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Correlation of Stable Elevations in Striatal µ-Opioid Receptor Availability in Detoxified Alcoholic Patients With Alcohol Craving
A Positron Emission Tomography Study Using Carbon 11–Labeled Carfentanil
Andreas Heinz, MD;
Matthias Reimold, MD;
Jana Wrase;
Derik Hermann, MD;
Bernhard Croissant, MD;
Götz Mundle, MD;
Bernhard M. Dohmen, MD;
Dieter H. Braus, MD;
Gunter Schumann, MD;
Hans-Jürgen Machulla, MD;
Roland Bares, MD;
Karl Mann, MD
Arch Gen Psychiatry. 2005;62:57-64.
Background The pleasant effects of food and alcohol intake are partially mediated by µ-opiate receptors in the ventral striatum, a central area of the brain reward system. Blockade of µ-opiate receptors with naltrexone reduces the relapse risk among some but not all alcoholic individuals.
Objective To test the hypothesis that alcohol craving is pronounced among alcoholic individuals with a high availability of µ-opiate receptors in the brain reward system.
Design Patients and comparison sample. The availability of central µ-opiate receptors was measured in vivo with positron emission tomography (PET) and the radioligand carbon 11–labeled carfentanil in the ventral striatum and compared with the severity of alcohol craving as assessed by the Obsessive Compulsive Drinking Scale (OCDS).
Setting Hospitalized care.
Participants Volunteer sample of 25 male alcohol-dependent inpatients assessed after detoxification of whom 12 underwent PET again 5 weeks later. Control group of 10 healthy men.
Main Outcome Measures After 1 to 3 weeks of abstinence, the availability of µ-opiate receptors in the ventral striatum, including the nucleus accumbens, was significantly elevated in alcoholic patients compared with healthy controls and remained elevated when 12 alcoholic patients had these levels measured 5 weeks later (P<.05 corrected for multiple testing). Higher availability of µ-opiate receptors in this brain area correlated significantly with the intensity of alcohol craving as assessed by the OCDS.
Conclusions Abstinent alcoholic patients displayed an increase in µ-opiate receptors in the ventral striatum, including the nucleus accumbens, which correlated with the severity of alcohol craving. These findings point to a neuronal correlate of alcohol urges.
Author Affiliations: Department of Psychiatry, Charité University Medicine Berlin, Campus Charité Mitte, Berlin, Germany (Dr Heinz and Ms Wrase); Departments of Nuclear Medicine (Drs Reimold, Dohmen, and Bares), Radiopharmacy and PET Center (Dr Machulla), and Psychiatry (Dr Mundle), University of Tuebingen, Germany; and Department for Addictive Behavior and Addiction Medicine (Drs Hermann, Croissant, and Mann), Department of Psychiatry (Drs Braus and Schumann), Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
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