Empirical evidence suggests substance dependence creates stress system dysregulation which, in turn, may limit the efficacy of verbal-based treatment interventions, as the recovering brain may not be functionally capable of executive level processing. Treatment models that target implicit functioning are necessary.
Methods:
An RCT was conducted to examine the effects of a dual-processing (DP) intervention compared to a didactic standard care (RP) model on brain function change in substance-dependent adults (N=29).
Results:
fMRI analyses showed decreased amygdala activation simultaneous with increased frontal lobe (medial frontal gyrus and ACC) activation in the DP group during passive watch condition, while the RP group showed continued amygdala activation simultaneous to frontal lobe activation during drug stressor presentation at post-treatment.
Conclusions:
Our study offers preliminary evidence that DP acts on neural functioning in ways that increase regulatory response in the presence of drug stressor cues by enhancing top-down functioning and diminishing amygdala reactivity.
BecharaA., (2004). The role of emotion in decision-making: Evidence from neurological patients with orbitofrontal damage. Brain Cognition, 55, 30–40.
2.
BisbyJ. A.KingJ. A.BrewinC. R.BurgessN.CurranH. V. (2010). Acute effects of alcohol on intrusive memory development and viewpoint dependence in spatial memory support a dual representation model. Biological Psychiatry, 68, 280–286.
3.
BollaK.ErnstM.KiehlK.MouratidisM.EldrethD.ContoreggiC.…LondonE. (2004). Prefrontal cortical dysfunction in abstinent cocaine abusers. Journal of Neuropsychiatry Clinical Neuroscience, 16, 456–464.
4.
BradleyM. M.LangP. J. (1994). Measuring emotion: The self-assessment manikin and the semantic differential. Journal of Behavior, Therapy & Experimental Psychiatry, 25, 49–59.
5.
BrewinC. R. (2001). A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behavior Research and Therapy, 39, 373–393.
6.
BrewinC. R.DagleishT.JosephS. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103, 670–686.
7.
ChildressA. R.EhrmanR. N.WangZ.LiY.SciortinoN.HakunJ.…O’BrienC. P. (2008). Prelude to passion: Limbic activation by “Unseen” drug and sexual cues. PLoS ONE, 3, e1506. doi:10.1371/journal.pone.0001506.
8.
ChurchwellJ. C.Lopez-LarsonM.Yurgelun-ToddD. A. (2010). Altered frontal cortical volume and decision-making in adolescent cannabis users. Frontiers in Psychology, 1, 225.
9.
ConnollyC. G.FoxeJ. J.NierenbergJ.ShpanerM.GaravanH. (2012). The neurobiology of cognitive control in successful cocaine abstinence. Drug and Alcohol Dependence, 121, 45–53.
10.
CopersinoM. L.Fals-StewartW.FitzmauriceG.SchretlenD. J.SokoloffJ.WeissR. D. (2009). Rapid cognitive screening of patients with substance use disorders. Experimental Clinical Psychopharmacology, 17, 337–344.
11.
Crits-ChristophP.Connolly GibbonsM. B.Ring-KurtzS.GallopR.PresentJ. (2009). A pilot study of community-friendly manual-guided drug counseling. Journal of Substance Abuse Treatment, 37, 8–16.
12.
FoxH. C.JacksonE. D.SinhaR. (2009). Elevated cortisol and learning and memory deficits in cocaine dependent individuals: Relationship to relapse outcomes. Psychoneuroendocrinology, 34, 1198–1207.
13.
GaravanH.KaufmanJ., N.HesterR. (2008). Acute effects of cocaine on the neurobiology of self-control. Philosophical Transactions of the Royal Society Biological Sciences, 363, 3267–3276.
14.
GaravanH.RossT. J.MurphyK.RocheR. A. P.SteinE. A. (2002). Dissociable executive functions in the dynamic control of behavior: Inhibition, error detection, & correction. NeuroImage, 17, 1820–1829.
15.
GarlandE. L.BoettigerC. A.HowardM. O. (2011). Targeting cognitive-affective risk mechanisms in stress-precipitated alcohol dependence: An integrated, biopsychosocial model of allostasis, automaticity, and addiction. Medical Hypotheses, 76, 745–754.
16.
GiesbrechtB.WoldorffM. G.SongA. W.MangunG. R. (2003). Neural mechanisms of top-down control during spatial and feature attention. Neuroimage, 19, 496–512.
17.
GoldinP. R.McRaeK.RamelW.GrossJ. J. (2008). The neural bases of emotion regulation: Reappraisal and suppression of negative emotion. Biological Psychiatry, 63, 577–586.
18.
GoldsteinR. Z.TomasiD.RajaramS.CottoneL. A.ZhangL.MaloneyT.…VolkowN. D. (2007). Role of the anterior cingulate and medial orbitofrontal cortex in processing drug cues in cocaine addiction. Neuroscience, 14(4), 1153–1159.
19.
GoldsteinR. Z.VolkowN. D. (2002). Drug addiction and its underlying neurobiological basis: Neuroimaging evidence for the involvement of the frontal cortex. American Journal of Psychiatry, 159, 1642–1652.
20.
HesterR.GaravanH. (2004). Executive dysfunction in cocaine addiction: evidence for discordant frontal, cingulated, and cerebellar activity. Journal of Neuroscience, 24, 11017–11022.
