New findings on biological factors predicting addiction relapse vulnerability

Abstract

Relapse is a highly prevalent phenomenon in addiction. This paper examines the new research on identifying biological factors that contribute to addiction relapse risk. Prospective studies examining relapse risk are reviewed, and clinical, biological, and neural factors that predict relapse risk are identified. Clinical factors, patient-related factors, and subjective and behavioral measures such as depressive symptoms, stress, and drug craving all predict future relapse risk. Among biological measures, endocrine measures such as cortisol and cortisol/corticotropin (ACTH) ratio as a measure of adrenal sensitivity and serum brain-derived neurotrophic factor were also predictive of future relapse risk. Among neural measures, brain atrophy in the medial frontal regions and hyperreactivity of the anterior cingulate during withdrawal were identified as important in drug withdrawal and relapse risk. Caveats pertaining to specific drug abuse type and phase of addiction are discussed. Finally, significant implications of these findings for clinical practice are presented, with a specific focus on determining biological markers of relapse risk that may be used to identify those individuals who are most at risk of relapse in the clinic. Such markers may then be used to assess treatment response and develop specific treatments that will normalize these neural and biological sequelae so as to significantly improve relapse outcomes.

Fig. 1

Data on proportion of patients remaining abstinent and surviving relapse at discharge from a large, publicly funded addiction treatment clinic (N=878). Patients are classified on the basis of primary drug of abuse (cocaine, marijuana, opioid, alcohol). Survival distribution function is shown on the y axis, which represents the proportion of patients surviving relapse and remaining abstinent during the assessment period of 350 days shown on the x axis environmental stimuli and interoceptive cues, it is important to examine the psychobiological consequences of chronic drug use and assess whether such changes are involved in increasing relapse risk.