Individual differences in anterior cingulate activation associated with attentional bias predict cocaine use after treatment

Abstract

Drug-dependent patients often relapse into drug use after treatment. Behavioral studies show that enhanced attentional bias to drug cues is a precursor of relapse. The present functional magnetic resonance imaging (fMRI) study examined whether brain regions involved in attentional bias are predictive of cocaine use after treatment. Attentional bias-related brain activity was measured-with a cocaine Stroop task-in cocaine-dependent patients during their first week in detoxification treatment and was used to predict cocaine use at 3-month follow-up. The predictive value of attentional bias-related brain activity in a priori defined regions of interest, in addition to other measures such as self-reports of substance severity, craving, and behavioral attentional bias were examined. The results show that craving in the week before treatment and individual variability in attentional bias-related activity in the dorsal anterior cingulate cortex (dACC) were significant predictors of days of cocaine use at 3-month follow-up and accounted for 45% in explained variance. Brain activity in the dACC uniquely contributed 22% of explained variance to the prediction model. These findings suggest that hyperactive attentional bias-related brain activity in the dACC might be a biomarker of relapse vulnerability as early as in the first week of detoxification treatment. Ultimately, this may help to develop individually tailored treatment interventions to reduce relapse risk.

Figure 1

A priori defined, literature-based regions of interest involved in attentional bias to substance cues. dACC, dorsal anterior cingulate cortex; DLPFC, dorsolateral prefrontal cortex; NACC, nucleus accumbens.

Figure 2

Correlation between (a) craving in the week before treatment and recent cocaine use and (b) attentional bias-related activation in the right dACC and recent cocaine use. dACC, dorsal anterior cingulate cortex.