Relapse rates as high as 60% have been reported among individuals who have been treated for substance use disorders.1 Particularly in the early stages of recovery from drug addiction, cravings induced by cues associated with the relevant drug represent a common relapse trigger. New findings by researchers from the departments of psychiatry and neuroscience at Icahn School of Medicine at Mount Sinai, New York, reveal a counterintuitive trajectory of such cravings at various points in early abstinence from cocaine addiction.2
The cross-sectional study, published in JAMA Psychiatry, included 76 individuals who had been abstinent for either 2 days, 1 week, 1 month, 6 months, or 1 year when the research began. The participants were initially assessed with the DSM-IV, the Addiction Severity Index, and other diagnostic measures, and their participation in the study spanned a period of roughly 5.5 years. The authors used the late positive potential (LPP) amplitudes from electroencephalography (EEG) as a marker of participants’ motivated attention to drug-related stimuli–in this case, photos of cocaine, or of people engaged in the preparation or use of the drug. The LPP has previously been found to predict drug-seeking behavior in cocaine abusers.3
Additionally, participants indicated their subjective ratings of cocaine “liking” and “wanting” before and after viewing the cocaine-related photos. The former measure reflects hedonic feelings about the drug, whereas the latter measure is designed to capture actual craving for the drug. Preclinical studies have discovered an inverted U-shaped pattern of craving over time, with an initial reduction followed by increases at later points in time, and then finally a steady decline. The authors hypothesized that a similar pattern would be observed in the present study.
The results support the authors’ hypothesis in showing a parabolic trajectory of incubated craving similar to those reported in preclinical studies. While no significant between-group differences were found for responses to non-drug pictures, the drug cues evoked mean (SD) LPPs that were higher at the 1-month (1.26 [1.36] µV) and 6-month (1.17 [1.19] µV) points of abstinence, and lower at the 2-day (0.17 [1.09] µV), 1-week (0.36 [1.26] µV), and 1-year (–0.27 [1.74] µV) points (P = .02, partial η2 = 0.16). However, the subjective cravings followed a linear reduction from baseline as the duration of abstinence increased.
Though further studies should build on these observations, the findings “highlight 1 month and 6 months of abstinence as the period during which abstaining individuals addicted to controlled substances may be most vulnerable to, and perhaps least cognizant of the risk of relapse,” the authors noted. These results “could help guide the implementation of alternative individually tailored and optimally timed intervention, prevention, and treatment strategies,” they concluded.
1. National Institutes of Health: National Institute on Drug Abuse. Drugs, brains, and behavior: the science of addiction. Retrieved 9/15/16 from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
2. Parvaz MA, Moeller SJ, Goldstein RZ. Incubation of cue-induced craving in adults addicted to cocaine measured by electroencephalography. JAMA Psychiatry. 2016; doi:10.1001/jamapsychiatry.2016.2181.
3. Moeller SJ, Hajcak G, Parvaz MA, Dunning JP, Volkow ND, Goldstein RZ. Psychophysiological prediction of choice: relevance to insight and drug addiction. Brain. 2012; 135(pt11):3481-3494.