Brain activation patterns associated with cue reactivity and craving in abstinent problem gamblers, heavy smokers and healthy controls: an fMRI study

Anna E Goudriaan, Michiel B de Ruiter, Wim van den Brink, Jaap Oosterlaan, Dick J Veltman, Anna E Goudriaan, Michiel B de Ruiter, Wim van den Brink, Jaap Oosterlaan, Dick J Veltman

Abstract

Abnormal cue reactivity is a central characteristic of addiction, associated with increased activity in motivation, attention and memory related brain circuits. In this neuroimaging study, cue reactivity in problem gamblers (PRG) was compared with cue reactivity in heavy smokers (HSM) and healthy controls (HC). A functional magnetic resonance imaging event-related cue reactivity paradigm, consisting of gambling, smoking-related and neutral pictures, was employed in 17 treatment-seeking non-smoking PRG, 18 non-gambling HSM, and 17 non-gambling and non-smoking HC. Watching gambling pictures (relative to neutral pictures) was associated with higher brain activation in occipitotemporal areas, posterior cingulate cortex, parahippocampal gyrus and amygdala in PRG compared with HC and HSM. Subjective craving in PRG correlated positively with brain activation in left ventrolateral prefrontal cortex and left insula. When comparing the HSM group with the two other groups, no significant differences in brain activity induced by smoking cues were found. In a stratified analysis, the HSM subgroup with higher Fagerström Test for Nicotine Dependence scores (FTND M = 5.4) showed higher brain activation in ventromedial prefrontal cortex, rostral anterior cingulate cortex, insula and middle/superior temporal gyrus while watching smoking-related pictures (relative to neutral pictures) than the HSM subgroup with lower FTND scores (FTND M = 2.9) and than non-smoking HC. Nicotine craving correlated with activation in left prefrontal and left amygdala when viewing smoking-related pictures in HSM. Increased regional responsiveness to gambling pictures in brain regions linked to motivation and visual processing is present in PRG, similar to neural mechanisms underlying cue reactivity in substance dependence. Increased brain activation in related fronto-limbic brain areas was present in HSM with higher FTND scores compared with HSM with lower FTND scores.

© 2010 The Authors, Addiction Biology © 2010 Society for the Study of Addiction.

Figures

Figure 1
Figure 1
Examples of gambling stimuli (left), smoking-related stimuli (middle) and neutral stimuli (right)
Figure 2
Figure 2
Activation patterns across groups for neutral pictures versus low-level baseline pictures (top left panel), gambling pictures versus low-level baseline pictures (top middle panel), smoking pictures versus low-level baseline pictures (top right panel), gambling pictures versus neutral pictures (lower left panel), smoking-related pictures versus neutral pictures (lower right panel)
Figure 3
Figure 3
Group interaction: Areas highlighted for higher activation in problem gamblers (PRG) versus the pooled sample of healthy controls (HC) and heavy smokers (HSM) at coordinates −9, 0, −18. Exclusion of PRG with co-morbid psychiatric disorders resulted in similar results, although differences in dorsolateral prefrontal cortex (DLPFC) in PRG compared with HC, and in right amygdala activation and left DLPFC in PRG compared with HSM ceased to be statistically significant. No significant relations between Beck Depression Inventory-II, or Conners Adult ADHD Rating Scales scores and blood oxygenation level-dependent response when viewing gambling pictures versus neutral pictures were present in PRG, HSM or HC
Figure 4
Figure 4
Group interaction: Areas highlighted for higher activation in Fagerström Test for Nicotine Dependence (FTND)-high group versus the pooled sample of FTND-low group, problem gamblers (PRG) and healthy controls (HC) at coordinates 3, −51, 21. No significant relations between Beck Depression Inventory-II, or Conners Adult ADHD Rating Scales scores and blood oxygenation level-dependent response when viewing smoking-related pictures versus neutral pictures were present in the FTND-high group, FTND-low group, PRG or HC

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