Functional magnetic resonance imaging of cocaine craving

Objective: Identification of brain activity associated with craving is impo rtant for understanding the neurobiology of addiction. Method: Brain activity was measured in cocaine addicts and healthy subjects by functional magnetic resonance imaging (fMRI) while the subjects watched videotapes designed to elicit happy feelings, sad feelings, or the desire to use cocaine. The subjects indicated the onset of drug craving or emotion al response, allowing comparison of groups before and after such feelings. Results: Robust activation of the anterior cingulate was evident in patient s watching cocaine-cue tapes but not in patients watching happy or sad tape s or in healthy subjects under any condition. Anterior cingulate activation preceded the reported onset of craving and was evident in patients who did not report craving. In contrast, patients showed less activation than heal thy subjects during the cocaine-cue tapes in areas of the frontal lobes. Af ter the reported onset of craving, cocaine-dependent subjects showed greate r activity than healthy subjects in regions that are more active in healthy subjects when they watch sad tapes than when they watch happy tapes, sugge sting a physiologic link between cocaine-cue responses and normal dysphoric states. Dynamic aspects of regional brain activations, but not the locatio n of activations, were abnormal in cocaine-dependent subjects watching sad tapes, suggesting more general affective dysregulation. Patients showed low activation of sensory areas during initial viewing of all videotapes, sugg esting generalized alteration in neuroresponsiveness. Conclusions: Cocaine cues lead to abnormally high cingulate and low frontal lobe activation in cocaine addicts. Addicts also show more general abnorma lities in affect-related brain activation.