21.
HesterR.GaravanH. (2009). Neural mechanisms underlying drug-related cue distraction in active cocaine users. Pharmacology, Biochemistry and Behavior, 93, 270–277.
22.
KaufmanJ. N.RossT. J.SteinE. A.GaravanH. (2003). Cingulate hyopactivity in cocaine users during a GO-NOGO task as revealed by event-related functional magnetic resonance imaging. Journal of Neuroscience, 23, 7839–7843.
23.
KellyA. B.MastermanP. W.YoungR. M. (2011). Negative mood, implicit alcohol-related memory, and alcohol use in young adults: The moderating effect of alcohol expectancy. Addictive Behaviors, 36, 148–151.
24.
KoobG.KreekM. J. (2007). Stress, dysregulation of drug reward pathways, and the transition to drug dependence. American Journal of Psychiatry, 164, 1149–1159.
25.
LancasterJ. L.Tordesillas-GutiérrezD.MartinezM.SalinasF.EvansA.ZillesK.…FoxP. T. (2007). Bias between MNI and Talairach coordinates analyzed using the ICBM-152 brain template. Human Brain Mapping, 28, 1194–205.
26.
LangP. J.BradleyM. M.CuthbertB. N. (2008). International affective picture system (IAPS): Affective ratings of pictures and instruction manual (Technical Report A-8). University of Florida, Gainesville, FL.
27.
LiC. S.LuoX.YanP.BergquistK.SinhaR. (2009). Altered impulse control in alcohol dependence: Neural measures of stop signal performance. Alcohol Clinical Experimental Research, 33, 740–750.
28.
MattoH. C. (2007). An innovative treatment: Stage I evaluation of a dual processing treatment protocol on self-regulation capacities of chronic substance dependent adults. Best Practices in Mental Health, 3, 41–51.
29.
MattoH. C.StrolinJ.Mogro-WilsonC. (2008). A pilot study of a dual processing substance user treatment intervention with adults. Substance Use & Misuse, 43, 285–294.
30.
MattoH. C.Strolin-GoltzmanJ.HadjiyaneM.VanMeterJ. W.KostM.MinterJ. K.WileyJ. (2013). Clinical trial of an innovative dual-processing group therapy relapse prevention protocol conducted in a community-based setting. Journal of Groups in Addiction & Recovery, 8, 240–261.
31.
MattoH. C.Strolin-GoltzmanJ.Mogro-WilsonC. (2010). Dual processing treatment modality: An innovative treatment to decrease physiological craving in substance abusers. Journal of Groups in Addiction & Recovery, 5, 113–123.
32.
MorgensternJ.NaqviN. H.DebellisR.BreiterH. C. (2013). The contributions of cognitive neuroscience and neuroimaging to understanding mechanisms of behavior change in addiction. Psychology of Addictive Behaviors, 27, 336–350.
33.
National Institute on Drug Abuse. (2012). Principles of drug treatment: A research-based guide (pp. 12–4180). Rockville, MD: NIH Pub.
34.
RounsavilleB. J.CarrollK. M.OnkenL. S. (2001). A stage model of behavioral therapies research: Getting started and moving on from stage 1. Clinical Psychology: Science and Practice, 8, 133–142.
35.
SchwabeL.WolfO. T. (2013). Stress and multiple memory systems: from ‘thinking’ to ‘doing’. Trends in Cognitive Sciences, 17, 60–68.
36.
SinhaR.LiC. S. (2007). Imaging stress-and cue-induced drug and alcohol craving: Association with relapse and clinical implications. Drug & Alcohol Review, 26, 25–31.
37.
SinhaR.TalihM.MalisonR.AndersonG. A.CooneyN.KreekM. (2003). Hypothalamic-pituitary-adrenal axis and sympatho-adreno-medullary responses during stress-induced and drug cue-induced cocaine craving states. Psychopharmacology, 170, 62–72.
38.
StrackF.DeutschR. (2004). Reflective and impulsive determinants of social behavior. Personality and Social Psychology Review, 8, 220–247.
39.
Strolin-GoltzmanJ.MattoH.Mogro-WilsonC. (2007). A comparative analysis of a dual processing substance abuse treatment intervention: Implications for the development of Latino-specific interventions. Hispanic Health Care International, 5, 162–168.
40.
TanabeJ.TregellasJ. R.DalwaniM.ThompsonL.OwensE.CrowleyT.BanichM. (2009). Medial orbitofrontal cortex gray matter is reduced in abstinent substance-dependent individuals. Biological Psychiatry, 65, 160–164.
41.
UhlG. R. (2008). “Higher order” addiction molecular genetics: Convergent data from genome-wide associations in humans and mice. Biochemical Pharmacology, 75, 98–111.
42.
VolkowN. D.BalerR. D. (2012). Neuroscience. To stop or not to stop?Science, 335, 546–548.
43.
WiersR. W.RinckM.KordtsR.HoubenK.StrackF. (2010). Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. Addiction, 105, 279–287.
44.
WiersR. W.StacyA. W. (2006). Handbook of implicit cognition and addiction. Thousand Oaks, CA: Sage.
45.
World Health Organization. (2012). World health statistics 2012. Geneva, Switzerland: WHO.
