Elsevier

Biological Psychiatry

Volume 68, Issue 8, 15 October 2010, Pages 697-703
Biological Psychiatry

Archival Report
Brain Mu-Opioid Receptor Binding Predicts Treatment Outcome in Cocaine-Abusing Outpatients

https://doi.org/10.1016/j.biopsych.2010.05.003Get rights and content

Background

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

Methods

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

Results

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

Conclusions

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

Section snippets

Subjects and Setting

Participants were 25 adult treatment seekers with current cocaine abuse or dependence (DSM-IV criteria) recruited from the community to an outpatient treatment program at the National Institute on Drug Abuse Intramural Research Program in Baltimore, Maryland. Screening included medical, psychiatric, and drug use histories; physical examination; urine and blood tests; Addiction Severity Index (9); Shipley Institute of Living Scale (10); and the Diagnostic Interview Schedule (11). Eligibility

Results

Forty-five participants enrolled in the study. Of these, 2 were disqualified because of MRI findings, 1 could not tolerate MRI scanning, 1 had a urine sample positive for opiates at the first PET scan, and 6 did not appear for their first PET scan, leaving 35 participants with PET scans. Of these 35 participants, 9 never started outpatient treatment and 1 started treatment but never provided a urine specimen. The 25 participants who started treatment and provided at least one urine specimen

Discussion

The present study found that elevated regional brain mOR binding in the anterior cingulate, medial frontal, middle frontal, middle temporal, and sublobar insular gyri before treatment was associated with a shorter duration of cocaine abstinence achieved during treatment among adult, cocaine-abusing or cocaine-dependent outpatients. In addition, elevated mOR binding in the medial and middle frontal gyri before treatment correlated with greater cocaine use during the first month of outpatient

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