Mindfulness-oriented recovery enhancement in opioid use disorder: Extended emotional regulation and neural effects and immediate effects of guided meditation in a pilot sample

OBJECTIVE

Mindfulness-Oriented Recovery Enhancement (MORE) is an efficacious intervention to aid recovery from substance use disorder. This study in a pilot sample of individuals in treatment for opioid use disorder (OUD) characterizes longer-term changes after the MORE intervention and immediate effects of a brief MORE guided meditation session.

DESIGN

Twelve female participants in residential treatment for OUD completed an 8-week MORE intervention. Participants completed two sessions: one before and one after the 8-week MORE intervention. Each session included an emotional regulation questionnaire outside an MRI scanner first and then a 10-minute guided MORE meditation inside the scanner during which functional magnetic resonance imaging (fMRI) data were collected. Emotional regulation was measured after 8-weeks of MORE intervention. In addition, functional connectivity (i.e. correlated fMRI signal) between regions in a hypothesized affect regulation network was measured during the meditation state to assess change in brain network function due to 8-weeks of MORE. For each 10-min guided meditation, we also assessed their mood and opioid craving.

RESULTS

Nine participants completed all measurements. Participants' emotional regulation difficulty significantly decreased after 8-weeks of MORE intervention. Furthermore, after 8-weeks of MORE, there was significantly increased connectivity between left ventromedial prefrontal cortex and left amygdala and between left ventrolateral prefrontal cortex and left nucleus accumbens captured during a meditation state. In both sessions, positive mood significantly increased after 10-min of guided mediation, however opioid craving was not significantly influenced.

CONCLUSIONS

This pilot study characterizes potential benefits of 8-week MORE intervention in improving emotional regulation difficulty and brain function. A 10-min guided MORE meditation may immediately improve mood, with potential to reduce acute stress- or cue-provoked craving. These results warrant future studies with larger sample size.

Data-driven connectivity profiles relate to smoking cessation outcomes

At a group level, nicotine dependence is linked to differences in resting-state functional connectivity (rs-FC) within and between three large-scale brain networks: the salience network (SN), default mode network (DMN), and frontoparietal network (FPN). Yet, individuals may display distinct patterns of rs-FC that impact treatment outcomes. This study used a data-driven approach, Group Iterative Multiple Model Estimation (GIMME), to characterize shared and person-specific rs-FC features linked with clinically-relevant treatment outcomes. 49 nicotine-dependent adults completed a resting-state fMRI scan prior to a two-week smoking cessation attempt. We used GIMME to identify group, subgroup, and individual-level networks of SN, DMN, and FPN connectivity. Regression models assessed whether within- and between-network connectivity of individual rs-FC models was associated with baseline cue-induced craving, and craving and use of regular cigarettes (i.e., "slips") during cessation. As a group, participants displayed shared patterns of connectivity within all three networks, and connectivity between the SN-FPN and DMN-SN. However, there was substantial heterogeneity across individuals. Individuals with greater within-network SN connectivity experienced more slips during treatment, while individuals with greater DMN-FPN connectivity experienced fewer slips. Individuals with more anticorrelated DMN-SN connectivity reported lower craving during treatment, while SN-FPN connectivity was linked to higher craving. In conclusion, in nicotine-dependent adults, GIMME identified substantial heterogeneity within and between the large-scale brain networks. Individuals with greater SN connectivity may be at increased risk for relapse during treatment, while a greater positive DMN-FPN and negative DMN-SN connectivity may be protective for individuals during smoking cessation treatment.

Systematic review and meta-analysis: Combining transcranial magnetic stimulation or direct current stimulation with pharmacotherapy for treatment of substance use disorders

BACKGROUND AND OBJECTIVES

Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have evidence for their potential in the treatment of substance use disorders (SUD). Medication for addiction treatment (MAT) is underutilized and not always effective. We identified randomized controlled trials (RCTs) and case studies that evaluated the effectiveness of TMS or tDCS used concurrently with MAT in SUD treatment.

METHODS

A systematic review of published literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on 6/1/2023 by a medical librarian. Craving-related scales were extracted for an effect size calculation. The Physiotherapy Evidence Database (PEDro) scale assessed study quality.

RESULTS

Eight studies (7 RCT, 1 case) including 253 individuals were published from 2015 to 2022, 5 of which had available data for meta-analysis. TMS or tDCS combined with MAT significantly reduced craving-related measures relative to sham stimulation (Hedges' g = -0.42, confidence interval: -0.73 to -0.11, p < .01). Opioid use disorder, methadone, and the dorsolateral prefrontal cortex were the most commonly studied SUD, MAT, and target region.

DISCUSSION AND CONCLUSIONS

Our results show a significant effect; however, is limited by a small number of studies with heterogeneous methodology across intervention methods and SUDs. Additional trials are needed to fully assess the clinical impact and mechanisms of combined brain stimulation and pharmacotherapy. We discuss a possible mechanism for synergism from these treatment combinations.

SCIENTIFIC SIGNIFICANCE

Adds the first systematic review of combination treatment with TMS or tDCS and MAT in SUD patients to the literature and estimates its overall effect size.

Heart Rate Variability in Adults With Substance Use Disorder: A Comprehensive Narrative Review

BACKGROUND

Heart rate variability (HRV) is an indicator of autonomic abnormalities. However, little is known about the role of HRV related to substance use behavior and the association between the changes in HRV and signs of relapse in substance use.

AIM

The purpose of this study was to review the existing literature on autonomic response to substance use (i.e., opioids, cocaine, and methamphetamine) measured by HRV and its outcomes related to the risk factors of relapse.

METHODS

A systematic search of the literature was conducted using PubMed, PsychINFO, and Ovid Medline databases. The study includes full-text articles published in English from 2010 to 2020, using measures of HRV in human subjects who use substances.

RESULTS

A total of 14 studies were reviewed. Studies included outpatients with a prescription or nonprescription opioid misuse behavior with a primary diagnosis being chronic pain or substance use disorder (SUD). Significantly decreased resting HRV was found in substance users compared to healthy controls. Lower resting HRV has been significantly associated with stress, craving, and greater symptom severities in individuals with SUD and other substance dependence. HRV indices can be potential measures of homeostatic imbalance and self-regulation flexibility.

CONCLUSION

HRV may be a useful tool for monitoring early indication of relapse so that relapse prevention measures can be implemented in a timely manner. Future studies in substance use may benefit from examining HRV in relations to substance use and relapse signs and symptoms in a larger population to guide future relapse prevention strategies.

rTMS effects on urges and severity of tobacco use disorder operate independently of a retrieval-extinction component and involve frontal-striatal pathways

BACKGROUND

Although smoking remains a leading cause of preventable disease, the treatment options for smoking are limited. The present study evaluated the neural features underlying effects of repetitive transcranial magnetic stimulation (rTMS) for reducing smoking cravings. In addition, the efficacy of a simulated retrieval-extinction procedure to augment rTMS efficacy was examined.

METHODS

Sixty-one individuals with tobacco use disorder (TUD) were randomized into three groups: classic rTMS, retrieval rTMS (viewed smoking videos before rTMS), and sham rTMS. rTMS was performed on the left dorsolateral prefrontal cortex (DLPFC) over 5 days using a standard figure-8 coil. Smoking cravings and brain responses to smoking cues were measured before and after rTMS treatment. Changes in functional connectivity (FC) among different brain regions were calculated.

RESULTS

rTMS reduced smoking urges in TUD. Both active-rTMS groups demonstrated greater activations of the DLPFC, caudate, and bilateral insula relative to the sham group. Increased FC was observed between executive and reward network brain regions, and decreased FC was observed within reward network regions. Compared with standard rTMS, retrieval-extinction rTMS demonstrated similar outcomes and was associated with less activation of the medial frontal gyrus.

CONCLUSIONS

rTMS increased activations in brain regions implicated in executive control and reward processing. Strengthened prefrontal-striatal pathway suggests that rTMS enhanced top-down control over smoking cravings. The retrieval-extinction process, although associated with some different and multiple similar neural correlates as the standard rTMS, did not enhance cessation outcomes.

A systematic review and meta-analysis of neuromodulation therapies for substance use disorders

While pharmacological, behavioral and psychosocial treatments are available for substance use disorders (SUDs), they are not always effective or well-tolerated. Neuromodulation (NM) methods, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) may address SUDs by targeting addiction neurocircuitry. We evaluated the efficacy of NM to improve behavioral outcomes in SUDs. A systematic literature search was performed on MEDLINE, PsychINFO, and PubMed databases and a list of search terms for four key concepts (SUD, rTMS, tDCS, DBS) was applied. Ninety-four studies were identified that examined the effects of rTMS, tDCS, and DBS on substance use outcomes (e.g., craving, consumption, and relapse) amongst individuals with SUDs including alcohol, tobacco, cannabis, stimulants, and opioids. Meta-analyses were performed for alcohol and tobacco studies using rTMS and tDCS. We found that rTMS reduced substance use and craving, as indicated by medium to large effect sizes (Hedge's g > 0.5). Results were most encouraging when multiple stimulation sessions were applied, and the left dorsolateral prefrontal cortex (DLPFC) was targeted. tDCS also produced medium effect sizes for drug use and craving, though they were highly variable and less robust than rTMS; right anodal DLPFC stimulation appeared to be most efficacious. DBS studies were typically small, uncontrolled studies, but showed promise in reducing misuse of multiple substances. NM may be promising for the treatment of SUDs. Future studies should determine underlying neural mechanisms of NM, and further evaluate extended treatment durations, accelerated administration protocols and long-term outcomes with biochemical verification of substance use.

