Behavioral and Accumbal Responses During an Affective Go/No-Go Task Predict Adherence to Injectable Naltrexone Treatment in Opioid Use Disorder

Abstract

Adherence is a major factor in the effectiveness of the injectable extended-release naltrexone as a relapse prevention treatment in opioid use disorder. We examined the value of a variant of the Go/No-go paradigm in predicting extended-release naltrexone adherence in 27 detoxified opioid use disorder patients who were offered up to 3 monthly extended-release naltrexone injections. Before extended-release naltrexone, participants performed a Go/No-go task that comprised positively valenced Go trials and negatively valenced No-go trials during a functional magnetic resonance imaging scan. Errors of commission and neural responses to the No-go vs Go trials were independent variables. Adherence, operationalized as the completion of all 3 extended-release naltrexone injections, was the outcome variable. Fewer errors of commission and greater left accumbal response during the No-go vs Go trials predicted better adherence. These findings support the clinical potential of the behavioral and neurophysiological correlates of response inhibition in the prediction of extended-release naltrexone treatment outcomes in opioid use disorder.

Keywords: adherence; errors of commission; extended-release naltrexone; nucleus accumbens; opioid use disorder.

Figure 1.

Receiver operating characteristic (ROC) curves for the logistic regression models predicting adherence to 3 months of extended-release naltrexone (XR-NTX) treatment in opioid use disorder. (A) Fewer errors of commission predicted better adherence to XR-NTX; area under the ROC curve (ROC-AUC) = 0.79, 95% bootstrap confidence interval (BootCI) = [0.58,0.93]. (B) Greater left nucleus accumbens response to the No-go vs Go trials predicted better adherence to XR-NTX; ROC-AUC = 0.82, 95% BootCI = [0.53,0.96].