Sustained incentive value of heroin-related cues in short- and long-term abstinent heroin users

• Published in: European neuropsychopharmacology Vol. 23; no. 10; pp. 1270 - 1279
• Main Authors: Preller, Katrin H, Wagner, Michael, Sulzbach, Christian, Hoenig, Klaus, Neubauer, Julia, Franke, Petra E, Petrovsky, Nadine, Frommann, Ingo, Rehme, Anne K, Quednow, Boris B
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-10-2013
• Subjects: Abstinence; Adaptations; Addiction memory; Adult; Affective startle modulation; Analgesics, Opioid - therapeutic use; Behavior, Addictive - etiology; Behavior, Addictive - prevention & control; Combined Modality Therapy; Cue-reactivity; Cues; Detoxification; Diagnostic and Statistical Manual of Mental Disorders; Female; Follow-Up Studies; Heroin; Heroin Dependence - drug therapy; Heroin Dependence - physiopathology; Heroin Dependence - prevention & control; Heroin Dependence - therapy; Humans; Internal Medicine; Longitudinal Studies; Male; Methadone - therapeutic use; Motivation; Opiate Substitution Treatment; Photic Stimulation - adverse effects; Photography; Psychiatry; Reflex, Startle; Secondary Prevention; Time Factors; Addiction memory; Cue-reactivity; Abstinence; Affective startle modulation; Heroin; Detoxification
• ISSN: 0924-977X; 1873-7862
• DOI: 10.1016/j.euroneuro.2012.11.007

Abstract Models of addiction and addiction memory propose that drug-associated cues elicit incentive effects in drug users, which play an important role in maintenance of drug use and relapse. Incentive effects have been demonstrated for smoking and alcohol-related cues but evidence for heroin-related cues has been inconclusive. Furthermore, it is unknown whether appetitive effects of heroin-related cues persist after prolonged abstinence, although heroin addiction is known to have high relapse rates. Therefore, we investigated implicit and explicit valence of heroin-related cues in dependent users at different stages of abstinence using affective startle modulation. In Study I , 15 current heroin users were measured before and after detoxification. Correspondingly, 15 healthy control participants were tested twice at an interval of 14 days. In Study II , 14 long-term abstinent heroin users were additionally measured in a single session. Implicit processing of drug-related stimuli was assessed using affective startle modulation by pictures of heroin and smoking scenes. Explicit reactions were measured using ratings of valence and craving. In contrast to controls, heroin-dependent participants showed a clear reduction of startle response during heroin-related pictures ( p <0.05). Detoxification did not significantly change their startle responses to heroin-cues. No difference between non-detoxified current and long-term abstinent heroin users was found in implicit reactions to heroin-cues, whereas explicit measures differed between both groups (all p <0.05). After detoxification and even after prolonged abstinence, heroin cues still exert implicit appetitive effects in heroin users. This implies that drug-induced adaptations of reward circuits are long-lasting, resulting in a highly stable addiction memory.