The Application of the Metacognitive Model of Desire Thinking and Craving in Problematic Social Networking Sites Use

Cognitive models of addictive behaviours have highlighted the central role of Desire Thinking (DT) - a conscious and voluntary cognitive process orienting to prefigure images and information about a positive target-related experience - in increasing craving and maintaining addictive behaviors. The metacognitive model of DT and craving posits that metacognition plays a central role in understanding dysregulation in DT. The current study aims to test the role of metacognitions about DT, DT, and craving in the relationship between Fear of Missing Out (FoMo), boredom proneness, negative emotional reactivity and Problematic Social Network Sites Use (PSNSU). A sample of 529 participants (Mage= 32.45 ± 13.33; F = 62.9%) completed an online survey. The hypothesised model produced an adequate fit to the data and accounted for 86% of PSNSU variance. FoMO predicted positive metacognitions about DT (PMDT), which predicted DT that, in association with craving, predicted PSNSU. Boredom proneness positively predicted PSNSU directly and indirectly through the serial mediation of PMDT, DT, and craving. A direct path between negative emotional reactivity and PSNSU was found. The current findings provide preliminary evidence for applying the metacognitive model of DT and craving in PSNSU. PMDT and DT may be central cognitive processes in craving and PSNSU for individuals who experience boredom proneness and FoMo.

Effects of Ovarian Hormone Levels on Stress, Cigarette Craving, and Smoking in a Laboratory Relapse Paradigm Among Females Who Smoke Daily

INTRODUCTION

Females, versus males, have shown a slower decline in smoking prevalence, greater smoking-related mortality and morbidity, and tend to have more difficulty achieving and maintaining abstinence. Identifying sex-specific risk factors is needed to improve outcomes. Though ovarian hormones have been evaluated for their role in smoking and relapse, measures tend to be static and infrequent, failing to capture the influence of increasing or decreasing levels.

AIMS AND METHODS

The present study evaluated the effect of static and fluctuating levels of ovarian hormones (ie, progesterone, estradiol, and estrogen to progesterone [E/P] ratio) on stress reactivity, cigarette craving, and smoking during a laboratory relapse paradigm. Female participants (assigned female at birth) reporting daily cigarette smoking (N = 91, ages 18-45) were recruited from the community. Participants provided daily salivary ovarian hormone levels leading up to a laboratory session, in which stress was induced and stress reactivity, cigarette craving, latency to smoke, and ad-libitum smoking were measured.

RESULTS

Static levels of estradiol were associated with stress reactivity (β = 0.28, SE = 0.13) and static E/P ratio was associated with smoking in the laboratory (HR = 1.4). Preceding 3-day changes in estradiol and E/P ratio, but neither static levels nor preceding 3-day changes in progesterone were associated with stress reactivity, cigarette craving, or smoking in a relapse paradigm.

CONCLUSIONS

Ovarian hormones are among several sex-specific factors involved in the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood.

IMPLICATIONS

Findings of the present study provide novel information regarding the role of ovarian hormones among female participants who smoke daily in stress reactivity and smoking in the context of a laboratory relapse paradigm and highlight several avenues for future research. We found that same-day estradiol levels were associated with increased subjective stress reactivity and same-day estrogen to progesterone ratio was associated with increased likelihood of smoking in a relapse paradigm. Ovarian hormones are among several sex-specific factors contributing to the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood.

The effect of cognitive reappraisal on food craving and consumption: Does working memory capacity influence reappraisal ability? An event-related potential study

Regulating cravings for unhealthy foods in favour of healthier options is essential for weight management. Cognitive reappraisal, which involves changing the meaning of a stimulus to modify its emotional impact, has shown promise for regulating food craving and consumption. Eighty participants were presented with high-calorie (HC) and low-calorie (LC) food pictures preceded by cues signalling instructions to naturally view the food (i.e., passive viewing; LOOK) or to imagine the future consequences of consuming that food (i.e., cognitive reappraisal; REGULATE). Participants' subjective craving and event-related potentials (ERPs) were measured, and food consumption after the task was assessed. Participants' working memory capacity (WMC) was measured with the automated Operation Span task. During cognitive reappraisal, cravings for HC foods decreased, whereas cravings for LC foods increased, compared to passive viewing. Cravings for LC and HC foods were correlated with consumptions of LC and HC foods, respectively. Occipital N1 (100-200ms) amplitudes were more negative for LC than for HC pictures, but were not modulated by strategy (LOOK or REGULATE), whereas early posterior negativity (EPN; 200-300ms) was not sensitive to food type (HC or LC) or strategy. Late positive potential (LPP; 400-1000ms) ERPs were largest in the HC-REGULATE condition, possibly due to cognitive processes induced by focusing on the consequences of unhealthy foods. Late LPP (1000-3000ms) was not affected by food type or strategy. LPP amplitudes were not correlated with cravings. WMC was weakly correlated with cravings for LC following reappraisal, suggesting that WMC may influence reappraisal ability. In sum, focusing on future consequences of eating may promote healthier food choices through craving regulation. Further research is needed to examine how regulatory effects evolve over time and how they relate to WMC and brain activity.

Predictive utility of the P3 event-related potential (ERP) response to alcohol cues for ecologically assessed alcohol craving and use

Neural measures of alcohol cue incentive salience have been associated with retrospective reports of riskier alcohol use behaviour and subjective response profiles. This study tested whether the P3 event-related potential (ERP) elicited by alcohol-related cues (ACR-P3) can forecast alcohol use and craving during real-world drinking episodes. Participants (N = 262; Mage  = 19.53; 56% female) completed a laboratory task in which they viewed images of everyday objects (Neutral), non-alcohol drinks (NonAlc) and alcohol beverages (Alc) while EEG was recorded and then completed a 21-day ecological momentary assessment (EMA) protocol in which they recorded alcohol craving and consumption. Anthropometrics were used to derive estimated blood alcohol concentration (eBAC) throughout drinking episodes. Multilevel modelling indicated positive associations between P3 amplitudes elicited by all stimuli and within-episode alcohol use measures (e.g., eBAC, cumulative drinks). Focal follow-up analyses indicated a positive association between AlcP3 amplitude and eBAC within episodes: Larger AlcP3 was associated with a steeper rise in eBAC. This association was robust to controlling for the association between NonAlcP3 and eBAC. AlcP3 also was positively associated with episode-level measures (e.g., max drinks, max eBAC). There were no associations between any P3 variables and EMA-based craving measures. Thus, individual differences in neural measures of alcohol cue incentive salience appear to predict the speed and intensity of alcohol consumption but not reports of craving during real-world alcohol use episodes.

The Role of Emotion Dysregulation in Heightened Alcohol Craving Related to Posttraumatic Stress Disorder and Depression Symptoms

Objective: Compared to their male counterparts, women with alcohol use disorders (AUD) alone and those with symptoms of co-occurring emotional disorders (posttraumatic stress disorder, PTSD, and depression) are particularly likely to have increased alcohol craving in response to negative affect and daily stressors. Emotion dysregulation is one transdiagnostic construct that may underlie heightened craving in response to stress within this population. In a secondary data analysis, the current study examined emotion dysregulation as a mediator of the associations of posttraumatic stress symptoms (PTSS) and depression symptoms with heightened stress-induced alcohol craving, as measured in the lab. Given the overlap in symptoms, the relative associations of PTSD and depression symptom clusters with stress-induced craving were explored. Method: 50 women Veterans (84% White, 88% Non-Hispanic, Mage=45.68) attended two in-lab sessions. Self-report measures of emotion dysregulation, PTSD, and depression symptoms were administered at baseline. During session two, participants reported on alcohol craving and negative affect at baseline and again after a personalized stress induction procedure. Results: Emotion dysregulation mediated the association of greater PTSS with heightened stress-induced craving, although emotion dysregulation was not a mediator of the association between depression and stress-induced craving. Greater alcohol craving after the stress induction was positively associated with cognitive-affective symptoms in PTSD and depression (and not with other symptom clusters of these diagnoses, e.g., avoidance, somatic-vegetative symptoms). Conclusions: Emotion dysregulation may be a transdiagnostic factor that helps to explain greater alcohol cravings and drinking in stressful contexts among women Veterans with heightened symptoms of co-occurring emotional disorders.

An electroencephalographic signature predicts craving for methamphetamine

Craving is central to methamphetamine use disorder (MUD) and both characterizes the disease and predicts relapse. However, there is currently a lack of robust and reliable biomarkers for monitoring craving and diagnosing MUD. Here, we seek to identify a neurobiological signature of craving based on individual-level functional connectivity pattern differences between healthy control and MUD subjects. We train high-density electroencephalography (EEG)-based models using data recorded during the resting state and then calculate imaginary coherence features between the band-limited time series across different brain regions of interest. Our prediction model demonstrates that eyes-open beta functional connectivity networks have significant predictive value for craving at the individual level and can also identify individuals with MUD. These findings advance the neurobiological understanding of craving through an EEG-tailored computational model of the brain connectome. Dissecting neurophysiological features provides a clinical avenue for personalized treatment of MUD.

