials) and heroin-related cue-induced craving before and immediately after treatment. RESULTS: The group that received active iTBS showed significantly improved two-choice oddball task performance after 10 days of intervention compared to both pre-intervention and the group who received sham iTBS. Similarly, a significant reduction in cue-induced craving was observed after following the intervention in the active iTBS group but not the sham iTBS group. The moderation model indicated that iTBS categories play a significant moderating role in the relationship between accuracy cost changing and altered cue-induced craving. CONCLUSIONS: The iTBS treatment protocol positively affects behavioral inhibition in patients with heroin addiction. Improvements in behavioral inhibition can substantially reduce craving.

The ineffective emotion regulation strategies of heroin use disorder patients: An event-related potential study.

BACKGROUND: People with substance use disorders (SUDs) usually experience emotion dysregulation, which may be a consequence of or a risk factor for the development and maintenance of substance misuse. Despite growing evidence on emotion dysregulation among people with SUDs, relatively few studies have explored emotion dysregulation in heroin use disorder (HUD) patients. METHODS: Using event-related potentials (ERP), we compared the emotion regulation ability of 33 HUD patients and 30 healthy controls according to their average electroencephalogram amplitudes of the late positive potential (LPP) component in 400-1000 ms and 1000-2000 ms time windows, while viewing neutral and unpleasant emotional pictures, and using emotion regulation strategies (expressive suppression, cognitive reappraisal, and a combination) while viewing unpleasant pictures. We recorded their mood states and how successfully they used emotion regulation strategies in each block using 7-point scales. RESULTS: Relative to healthy controls, the LPP amplitudes of HUD patients were significantly lower when viewing emotional stimuli (pearlyLPP < 0.05) and using emotion regulation strategies (all p < 0.05). The left hemisphere was more active in healthy controls (pearlyLPP < 0.05, plateLPP < 0.01); there were no differences in scalp position activation among HUD patients. DISCUSSION: Compared to healthy controls, HUD patients' emotional arousal and emotion regulation ability were impaired, as reflected by the LPP component. Their abnormal scalp activation pattern may imply abnormal brain activity. Future research could explore this with electroencephalogram source analysis techniques, functional magnetic resonance imaging, or other technologies. Intervention effects for emotion dysregulation in HUD treatment are also worth exploring.