fMRI Study of a Dual Process Treatment Protocol With Substance Dependent Adults

• fMRI blood-oxygenation-level-dependent (BOLD) signal change as a measure of emotional reactivity related to the visual presentation of drug-imagery. [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  In a subset of approximately 26 subjects, fMRI technology will be employed to examine brain structure and function change (pre-treatment and post-treatment) in the amygdaloid region, orbitofrontal cortex, in the anterior cingluate cortex (structure implicated in drug cue attention); in medial prefrontal cortex and right dorsolateral prefrontal cortex (associated with effective behavioral decision-making in substance abusers).
  
  

• Heart rate during MRI scanning as a measure of emotional reactivity related to the visual presentation of drug-imagery. [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  Changes in heart rate related to the visual presentation of drug-imagery during MRI scanning, to assess cue reactivity differences across the treatment and control groups at two time-points (pre-intervention and post-intervention).
  
  
• Quality of Life Inventory (QOLI) as a measure of the subject's quality of life. [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  Questionnaire completed by subjects at baseline and at the end of the study. We will measure changes in Overall QOLI score and Weighted Satisfaction Profile score at the two time-points (pre-intervention and post-intervention).
  
  
• Brief Symptoms Inventory (BSI), as a measure of subjective craving, anxiety, and somatization [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  Questionnaire completed by subjects at baseline and at the end of the study. We will measure changes in Nonpatient T Score and Percentile in the 12 domains at the two time-points (pre-intervention and post-intervention).
  
  
• Hamilton - Depression Inventory (HAM-D) as a measure of depression. [ Time Frame: 10 weeks ] [ Designated as safety issue: No ]
  Questionnaire completed by subjects at baseline and at the end of the study. We will measure changes in the total Hamilton depression scale score at the two time-points (pre-intervention and post-intervention).
  
  
• Urine specimen toxicology analysis as a measure of treatment retention. [ Time Frame: Weekly for 10 weeks ] [ Designated as safety issue: No ]
  Urine specimen collection and analysis to track patient drug use on a weekly basis during the 10 weeks in treatment.
  
  
• Blood Alcohol Level analysis as a measure of treatment retention. [ Time Frame: Weekly for 10 weeks ] [ Designated as safety issue: No ]
  Breathalizer test for alcohol to track patient alcohol use on a weekly basis during the 10 weeks in treatment.
  
  

The substance abuse literature consistently shows that negative emotional states and subjective stress are highly predictive of relapse and significantly influence behavioral motivation. From a neurobiological perspective, stress associated with withdrawal and substance abuse experiences stimulates chemical and hormonal changes in the brain creating a protracted hyperaroused state. Further, cognitive control resources (i.e., cognitive coping skills/relapse prevention training) have been shown to exert minimal impact on behavioral decision-making in the presence of intense affective material. Thus, implicit cognitive processes play a significant role in drug use behavior, decreasing self regulation capacities and increasing risk of. Specifically, high levels of stress can compromise prefrontal cortex functioning, with the nucleus accumbens, orbitofrontal cortex and amygdala functional changes related to increased cue reactivity.

Taken together, the current literature strongly suggests that verbally-based therapies may have limited utility as a singular form of treatment in early substance abuse recovery, as the brain may not be functionally ready for executive level processing. Instead, the multidisciplinary substance abuse literature suggests that psychosocial treatment methods need to include a range of learning approaches that allow for visual-sensory processing, in addition to traditional verbal-based processing. Integrated multi-modal interventions are needed to offer opportunities for activation of these different brain regions to facilitate cognitive-affective balance in behavioral decision-making.