Cognitive reappraisal of food craving and emotions: a coordinate-based meta-analysis of fMRI studies

Growing evidence supports the effectiveness of cognitive reappraisal in down-regulating food desire. Still, the neural bases of food craving down-regulation via reappraisal, as well as their degree of overlap vs specificity compared with emotion down-regulation, remain unclear. We addressed this gap through activation likelihood estimation meta-analyses of neuroimaging studies on the neural bases of (i) food craving down-regulation and (ii) emotion down-regulation, alongside conjunction and subtraction analyses among the resulting maps. Exploratory meta-analyses on activations related to food viewing compared with active regulation and up-regulation of food craving have also been performed. Food and emotion down-regulation via reappraisal consistently engaged overlapping activations in dorsolateral and ventrolateral prefrontal, posterior parietal, pre-supplementary motor and lateral posterior temporal cortices, mainly in the left hemisphere. Its distinctive association with the right anterior/posterior insula and left inferior frontal gyrus suggests that food craving down-regulation entails a more extensive integration of interoceptive information about bodily states and greater inhibitory control over the appetitive urge towards food compared with emotion down-regulation. This evidence is suggestive of unique interoceptive and motivational components elicited by food craving reappraisal, associated with distinctive patterns of fronto-insular activity. These results might inform theoretical models of food craving regulation and prompt novel therapeutic interventions for obesity and eating disorders.

Cannabis cravings predict cigarette use in schizophrenia: a secondary analysis from two cannabis abstinence studies

CLINICAL TRIAL NAME

Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Cannabis Use and Cognitive Outcomes in SchizophreniaURL: www.clinicaltrials.gov; Registration Number: NCT03189810.

Craving modulates attentional bias towards alcohol in severe alcohol use disorder: An eye-tracking study

BACKGROUND AND AIMS

Competing models disagree on three theoretical questions regarding alcohol-related attentional bias (AB), a key process in severe alcohol use disorder (SAUD): (1) is AB more of a trait (fixed, associated with alcohol use severity) or state (fluid, associated with momentary craving states) characteristic of SAUD; (2) does AB purely reflect the over-activation of the reflexive/reward system or is it also influenced by the activity of the reflective/control system and (3) does AB rely upon early or later processing stages? We addressed these issues by investigating the time-course of AB and its modulation by subjective craving and cognitive load in SAUD.

DESIGN

A free-viewing eye-tracking task, presenting pictures of alcoholic and non-alcoholic beverages, combined with a concurrent cognitive task with three difficulty levels.

SETTING

A laboratory setting in the detoxification units of three Belgian hospitals.

PARTICIPANTS

We included 30 patients with SAUD self-reporting craving at testing time, 30 patients with SAUD reporting a total absence of craving and 30 controls matched on sex and age. All participants from SAUD groups met the DSM-5 criteria for SAUD.

MEASUREMENTS

We assessed AB through early and late eye-tracking indices. We evaluated the modulation of AB by craving (comparison between patients with/without craving) and cognitive load (variation of AB with the difficulty level of the concurrent task).

FINDINGS

Dwell time measure indicated that SAUD patients with craving allocated more attention towards alcohol-related stimuli than patients without craving (P < 0.001, d = 1.093), resulting in opposite approach/avoidance AB according to craving presence/absence. SAUD patients without craving showed a stronger avoidance AB than controls (P = 0.003, d = 0.806). AB did not vary according to cognitive load (P = 0.962, η2 p  = 0.004).

CONCLUSIONS

The direction of alcohol-related attentional bias (approach/avoidance) appears to be determined by patients' subjective craving at testing time and does not function as a stable trait of severe alcohol use disorder. Alcohol-related attentional bias appears to rely on later/controlled attentional stages but is not modulated by the saturation of the reflective/control system.

Progesterone Attenuates the Stress Response in Individuals with Alcohol Dependence and Post-Traumatic Stress Disorder - A Pilot Study

OBJECTIVE

Evidence from laboratory studies suggests that progesterone may be effective in reducing stress and craving, and may improve cognitive performance in smokers and individuals with cocaine dependence. The objective of this study was to examine if progesterone would attenuate stress-induced craving, anxiety, affect and physiological measures, as well as improve stress-induced cognitive performance (processing speed and selective attention) in individuals diagnosed with alcohol use disorder (AUD) and post traumatic stress disorder (PTSD).

METHODS

This laboratory study included (n = 13) participants who were diagnosed with current AUD and PTSD who were randomly assigned to recive either progesterone (200mg bid) or placebo in identical looking capsules for 3 days. On the fourth day they completed a laboratory session. In the morning of the test session, they received the last dose of medication and completed the rest of the laboratory procedures. The procedures included presentation in random order of personalized trauma and neutral scripts with relaxation in between. Main outcomes included measure of craving, anxiety, affect and cognitive performance.

RESULTS

Consistent with other research, trauma scripts produced significantly greater increases in craving, anxiety and negative affect when compared with neutral scripts. Progesterone significantly reduced stress-induced symptoms of craving, anxiety, fear, anger and sadness but had no effect on positive emotions (joy, relaxation). Progesterone was effective in ameliorating stress-induced decreases in cognitive performance.

CONCLUSIONS

The findings from this study demonstrate that progesterone can be effective in reducing stress-induced craving, anxiety and negative affect in a laboratory setting in individuals with comorbid AUD and PTSD. Interestingly, progesterone also improved cognitive performance. These findings require replication in a larger clinical trial and may have implications for treatment among individuals with AUD and PTSD.This study was registered as NCT02187224, at www.clinicaltrials.gov.

Targeting cravings in substance addiction with transcranial direct current stimulation: insights from a meta-analysis of sham-controlled trials

Addiction is a substantial health concern; craving-the core symptom of addiction-is strongly associated with relapse. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that reduces cravings by altering cortical excitability and connectivity in brain regions. This systematic review and meta-analysis was conducted (following the PRISMA guidelines) to evaluate the efficacy of tDCS in reducing cravings for substances. Our analysis included 43 randomized, sham-controlled trials involving 1,095 and 913 participants receiving tDCS and sham stimulation, respectively. We analyzed the changes in craving scores and found that tDCS led to a moderate reduction in cravings compared with the sham effects. This effect was particularly pronounced when bilateral stimulation was used, the anodal electrode was placed on the right dorsolateral prefrontal cortex, current intensities ranged from 1.5 to 2 mA, stimulation sessions lasted 20 minutes, and the electrodes size was ≥35 cm². Notably, tDCS effectively reduced cravings for opioids, methamphetamine, cocaine, and tobacco but not for alcohol or cannabis. Our findings indicate tDCS as a promising, noninvasive, and low-risk intervention for reducing cravings for opioids, methamphetamine, cocaine, and tobacco. Additional studies are warranted to refine stimulation parameters and evaluate the long-term efficacy of tDCS in managing substance cravings.

Effects of virtual reality-based cue exposure therapy on craving and physiological responses in alcohol-dependent patients-a randomised controlled trial

BACKGROUND

Cue exposure therapy is used to treat alcohol dependence. However, its effectiveness is controversial due to the limitations of the clinical treatment setting. Virtual reality technology may improve the therapeutic effect. The aim of this study is to explore whether virtual reality-based cue exposure therapy can reduce the psychological craving and physiological responses of patients with alcohol dependence.

METHODS

Forty-four male alcohol-dependent patients were recruited and divided into the study group (n = 23) and the control group (n = 21) according to a random number table. The control group received only conventional clinical treatment for alcohol dependence. The study group received conventional clinical treatment with the addition of VR cue exposure (treatment). The primary outcome was to assess psychological craving and physiological responses to cues of patients before and after treatment.

RESULTS

After virtual reality-based cue exposure therapy, the changes in VAS and heart rate before and after cue exposure in the study group were significantly lower than those in the control group (P < 0.05), while the changes in skin conductance and respiration between the study group and the control group were not significantly different (P > 0.05). The changes in VAS and heart rate before and after cue exposure in the study group were significantly lower than those before treatment (P < 0.05), while the changes in skin conductance and respiration were not significantly different from those before treatment (P > 0.05). The changes in VAS, heart rate, skin conductance and respiration before and after cue exposure in the control group were not significantly different from those before treatment (P > 0.05).

CONCLUSION

Virtual reality-based cue exposure therapy can reduce the psychological craving and part of the physiological responses of alcohol-dependent patients during cue exposure in the short term and may be helpful in the treatment of alcohol dependence.

TRIAL REGISTRATION

The study protocol was registered at the China Clinical Trial Registry on 26/02/2021 ( www.chictr.org.cn ; ChiCTR ID: ChiCTR2100043680).

Connectome-based prediction of craving in gambling disorder and cocaine use disorder

INTRODUCTION

Craving, involving intense and urgent desires to engage in specific behaviours, is a feature of addictions. Multiple studies implicate regions of salience/limbic networks and basal ganglia, fronto-parietal, medial frontal regions in craving in addictions. However, prior studies have not identified common neural networks that reliably predict craving across substance and behavioural addictions.

