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Prefrontal Cortical Activation, but Not Behavioral Performance of Impulsivity and Risky Decision-Making Tasks, was Associated with Treatment Outcome in Residential Patients with Alcohol or Prescription Opioid Use Disorder
Abstract   Open access

Prefrontal Cortical Activation, but Not Behavioral Performance of Impulsivity and Risky Decision-Making Tasks, was Associated with Treatment Outcome in Residential Patients with Alcohol or Prescription Opioid Use Disorder

Sarah Tilden, Jonathan Harris, Andrew Huhn, Erin Deneke, Jessica Parascando, Roger Meyer, Edward Bixler, Hasan Ayaz and Scott Bunce
Frontiers in human neuroscience, v 12
2018
url
https://doi.org/10.3389/conf.fnhum.2018.227.00126View
Published, Version of Record (VoR) Open CC BY V4.0

Abstract

Alcohol use disorder (AUD) and prescription opioid use disorder (pOUD) are disorders of chronic relapse, with 50-70% of patients relapsing within the first 90 days of treatment completion. The neurophysiological substrate underlying these and other substance use disorders (SUDs) has been linked to both impulsive and compulsive control disorders. Current treatment for AUD and pOUD is not based upon the neurophysiological aspects of the disorders, despite the development of the allostatic model and the impaired response inhibition and salience attribution (iRISA) syndrome model over the past two decades. In this study, we used functional near-infrared spectroscopy (fNIRs), a portable and affordable neuroimaging device, to evaluate the blood-oxygenation-level determined (BOLD) signal in the prefrontal cortex during impulsive and risky decision-making tasks. We then followed patients for 90-days after completion of residential treatment and compared outcome (relapsed vs. abstained) predictability between the behavioral/subjective data and neurophysiology/objective data. Working with the Caron Treatment Center, an in-patient treatment facility, we recruited, in two separate studies, 49 pOUD patients and 50 AUD patients. AUD patients completed a Colored-Word Stroop Task, a measure of impulse control. POUD patients completed an adapted Balloon Analogue Risk Task (BART), a task that measures risky-decision-making. In addition to performance data, prefrontal cortical (PFC) activity was monitored throughout the duration of the tasks using fNIRs. Patients were followed for 90-days after they left residential treatment to determine their treatment outcome status (abstained vs. relapsed). Performance measures on the BART did not differ between relapsers and abstainers (p= 0.97). However, activation in the right ventromedial PFC and left dorsolateral PFC accurately classified 91.8% of pOUD patients that relapsed to opioid use within the first 90 days post-treatment completion. Similarly, Stroop task performance did not differ between relapsers and abstainers in the AUD population (p=not significant). However, relapsing patients showed reduced activation in the bilateral dorsolateral PFC relative to abstaining patients (p< 0.05), which accurately classified 80% of AUD patients as relapsers versus abstainers. These results suggest that fNIRs-based brain responses could provide objective, affordable, measures of relative risk of relapse that will help clinicians devise and implement personalized treatments in SUD patients.

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