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Neural Activation Patterns of Methamphetamine-Dependent Subjects During Decision Making Predict Relapse
Martin P. Paulus, MD;
Susan F. Tapert, PhD;
Marc A. Schuckit, MD
Arch Gen Psychiatry. 2005;62:761-768.
Context Relapse is a common clinical problem in individuals with substance dependence. Previous studies have implicated a multifactorial process underlying relapse; however, the contribution of specific neural substrates has not yet been examined.
Objective To determine whether results from functional magnetic resonance imaging (fMRI) shortly after drug cessation could predict relapse in stimulant-dependent individuals.
Participants and Design Treatment-seeking methamphetamine-dependent males (N = 46) underwent fMRI 3 to 4 weeks after cessation of drug use. Of the 40 subjects who were followed up a median of 370 days, 18 relapsed and 22 did not.
Main Outcome Measure Blood oxygen level–dependent fMRI activation during a simple 2-choice prediction task.
Results The fMRI activation patterns in right insular, posterior cingulate, and temporal cortex obtained early in recovery correctly predicted 20 of 22 subjects who did not relapse and 17 of 18 subjects who did. A Cox regression analysis revealed that the combination of right middle frontal gyrus, middle temporal gyrus, and posterior cingulate activation best predicted the time to relapse.
Conclusion To our knowledge, this is the first investigation to show that fMRI can be used to predict relapse in substance-dependent individuals.
Author Affiliations: Laboratory of Biological Dynamics and Theoretical Medicine (Dr Paulus), Department of Psychiatry (Drs Paulus, Tapert, and Schuckit), University of California San Diego, La Jolla; Veterans Affairs San Diego Healthcare System, San Diego (Drs Paulus, Tapert, and Schuckit).
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