METHODS

Functional magnetic resonance imaging during an audiovisual cue-reactivity task and connectome-based predictive modelling (CPM), a data-driven method for generating brain-behavioural models, were used to study individuals with cocaine-use disorder and gambling disorder. Functions of nodes and networks relevant to craving were identified and interpreted based on meta-analytic data.

RESULTS

Craving was predicted by neural connectivity across disorders. The highest degree nodes were mostly located in the prefrontal cortex. Overall, the prediction model included complex networks including motor/sensory, fronto-parietal, and default-mode networks. The decoding revealed high functional associations with components of memory, valence ratings, physiological responses, and finger movement/motor imagery.

CONCLUSIONS

Craving could be predicted across substance and behavioural addictions. The model may reflect general neural mechanisms of craving despite specificities of individual disorders. Prefrontal regions associated with working memory and autobiographical memory seem important in predicting craving. For further validation, the model should be tested in diverse samples and contexts.

Transcranial Magnetic Stimulation for the Treatment of Gambling Disorder: A Systematic Review

BACKGROUND

Gambling Disorder (GD) is a behavioral addiction listed within the diagnostic category of substance-related and addictive disorders. Recently, transcranial magnetic stimulation (TMS), which non-invasively stimulates the brain and has neuromodulatory properties, has emerged as an innovative treatment tool for GD, thus offering a new option for the management of this complex disorder. The present review explored the efficacy of TMS as a possible non-pharmacological treatment for GD.

METHODS

An exhaustive search was performed across the MEDLINE, Web of Science, and EMBASE databases using a specific search string related to GD and TMS. A total of 20 papers were selected for full-text examination, out of which eight fulfilled the inclusion criteria and were therefore systematically analyzed in the present review.

RESULTS

This review included eight studies: three randomized-controlled trials (RCTs), three non-controlled studies, one case series, and one case report. Two cross-over RCTs described a decrease in craving after high-frequency (excitatory), repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) and the medial prefrontal cortex (PFC), respectively; another study applying low-frequency (inhibitory) rTMS on the right DLPFC did not find any positive effect on craving. Among uncontrolled studies, one demonstrated the beneficial effect of high-frequency rTMS over the left DLPFC, while another showed the efficacy of a continuous theta burst stimulation protocol directed over the pre-supplementary motor area, bilaterally.

CONCLUSION

The included studies showed the promising effect of excitatory stimulation over the left PFC. However, further investigation is needed, particularly in terms of standardizing stimulation protocols and psychometric assessments.

Effects of transcranial magnetic stimulation on cocaine addiction: A systematic review of randomized controlled trials

OBJECTIVE

While pharmacological strategies appear to be ineffective in treating long-term addiction, repetitive transcranial magnetic stimulation (rTMS) is emerging as a promising new tool for the attenuation of craving among multiple substance dependent populations.

METHOD

A systematic review of randomized controlled trials (RCTs) was conducted on the efficacy and tolerability of rTMS in treating cocaine use disorder (CUD). Relevant papers published in English through November 30th 2022 were identified, searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library.

RESULTS

Eight studies matched inclusion criteria. The best findings were reported by the RCTs conducted at high-frequency (≥5 Hz) multiple sessions of rTMS delivered over the left dorsolateral prefrontal cortex (DLPFC): a significant decrease in self-reported cue-induced cocaine craving and lower cocaine craving scores and a considerable amelioration in the tendency to act rashly under extreme negative emotions (impulsivity) were found in the active group compared to controls.

CONCLUSION

Although still scant and heterogeneous, the strongest evidence so far on the use of rTMS on individuals with CUD support the high frequency stimulation over the left DLPFC as a well tolerated treatment of cocaine craving and impulsivity.

Randomized trial of mindfulness- and reappraisal-based regulation of craving training among daily cigarette smokers

OBJECTIVE

Craving predicts smoking, yet existing interventions may not adequately target regulation of craving. We evaluated two versions of regulation of craving-training (ROC-T), a computerized intervention with intensive practice of strategies when exposed to smoking-related images.

METHOD

Ninety-two nicotine-dependent daily smokers were randomized to mindfulness-based therapy (MBT) ROC-T focusing on mindful acceptance, and cognitive behavioral therapy (CBT) ROC-T focusing on reappraisal or no intervention control. The ROC task was administered pre- and postintervention to assess changes in cue-induced craving and mindfulness- and reappraisal-based regulation of craving.

RESULTS

MBT and CBT-versus control-showed significantly greater reductions in smoking during the intervention phase (baseline to Week 4), corresponding to large (d = -1.08, 95% CI [-1.64, -0.52]) and medium-to-large effect sizes (d = -0.69, 95% CI [-1.22, -0.15]), respectively. During follow-up (Week 4-16), CBT showed significant increases in smoking, whereas MBT and control did not. For the entire study (baseline to Week 16), MBT showed significantly greater reductions in smoking compared to control (d = -1.6, 95% CI [-2.56, -0.66]) but CBT was not significantly different than control (d = -0.82, 95% CI [-1.77, 0.13]). There were no effects on smoking when directly comparing MBT and CBT. Quit rates were low across the sample, with no difference among conditions. MBT and CBT-versus control-significantly reduced cue-induced craving. CBT (but not MBT)-versus control-significantly improved reappraisal-based regulation of craving. Both MBT and CBT-versus control-significantly improved mindfulness-based regulation of craving.

CONCLUSIONS

MBT- and CBT-ROC-T may reduce cue-induced craving and smoking, and MBT may be more durable than CBT. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Modeling Idiographic Longitudinal Relationships between Affect and Cigarette Use: An Ecological Momentary Assessment Study

Background: Despite public knowledge of the adverse health effects of tobacco use, cigarettes remain widely used due to the addictive nature of nicotine. Physiologic adaptation to the presence of nicotine over time leads to unpleasant effects during withdrawal periods. Alongside these physiological effects, tobacco users often report changes in their consumption of tobacco in response to their emotional state. Objectives: We hypothesized that idiographic, or person-specific level, increases in participants' negative affect (NA) and positive affect (PA) ratings at a given time point would be associated with higher and lower craving and smoking over the following several hours, respectively. Fifty-two participants completed block randomized ecological momentary assessment surveys on their smartphones 4 times per day for 30 days, reporting from 0-100 their level of seven discrete emotions, stress, current craving, and smoking behavior. We analyzed the relationships between affect and smoking and craving using idiographic generalized linear models. Results: While some participants exhibited the hypothesized relationships, each participant varied in the strength and direction of the relationships between affect and craving/smoking. These outcomes were partially moderated at the group level by anxiety/depression at baseline, but not by level of nicotine dependence or sex. Conclusions: This suggests that the factors driving cigarette use vary significantly between individuals.

Association between rumination and drug craving in Chinese male methamphetamine use disorder patients with childhood trauma

BACKGROUND

In China, males make up the majority of methamphetamine (MA) dependent individuals and the majority of treatment seekers. Childhood trauma (CT) and rumination are associated with an increased risk of MA use. However, the association between CT, rumination, and drug craving remains largely unknown.

OBJECTIVE

The present study aims to explore the association between rumination and drug craving in methamphetamine use disorder (MAUD) patients with CT.

PARTICIPANTS AND SETTING

This study recruited 404 male participants with MAUD from a male drug rehabilitation center in Southwest China.

METHODS

Patients with CT were identified by the short form of Childhood Trauma Questionnaire (CTQ-SF). Rumination and drug craving were assessed by the Ruminative Responses Scale (RRS) and the Obsessive Compulsive Drug Use Scale (OCDUS), respectively.

RESULTS

188 patients (46.5 %) experienced CT. Patients who had experienced CT showed significantly higher RRS symptom rumination score and OCDUS total score than those who had not. In patients with CT, RRS total and all subscale scores were positively associated with OCDUS interference of drug. Furthermore, the RRS brooding (β = 0.34, p < 0.001) and total scores (β = 0.38, p < 0.001) were determined to be separate contributors to the OCDUS total score in patients with CT.

CONCLUSIONS

Our study suggests that CT is common in male MAUD patients, and those who have suffered CT may exhibit higher levels of rumination and drug craving. Moreover, CT may play an influential role in the association between rumination and drug craving in patients with MAUD.

