Medication and group therapy improve control for heroin addiction

According to their previous research, scientists from the Icahn School of Medicine at Mount Sinai Medical Center showed that people with heroin use disorder have reduced activity in the anterior and dorsolateral prefrontal cortex (PFC) during an impulse inhibition task compared to healthy controls.

Importantly, 15 weeks of medication-assisted treatment, which included adjunctive group therapy, improved impaired anterior and dorsolateral PFC function during an impulse inhibition task in a group of participants with disorder. Use of heroin. This provides evidence for a time course of recovery of impulse control and PFC function in individuals with heroin use disorder following this intervention.

The study was published in the journal Nature Mental Health.

Opioid overdose deaths (including heroin) continue to rise rapidly among adults. Impulse control—the ability to suppress unwanted behaviors such as drug use despite significant negative consequences and desire to quit—is impaired in people with drug addiction and is accompanied by functional deactivations in the prefrontal cortex, the region of the brain involved in self-control processes.

This study recruited 26 inpatients with heroin use disorder undergoing medication-assisted treatment and 24 demographically matched healthy participants for a longitudinal study using functional MRI (fMRI). Participants took part in two fMRI sessions 15 weeks apart for inpatient treatment of patients with heroin use disorder and a comparable time interval for healthy participants.

During fMRI, participants performed a stop-signal task, a well-validated tool for assessing brain function during impulse control. During the task, participants responded to arrow stimuli and were deterred from responding when the arrow periodically turned red (stop signal). In addition to increased activity in PFC regions after 15 weeks of inpatient treatment, increased activity was correlated with improved behavior on a stop signal task in people with heroin use disorder.

Brain activity responsible for impulse control increases from baseline to follow-up in the iHUD group compared to the HC group. A,b, Activity in the right aPFC (a) and right dlPFC (b) during successful and unsuccessful stops showed a significant increase from baseline to follow-up in the iHUD group compared with the HC group. Source: Nature Mental Health (2024). DOI: 10.1038/s44220-024-00230-4

"Overall, our results identify anterior and dorsolateral areas of the PFC as potentially amenable to targeted interventions that may accelerate their recovery during impulse control, which may have practical implications for informing future treatments," says Ahmet O. Ceceli, Ph.D., senior postdoctoral fellow and lead author of the article.

"More research is needed to determine whether there is a specific aspect of hospital care that significantly contributes to improvement and to examine other specific factors. For example, our research team plans to test whether the recovery effects we observed in this study are due to the intervention, a mindfulness-based intervention that was part of a complementary group therapeutic intervention,” says Rita Z. Goldstein, PhD, professor of psychiatry and neurosciences at the Icahn School of Medicine at Mount Sinai and senior author of the paper.