No effect of prefrontal transcranial direct current stimulation (tDCS) on food craving, food reward and subjective appetite in females displaying mild-to-moderate binge-type behaviour

Previous work suggests there may be an effect of transcranial direct current stimulation (tDCS) on appetite control in people at risk of overconsumption, however findings are inconsistent. This study aimed to further understand the potential eating behaviour trait-dependent effect of tDCS, specifically in those with binge-type behaviour. Seventeen females (23 ± 7 years, 25.4 ± 3.8 kg m-2) with mild-to-moderate binge eating behaviour completed two sessions of double-blind, randomised and counterbalanced anodal and sham tDCS applied over the right dorsolateral prefrontal cortex at 2.0 mA for 20 min. Subjective appetite visual analogue scales (VAS), the Food Craving Questionnaire-State (FCQ-S), and Leeds Food Preference Questionnaire (LFPQ) were completed pre- and post-tDCS. Participants then consumed a fixed-energy meal, followed by the VAS, FCQ-S and LFPQ. No difference between pre- and post-tDCS scores were found across fullness (p = 0.275, BF10 = 0.040), prospective consumption (p = 0.127, BF10 = 0.063), desire to eat (p = 0.247, BF10 = 0.054) or FCQ-S measures (p = 0.918, BF10 = 0.040) when comparing active and sham protocols. Only explicit liking and wanting for high-fat sweet foods were significantly different between conditions, with increased scores following active tDCS. When controlling for baseline hunger, the significant differences were removed (p = 0.138 to 0.161, BF10 = 0.810 to 1.074). The present data does not support the eating behaviour trait dependency of tDCS in a specific cohort of female participants with mild-to-moderate binge eating scores, and results align with those from individuals with healthy trait scores. This suggests participants with sub-clinical binge eating behaviour do not respond to tDCS. Future work should further explore effects in clinical and sub-clinical populations displaying susceptibility to overconsumption and weight gain.

Are medication effects on subjective response to alcohol and cue-induced craving associated? A meta regression study

RATIONALE

Alcohol administration and cue-reactivity paradigms are frequently used to screen for the initial efficacy of medications for alcohol use disorder (AUD). While medication effects on the primary outcomes for these paradigms are assumed to be qualitatively related, there is a critical lack of quantitative evidence to support this hypothesis.

OBJECTIVES

The study aims to test the relationship between medication effect sizes on subjective response to alcohol administration and medication effect sizes for cue-induced craving to cue exposure, using meta-analysis.

METHODS

Systematic literature searches were conducted to identify randomized trials, wherein AUD medications were tested using the alcohol administration and/or cue-reactivity paradigms. From these studies, descriptive statistics were collected to compute medication effect sizes on the primary outcomes for each respective paradigm. With medication as the unit of analysis, medication effect sizes in alcohol administration studies were compared with medication effect sizes in cue-reactivity studies using the Williamson-York regression which allows for meta-regression across independent samples.

RESULTS

Medication effect sizes on alcohol-induced stimulation and alcohol-induced craving were not significantly associated with medication effect sizes on cue-induced alcohol craving (k stimulation = 10 medications, [Formula: see text] and k craving = 11 medications, [Formula: see text] (SE = 0.237), [Formula: see text]), respectively. Medication effect sizes on alcohol-induced sedation were significantly associated with medication effects on cue-induced craving (k = 10 medications, [Formula: see text] (SE = 0.258), [Formula: see text]), such that medications that increased alcohol-induced sedation were more likely to reduce cue-induced alcohol craving.

CONCLUSIONS

With the exception of alcohol-induced sedation, there is little quantitative evidence of medication effects on subjective response domains measured during alcohol administration parallel medication effects on cue-induced alcohol craving. To provide additional context to the current study, future work should examine whether cue-reactivity findings predict clinical trial outcomes.

Mood Variability, Craving, and Substance Use Disorders: From Intrinsic Brain Network Connectivity to Daily Life Experience

BACKGROUND

Substance use disorders (SUDs) are major contributors to morbidity and mortality rates worldwide, and this global burden is attributable in large part to the chronic nature of these conditions. Increased mood variability might represent a form of emotional dysregulation that may have particular significance for the risk of relapse in SUD, independent of mood severity or diagnostic status. However, the neural biomarkers that underlie mood variability remain poorly understood.

METHODS

Ecological momentary assessment was used to assess mood variability, craving, and substance use in real time in 54 patients treated for addiction to alcohol, cannabis, or nicotine and 30 healthy control subjects. Such data were jointly examined relative to spectral dynamic causal modeling of effective brain connectivity within 4 networks involved in emotion generation and regulation.

RESULTS

Differences in effective connectivity were related to daily life variability of emotional states experienced by persons with SUD, and mood variability was associated with craving intensity. Relative to the control participants, effective connectivity was decreased for patients in the prefrontal control networks and increased in the emotion generation networks. Findings revealed that effective connectivity within the patient group was modulated by mood variability.

CONCLUSIONS

The intrinsic causal dynamics in large-scale neural networks underlying emotion regulation play a predictive role in a patient's susceptibility to experiencing mood variability (and, subsequently, craving) in daily life. The findings represent an important step toward informing interventional research through biomarkers of factors that increase the risk of relapse in persons with SUD.

Immediate and lasting effects of different regulation of craving strategies on cue-induced craving and the late positive potential in smokers

Craving, induced by substance-related cues, contributes to continued substance use and relapse. Therefore, regulation of craving (ROC) is important for treatment success. Distraction involves disengaging from craving-inducing cues; whereas, reappraisal requires engaging with potential risks of substance use. Given this difference in elaboration, we addressed the question whether reappraisal entails lasting advantages over distraction in successful ROC. To elucidate how this is implemented neurally, we examined the late positive potential (LPP) as an electrocortical indicator of motivated attention to cues. N = 62 smokers viewed smoking-related pictures and indicated the degree of craving each picture induced. While viewing the pictures, EEG was recorded, and the participants focused on the long-term negative (LATER) or short-term positive (NOW) consequences of smoking or performed an arithmetic task to distract themselves from processing the pictures (DISTRACT). After a break, all pictures were presented again without regulation instruction (re-exposure). Results revealed that LATER and DISTRACT achieved similar degrees of immediate ROC success, but only LATER had a sustained effect during re-exposure. In contrast, LPP amplitudes were more prominently reduced during DISTRACT than LATER, and there was no difference in LPP amplitudes during re-exposure. These findings imply that it may be beneficial to engage with the risks of drug use (reappraisal) rather than avoiding triggers of craving (distraction). However, these effects do not seem to be mediated by lasting changes in cue-related motivated attention (LPP).

Cue-reactivity to distal cues in individuals at risk for gaming disorder

BACKGROUND

Gaming disorder (GD) is a disorder due to addictive behaviors (ICD-11). Cue-reactivity and craving are relevant mechanisms in the development and maintenance of addictive behaviors. When confronted with cues showing in-game content (proximal cues) individuals with higher symptom severity show increased cue-reactivity. Based on conditioning and addiction theories on incentive sensitization, cue-reactivity responses may generalize to more distal cues, e.g. when individuals at risk of developing a GD are confronted with a starting page of an online game. In cue-reactivity paradigms so far, only proximal gaming cues have been used.

METHODS

We investigated the effect of distal gaming cues compared to gaming-unrelated control cues on cue-reactivity and craving in 88 individuals with non-problematic use of online games (nPGU) and 69 individuals at risk for GD (rGD). The distal cues showed the use of an electronic device (e.g., desktop PC or smartphone) whose screen showed starting pages of either games (target cues), shopping- or pornography sites (control cues) from a first-person perspective.

FINDINGS

We found significantly higher urge and arousal ratings as well as longer viewing times for gaming-related compared to gaming-unrelated control cues in rGD compared to nPGU. Valence ratings did not differ between groups.

INTERPRETATION

The results demonstrate that already distal gaming-specific cues lead to cue-reactivity and craving in rGD. This finding indicates that based on conditioning processes, cue-reactivity and craving develop during the course of GD and generalize to cues that are only moderately related to the specific gaming activity.

Emotion regulation strategies moderate the impact of negative affect induction on alcohol craving in college drinkers: an experimental paradigm

Objectives: Observational studies suggest emotion regulation (ER) as a potential treatment target for problematic college drinking. The primary aim of this laboratory study was to determine whether trait ER strategies would moderate the impact of negative affect induction on alcohol craving in college drinkers. Methods: Participants were randomly assigned to a neutral (n = 74) or a negative affect induction (n = 76) and reported their craving after the affect inductions. Results: Greater use of drinking to cope and less use of cognitive reappraisal predicted greater alcohol craving after the negative affect induction, but not after the neutral condition. In contrast, emotion suppression did not predict alcohol craving in either condition. Conclusion: Our results highlight the role of ER tendencies-particularly the benefits of cognitive reappraisal-on alcohol craving when experiencing emotional distress. Therefore, ER strategies may be an important target for college drinkers to prevent and reduce problematic drinking.

Gut-derived bacterial LPS attenuates incubation of methamphetamine craving via modulating microglia

BACKGROUND

The microbiota-gut-brain axis plays a critical role in the pathophysiology of neuropsychiatric disorders, and the compositions of gut microbiota are altered by addictive drugs. However, the role of gut microbiota in the incubation of methamphetamine (METH) craving remains poorly understood.

METHODS

16S rRNA gene sequencing was performed to assess the richness and diversity of gut microbiota in METH self-administration model. Hematoxylin and eosin staining was performed to evaluate the integrity of intestinal barrier. Immunofluorescence and three-dimensional reconstruction were performed to assess the morphologic changes of microglia. Serum levels of lipopolysaccharide (LPS) were determined using the rat enzyme-linked immunosorbent assay kits. Quantitative real-time PCR was performed to assess transcript levels of dopamine receptor, glutamate ionotropic AMPA receptor 3 and brain-derived neurotrophic factor.

RESULTS

METH self-administration induced gut microbiota dysbiosis, intestinal barrier damage and microglia activation in the nucleus accumbens core (NAcc), which was partially recovered after prolonged withdrawal. Microbiota depletion via antibiotic treatment increased LPS levels and induced a marked change in the microglial morphology in the NAcc, as indicated by the decreases in the lengths and numbers of microglial branches. Depleting the gut microbiota also prevented the incubation of METH craving and increased the population of Klebsiella oxytoca. Furthermore, Klebsiella oxytoca treatment or exogenous administration of the gram-negative bacterial cell wall component LPS increased serum and central LPS levels, induced microglial morphological changes and reduced the dopamine receptor transcription in the NAcc. Both treatments and NAcc microinjections of gut-derived bacterial LPS significantly decreased METH craving after prolonged withdrawal.

CONCLUSIONS

These data suggest that LPS from gut gram-negative bacteria may enter circulating blood, activate microglia in the brain and consequently decrease METH craving after withdrawal, which may have important implications for novel strategies to prevent METH addiction and relapse.

Daily ovarian hormone exposure and loss of control eating in adolescent girls: A registered report

OBJECTIVE

The daily biobehavioral factors that precipitate loss of control eating (LOCE) in adolescent girls are not well known. Ovarian hormone levels are key biological factors associated with the etiology of eating disorders in adolescent girls. Yet, models on how daily ovarian hormone exposure predicts LOCE in adolescent girls are underdeveloped. The goal of this study is to examine the daily patterns and mechanisms of ovarian hormone levels on LOCE across the menstrual cycle in adolescent girls and the mediating roles of food-related reward anticipation and response inhibition. Ecological momentary assessment (EMA) paired with daily hormonal sampling will be used to examine (1) daily associations between within-person hormones and LOCE, and (2) the mediating role of within-person food-related reward anticipation and response inhibition.

METHODS

Normally cycling adolescent girls who have reached menarche will provide daily saliva samples for hormone analysis and complete EMA for 35 days. During EMA, girls will report LOCE and will complete task-based and self-report measures of food-related response inhibition and reward anticipation.

DISCUSSION

This work has implications for the development of new real-world biobehavioral models of LOCE in adolescent girls, which will guide theory improvements and treatment for LOCE. Results will provide preliminary evidence for treatment targets for novel interventions for adolescent girls-for example, a response inhibition intervention.

PUBLIC SIGNIFICANCE

Adolescent eating disorders are severe mental health conditions, often marked by loss of control eating. Estrogen and progesterone play a role in the development and persistence of loss of control eating. The current study will examine how daily exposure to estrogen and progesterone predicts loss of control eating in adolescent girls and identify possible daily mechanisms linking estrogen and progesterone exposure and loss of control eating.

Orbitofrontal cortex microRNAs support long-lasting heroin seeking behavior in male rats

Recovery from opioid use disorder (OUD) and maintenance of abstinence from opioid use is hampered by perseverant drug cravings that may persist for months after cessation of drug use. Drug cravings can intensify during the abstinence period, a phenomenon referred to as the 'incubation of craving' that has been well-described in preclinical studies. We previously reported that animals that self-administered heroin at a dosage of 0.075 mg/kg/infusion (HH) paired with discrete drug cues displayed robust incubation of heroin craving behavior after 21 days (D) of forced abstinence, an effect that was not observed with a lower dosage (0.03 mg/kg/infusion; HL). Here, we sought to elucidate molecular mechanisms underlying long-term heroin seeking behavior by profiling microRNA (miRNA) pathways in the orbitofrontal cortex (OFC), a brain region that modulates incubation of heroin seeking. miRNAs are small noncoding RNAs with long half-lives that have emerged as critical regulators of drug seeking behavior but their expression in the OFC has not been examined in any drug exposure paradigm. We employed next generation sequencing to detect OFC miRNAs differentially expressed after 21D of forced abstinence between HH and HL animals, and proteomics analysis to elucidate miRNA-dependent translational neuroadaptations. We identified 55 OFC miRNAs associated with incubation of heroin craving, including miR-485-5p, which was significantly downregulated following 21D forced abstinence in HH but not HL animals. We bidirectionally manipulated miR-485-5p in the OFC to demonstrate that miR-485-5p can regulate long-lasting heroin seeking behavior after extended forced abstinence. Proteomics analysis identified 45 proteins selectively regulated in the OFC of HH but not HL animals that underwent 21D forced abstinence, of which 7 were putative miR-485-5p target genes. Thus, the miR-485-5p pathway is dysregulated in animals with a phenotype of persistent heroin craving behavior and OFC miR-485-5p pathways may function to support long-lasting heroin seeking.

The Microbiome-Gut-Brain axis regulates social cognition & craving in young binge drinkers

BACKGROUND

Binge drinking is the consumption of an excessive amount of alcohol in a short period of time. This pattern of consumption is highly prevalent during the crucial developmental period of adolescence. Recently, the severity of alcohol use disorders (AUDs) has been linked with microbiome alterations suggesting a role for the gut microbiome in its development. Furthermore, a strong link has emerged too between microbiome composition and socio-emotional functioning across different disorders including AUD. The aim of this study was to investigate the potential link (and its predictive value) between alcohol-related altered microbial profile, social cognition, impulsivity and craving.

METHODS

Young people (N = 71) aged 18-25 reported their alcohol use and underwent a neuropsychological evaluation. Craving was measured at baseline and three months later. Diet was controlled for. Blood, saliva and hair samples were taken for inflammatory, kynurenine and cortisol analysis. Stool samples were provided for shotgun metagenomic sequencing and short-chain fatty acids (SCFAs) were measured.

FINDINGS

Binge drinking was associated with distinct microbiome alterations and emotional recognition difficulties. Associations were found for several microbiome species with emotional processing and impulsivity. Craving showed a strong link with alterations in microbiome composition and neuroactive potential over time.

INTERPRETATION

In conclusion, this research demonstrates alterations in the gut microbiome of young binge drinkers (BDs) and identifies early biomarkers of craving. Associations between emotional processing and microbiome composition further support the growing literature on the gut microbiome as a regulator of social cognition. These findings are of relevance for new gut-derived interventions directed at improving early alcohol-related alterations during the vulnerability period of adolescence.

FUNDING

C.C. and R.G-C. received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No. 754535. APC Microbiome Ireland is a research centre funded by Science Foundation Ireland (SFI), through the Irish Government's National Development Plan [grant no. SFI/12/RC/2273_P2]. J.F.C has research support from Cremo, Pharmavite, DuPont and Nutricia. He has spoken at meetings sponsored by food and pharmaceutical companies. G.C. has received honoraria from Janssen, Probi, and Apsen as an invited speaker; is in receipt of research funding from Pharmavite, Fonterra, Nestle and Reckitt; and is a paid consultant for Yakult, Zentiva and Heel pharmaceuticals. All the authors declare no competing interests.

An Interpretable and Predictive Connectivity-Based Neural Signature for Chronic Cannabis Use

BACKGROUND

Cannabis is one of the most widely used substances in the world, with usage trending upward in recent years. However, although the psychiatric burden associated with maladaptive cannabis use has been well established, reliable and interpretable biomarkers associated with chronic use remain elusive. In this study, we combine large-scale functional magnetic resonance imaging with machine learning and network analysis and develop an interpretable decoding model that offers both accurate prediction and novel insights into chronic cannabis use.

METHODS

Chronic cannabis users (n = 166) and nonusing healthy control subjects (n = 124) completed a cue-elicited craving task during functional magnetic resonance imaging. Linear machine learning methods were used to classify individuals into chronic users and nonusers based on whole-brain functional connectivity. Network analysis was used to identify the most predictive regions and communities.

RESULTS

We obtained high (∼80% out-of-sample) accuracy across 4 different classification models, demonstrating that task-evoked connectivity can successfully differentiate chronic cannabis users from nonusers. We also identified key predictive regions implicating motor, sensory, attention, and craving-related areas, as well as a core set of brain networks that contributed to successful classification. The most predictive networks also strongly correlated with cannabis craving within the chronic user group.

CONCLUSIONS

This novel approach produced a neural signature of chronic cannabis use that is both accurate in terms of out-of-sample prediction and interpretable in terms of predictive networks and their relation to cannabis craving.

Persistent Neuroadaptations in the Nucleus Accumbens Core Accompany Incubation of Methamphetamine Craving in Male and Female Rats

Relapse is a major problem in treating methamphetamine use disorder. "Incubation of craving" during abstinence is a rat model for persistence of vulnerability to craving and relapse. While methamphetamine incubation has previously been demonstrated in male and female rats, it has not been demonstrated after withdrawal periods greater than 51 d and most mechanistic work used males. Here, we address both gaps. First, although methamphetamine intake was higher in males during self-administration training (6 h/d × 10 d), incubation was similar in males and females, with "incubated" craving persisting through withdrawal day (WD)100. Second, using whole-cell patch-clamp recordings in medium spiny neurons (MSNs) of the nucleus accumbens (NAc) core, we assessed synaptic levels of calcium-permeable AMPA receptors (CP-AMPARs), as their elevation is required for expression of incubation in males. In both sexes, compared with saline-self-administering controls, CP-AMPAR levels were significantly higher in methamphetamine rats across withdrawal, although this was less pronounced in WD100-135 rats than WD15-35 or WD40-75 methamphetamine rats. We also examined membrane properties and NMDA receptor (NMDAR) transmission. In saline controls, MSNs from males exhibited lower excitability than females. This difference was eliminated after incubation because of increased excitability of MSNs from males. NMDAR transmission did not differ between sexes and was not altered after incubation. In conclusion, incubation persists for longer than previously described and equally persistent CP-AMPAR plasticity in NAc core occurs in both sexes. Thus, abstinence-related synaptic plasticity in NAc is similar in males and females although other methamphetamine-related behaviors and neuroadaptations show differences.

Abstinence-Induced Nicotine Seeking Relays on a Persistent Hypoglutamatergic State within the Amygdalo-Striatal Neurocircuitry

Nicotine robustly sustains smoking behavior by acting as a primary reinforcer and by enhancing the incentive salience of the nicotine-associated stimuli. The motivational effects produced by environmental cues associated with nicotine delivery can progressively manifest during abstinence resulting in reinstatement of nicotine seeking. However, how the activity in reward neuronal circuits is transformed during abstinence-induced nicotine seeking is not yet fully understood. In here we used a contingent nicotine and saline control self-administration model to disentangle the contribution of cue-elicited seeking responding for nicotine after drug abstinence in male Wistar rats. Using ex vivo electrophysiological recordings and a network analysis approach, we defined temporal and brain-region specific amygdalo-striatal glutamatergic alterations that occur during nicotine abstinence. The results from this study provide critical evidence indicating a persistent hypoglutamatergic state within the amygdalo-striatal neurocircuitry over protracted nicotine abstinence. During abstinence-induced nicotine seeking, electrophysiological recordings showed progressive neuroadaptations in dorsal and ventral striatum already at 14-d abstinence while neuroadaptations in subregions of the amygdala emerged only after 28-d abstinence. The observed neuroadaptations pointed to a brain network involving the amygdala and the dorsolateral striatum (DLS) to be implied in cue-induced reinstatement of nicotine seeking. Together these data suggest long-lasting neuroadaptations that might reflect neuroplastic changes responsible to abstinence-induced nicotine craving. Neurophysiological transformations were detected within a time window that allows therapeutic intervention advancing clinical development of preventive strategies in nicotine addiction.

A neuromarker for drug and food craving distinguishes drug users from non-users

Craving is a core feature of substance use disorders. It is a strong predictor of substance use and relapse and is linked to overeating, gambling, and other maladaptive behaviors. Craving is measured via self-report, which is limited by introspective access and sociocultural contexts. Neurobiological markers of craving are both needed and lacking, and it remains unclear whether craving for drugs and food involve similar mechanisms. Across three functional magnetic resonance imaging studies (n = 99), we used machine learning to identify a cross-validated neuromarker that predicts self-reported intensity of cue-induced drug and food craving (P < 0.0002). This pattern, which we term the Neurobiological Craving Signature (NCS), includes ventromedial prefrontal and cingulate cortices, ventral striatum, temporal/parietal association areas, mediodorsal thalamus and cerebellum. Importantly, NCS responses to drug versus food cues discriminate drug users versus non-users with 82% accuracy. The NCS is also modulated by a self-regulation strategy. Transfer between separate neuromarkers for drug and food craving suggests shared neurobiological mechanisms. Future studies can assess the discriminant and convergent validity of the NCS and test whether it responds to clinical interventions and predicts long-term clinical outcomes.

Altered prefrontal signaling during inhibitory control in a salient drug context in cocaine use disorder

INTRODUCTION

Drug addiction is characterized by impaired response inhibition and salience attribution (iRISA), where the salience of drug cues is postulated to overpower that of other reinforcers with a concomitant decrease in self-control. However, the neural underpinnings of the interaction between the salience of drug cues and inhibitory control in drug addiction remain unclear.

METHODS

We developed a novel stop-signal functional magnetic resonance imaging task where the stop-signal reaction time (SSRT-a classical inhibitory control measure) was tested under different salience conditions (modulated by drug, food, threat, or neutral words) in individuals with cocaine use disorder (CUD; n = 26) versus demographically matched healthy control participants (n = 26).

RESULTS

Despite similarities in drug cue-related SSRT and valence and arousal word ratings between groups, dorsolateral prefrontal cortex (dlPFC) activity was diminished during the successful inhibition of drug versus food cues in CUD and was correlated with lower frequency of recent use, lower craving, and longer abstinence (Z > 3.1, P < 0.05 corrected).

DISCUSSION

Results suggest altered involvement of cognitive control regions (e.g. dlPFC) during inhibitory control under a drug context, relative to an alternative reinforcer, in CUD. Supporting the iRISA model, these results elucidate the direct impact of drug-related cue reactivity on the neural signature of inhibitory control in drug addiction.

Differential Orbitofrontal Cortex Responses to Chocolate Images While Performing an Approach-Avoidance Task in the MRI Environment

Background: Chocolate is one of the most frequently craved foods, and it often challenges self-regulation. These cravings may be underpinned by a neural facilitation of approach behavior toward chocolate. This preregistered study investigated the behavioral and neural correlates of such a bias using functional magnetic resonance imaging (fMRI) and reaction times (RTs). Methods: A total of n = 30 frequent chocolate eaters performed a relevant-feature approach-avoidance task (AAT) in the MRI scanner using buttons to enlarge (approach) or to shrink (avoid) pictures of chocolate and inedible control objects. We tested (a) whether implicit RT-based approach biases could be measured in a supine position in the scanner, (b) whether those biases were associated with activity in reward-related brain regions such as the insula, amygdala, striatum, and orbitofrontal cortex (OFC), and (c) whether individual RT-based bias-scores correlated with measures of chocolate craving. Results: Behaviorally, we found a highly reliable approach bias toward chocolate, defined by faster RTs in the compatible conditions (approach chocolate, avoid objects) compared to the incompatible conditions (avoid chocolate, approach objects). Neurally, this compatibility effect involved activity in the left medial OFC, a neural response that was positively correlated with individual approach bias scores. Conclusions: This study shows that the relevant feature AAT can be implemented in an fMRI setting in a supine position using buttons. An approach bias toward chocolate seems related to medial OFC activation that might serve to devalue chocolate when it has to be avoided. Our demonstration of neural and behavioral approach biases for chocolate underscores the need for stimulus-specific cognitive trainings to support healthy consumption and successful self-regulation.

The association between anxiety sensitivity and food cravings among individuals seeking treatment for weight-related behaviors

BACKGROUND

A better understanding of risk-factors associated with state-like food cravings may be one clinically relevant component in an effort to better understand obesity. Existing work has shown anxiety sensitivity (AS) to be a significant risk factor for increased cravings across a variety of health behaviors (e.g., smoking, alcohol use). Yet, no work has examined the relationship between AS and state-like food cravings. Therefore, the current study sought to examine the association between AS and a variety of state-like food cravings, including: (1) an intense desire to eat, (2) anticipation of relief from negative states and feelings/improvement in mood that may result from eating, (3) obsessive preoccupation with food or lack of control over eating, and (4) craving as a physiological state.

METHODS

Participants included 161 (Mage = 31.58, SD = 10.71; 60.9 % female) individuals seeking treatment for weight-related behaviors.

RESULTS

Results indicated that elevated AS was associated with reinforcement-based and physiological food cravings.

CONCLUSION

Our findings indicate that there may be clinical utility in screening for AS among individuals seeking treatment for weight-related behaviors in efforts to better understand specific types of food craving.

Intense craving for eat: standardization of the Food Cravings Questionnaire-State in Mexico

BACKGROUND

Food craving is an intense-compulsive response to eating highly appetizing foods. The Food Cravings Questionnaire-State (FCQ-S) is the most used instrument for its diagnosis. It is a multidimensional instrument, sensitive and adaptable to contextual and cultural changes.

OBJECTIVE

To standardize the FCQ-S in the adult population of Mexico City.

METHOD

Non-experimental, cross-sectional, at convenience design, with 1059 adults of both sexes, aged 18-84 years. It is highlighted that 71.9% of the participants were women.

RESULTS

A reliability coefficient of 0.95 was obtained, the correlations between the items were from r = 0.598 to r = 0.793. With the exploratory factorial analysis, an MKO of sampling adequacy of 0.943 was obtained, and with the Bartlett sphericity test a p = 0.000. The factors explain 78.61% of the total variation of the data. The RMSEA was 0.068, which indicates an acceptable fit. The CFI was 0.974, considered good, and NNFI was 0.969, good fit. The correlations ranged from p < 0.05 to p < 0.01, showing a connection between the different dimensions.

CONCLUSIONS

The FCQ-S is valid and adaptable in the Mexican population.

Simultaneous use of alcohol and cigarettes in a mixed psychiatric sample: Daily-life associations with smoking motives, craving, stimulation, sedation, and affect

Co-use of alcohol and cigarettes is common and associated with greater negative consequences compared to use of either substance alone. Furthermore, alcohol and cigarettes are often used at the same time, and these "simultaneous" use events are associated with greater consumption of each substance. Given the prevalence and negative consequences associated with this pattern, we sought to identify proximal predictors and reinforcers of simultaneous use in individuals with a range of emotional and behavioral dysregulation who may be at greater risk of experiencing substance-related problems. Specifically, 41 adults who drank alcohol and smoked cigarettes (28 with borderline personality disorder and 13 community individuals) completed 21 days of ecological momentary assessment (EMA). First, we used multilevel models on cigarette-use moments to examine whether momentary cigarette motive endorsement differed based on whether participants were also drinking alcohol in that moment. Second, we used multilevel models on all EMA moments to examine whether simultaneous use was associated with greater craving and reinforcing effects compared to use of either substance alone. Participants reported greater enhancement and social motives for smoking cigarettes when also drinking alcohol compared to when they were only smoking. Participants also reported greater alcohol craving, greater sedation, attenuated positive affect, and greater fear following simultaneous use compared to use of either substance alone. Our results add to a growing body of research characterizing proximal influences on simultaneous substance use. Findings highlight potential treatment targets for individuals seeking to better understand or cut down on their use of alcohol, cigarettes, or both. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

GluA2-lacking AMPA receptors in the nucleus accumbens core and shell contribute to the incubation of oxycodone craving in male rats

One of the most challenging issues in the treatment of substance use disorder, including misuse of opioids such as oxycodone, is persistent vulnerability to relapse, often triggered by cues or contexts previously associated with drug use. In rats, cue-induced craving progressively intensifies ('incubates') during withdrawal from extended-access self-administration of several classes of misused drugs, including the psychostimulants cocaine and methamphetamine. For these psychostimulants, incubation is associated with strengthening of excitatory synapses in the nucleus accumbens (NAc) through incorporation of α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors that lack the GluA2 subunit and are therefore Ca2+ -permeable (CP-AMPARs). Once CP-AMPAR upregulation occurs, their stimulation is required for expression of incubation. It is not known if a similar mechanism contributes to incubation of oxycodone craving. Using male rats, we established that incubation occurs by withdrawal day (WD) 15 and persists through WD30. Then, using cell-surface biotinylation, we found that surface levels of the AMPAR subunit GluA1 but not GluA2 are elevated in NAc core and shell of oxycodone rats on WD15, although this wanes by WD30. Next, using intra-NAc injection of the selective CP-AMPAR antagonist Naspm before a seeking test, we demonstrate that CP-AMPAR blockade in either subregion decreases oxycodone seeking on WD15 or WD30 (after incubation), but not WD1, and has no effect in saline self-administering animals. The Naspm results suggest CP-AMPARs persist in synapses through WD30 even if total cell surface levels wane. These results suggest that a common neurobiological mechanism contributes to expression of incubation of craving for oxycodone and psychostimulants.

Trauma Cue-Elicited Alcohol Craving as a Function of Adult Versus Childhood-Onset Interpersonal Traumatic Events in Young Adult Drinkers

OBJECTIVE

Childhood trauma may influence risk for alcohol use disorder and posttraumatic stress disorder through negative and positive reinforcement drinking. Laboratory studies evaluating childhood trauma in relation to these phenotypes are limited.

METHOD

This study examined the influence of childhood index traumas on responses to trauma and alcohol cues among 184 college students (50.0% female) endorsing lifetime interpersonal trauma and current weekly alcohol use. Participants' subjective alcohol craving and distress were measured in response to four narrative (trauma vs. neutral) and beverage (alcohol vs. water) cue combinations.

RESULTS

Forward-fitted linear mixed-effects models indicated main effects of childhood index traumas on distress (β= 6.151, p = .001) and craving (β = 0.656, p = .023), wherein individuals with childhood index traumas showed evidence of elevated levels of distress and craving. Childhood index trauma interacted with the narrative cue to predict distress (β = -10.764, p = .002), wherein individuals with childhood index traumas showed greater levels of distress to the neutral cue, and individuals with adult index traumas showed greater levels of distress to the trauma cue. Childhood index trauma interacted with the beverage cue to predict craving (β = -0.599, p = .011), wherein childhood index traumas were associated with greater levels of craving to neutral cues. Childhood index trauma did not significantly interact with the beverage cue to predict distress or the narrative cue to predict craving (ps > .05).

CONCLUSIONS

Childhood trauma may be more relevant to positive rather than negative reinforcement aspects of alcohol use disorder during young adulthood.

Daily stress predicts later drinking initiation via craving in heavier social drinkers: A prospective in-field daily diary study

Stress has been linked to increased alcohol use but how stress may increase drinking in social drinkers is not well understood. Negative reinforcement processes may explain this link but the role of specific motivational processes, such as craving, and how these motivational processes are altered by drinking have not been studied. The current study assessed social drinkers (n = 81) for recent quantity and frequency of alcohol intake (quantity and frequency index, QFI) upon study enrollment, who then completed 30 days of electronic daily records of stress, craving, and alcohol intake. Multilevel structural equation models tested if person-averaged (between-person) and daily (within-person) craving mediated the link between stress and later drinking each evening and if recent quantity-frequency of drinking (QFI) moderated these associations. At the between-person level, both greater subjective stress, Est = .38, 95% confidence interval (CI) [.19, .57], and higher QFI predicted higher levels of craving, Est = .34, 95% CI [.20, .49]. Higher craving predicted more frequent drinking throughout the study, Est = .34, 95% CI [.01, .29]. At the within-person level, higher subjective stress predicted higher within-person craving; and the link between craving and later drinking was significant among those who had a higher QFI, Est = .84, 95% CI [.58, 1.12]. The subjective stress-drinking relationship was mediated by a greater alcohol craving response in social drinkers, and higher the QFI, greater the alcohol craving response. These results indicate that both higher levels of stress and greater recent alcohol intake patterns sensitize the craving response that in turn facilitates later alcohol intake. The findings suggest that higher recent alcohol use predict greater stress-potentiated initiation of drinking via higher craving responses. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neurobiological regulation of eating behavior: Evidence based on non-invasive brain stimulation

The prefrontal cortex is appreciated as a key neurobiological player in human eating behavior. A special focus is herein dedicated to the dorsolateral prefrontal cortex (DLPFC), which is critically involved in executive function such as cognitive control over eating. Persons with obesity display hypoactivity in this brain area, which is linked to overconsumption and food craving. Contrary to that, higher activity in the DLPFC is associated with successful weight-loss and weight-maintenance. Transcranial direct current stimulation (tDCS) is a non-invasive neurostimulation tool used to enhance self-control and inhibitory control. The number of studies using tDCS to influence eating behavior rapidly increased in the last years. However, the effectiveness of tDCS is still unclear, as studies show mixed results and individual differences were shown to be an important factor in the effectiveness of non-invasive brain stimulation. Here, we describe the current state of research of human studies using tDCS to influence food intake, food craving, subjective feeling of hunger and body weight. Excitatory stimulation of the right DLPFC seems most promising to reduce food cravings to highly palatable food, while other studies provide evidence that stimulating the left DLPFC shows promising effects on weight loss and weight maintenance, especially in multisession approaches. Overall, the reported findings are heterogeneous pointing to large interindividual differences in tDCS responsiveness.

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.

Association of Drug Cues and Craving With Drug Use and Relapse: A Systematic Review and Meta-analysis

Importance

Craving, which is a strong desire for drugs, is a new DSM-5 diagnostic criterion for substance use disorders (SUDs), which are the most prevalent, costly, and deadly forms of psychopathology. Despite decades of research, the roles of drug cues and craving in drug use and relapse remain controversial.

Objective

To assess whether 4 types of drug cue and craving indicators, including cue exposure, physiological cue reactivity, cue-induced craving, and self-reported craving (without cue exposure), are prospectively associated with drug use and relapse.

Data Sources

Google Scholar was searched for published studies from inception through December 31, 2018. In addition, backward and forward searches were performed on included articles to identify additional articles.

Study Selection

Included studies reported a prospective statistic that linked cue and craving indicators at time 1 to drug use or relapse at time 2, in humans.

Data Extraction and Synthesis

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Study characteristics and statistics were extracted and/or coded by 1 of the 2 authors and then checked by the other. Statistical analyses were performed from May to July 2021.

Main Outcomes and Measures

Random-effects models were used to calculate prospective odds ratios (ORs) representing the association between cue and craving indicators and subsequent drug use/relapse.

Results

A total of 18 205 records were identified, and 237 studies were included. Across 656 statistics, representing 51 788 human participants (21 216 with confirmed SUDs), a significant prospective association of all cue and craving indicators with drug use/relapse was found (OR, 2.05; 95% CI, 1.94-2.15), such that a 1-unit increase in cue and craving indicators was associated with more than double the odds of future drug use or relapse. A Rosenthal fail-safe analysis revealed that 180 092 null studies would need to be published to nullify this finding. Trim-and-fill analysis brought the adjusted effect size to an OR of 1.31 (95% CI, 1.25-1.38). Moderator analyses showed that some of the strongest associations were found for cue-induced craving, real cues or images, drug use outcome, same-day time lag, studies using ecological momentary assessment, and male participants.

Conclusions and Relevance

Findings from this systematic review and meta-analysis suggest that drug cue and craving indicators play significant roles in drug use and relapse outcomes and are an important mechanism underlying SUDs. Clinically, these results support incorporating craving assessment across stages of treatment, as early as primary care.