Engaging Interdisciplinary Partners to Examine Treatment Participation and Change In Neural Activation: Results from an fMRI Clinical Trial for Substance-Dependent Adults
The substance abuse literature consistently shows that negative emotional states and subjective stress are highly predictive of relapse and significantly influence behavioral motivation. Cognitive control resources have been shown to exert minimal impact on behavioral decision-making in the presence of intense affective material. Taken together, the current literature strongly suggests that verbal-based therapies may have limited utility as a singular form of treatment in early recovery; instead, treatment methods need to include a range of learning approaches that allow for visual-sensory processing, in addition to traditional verbal-based processing.
Aim 1: To examine cue reactivity in drug-dependent adults who participate in outpatient treatment. We hypothesized BOLD signal decrease in amygdaloid region and increase in orbitofrontal cortex at post-treatment scan.
Aim 2: To examine response inhibition and cognitive control ability. We hypothesized BOLD signal increase in the anterior cingulate cortex (structure implicated in drug cue attention) and increase in the medial prefrontal cortex at post-treament scan.
A randomized clinical trial was conducted in partnership with Inova Fairfax Hospital’s Comprehensive Addiction Treatment Services program and Georgetown University’s Center for Functional and Molecular Imaging. Our treatment protocol, which includes treatment manual, training protocol, competency and fidelity measures, is a 10-week, 20-session intervention that combines a visual processing (structured drawing activities) and a verbal processing component (structured CBT) (total sample N=29). We used E-Prime software to present visual stimuli (drug stressor and neutral cues) to clients in the scanner before and after 10-week treatment participation. Clients were randomly prompted to “watch” or “use what you know to reduce your discomfort” for each drug stressor image. After each image, clients rated the valence, negativity, and arousal level of each photo, using a joy-stick.
We examined passive negative > reappraisal condition at both pre-treatment and post-treatment scans. Results showed cognitive control regions, specifically the anterior cingulate cortex and orbitofrontal cortex were activated (p<.05) at post-treatment, but not pre-treatment, when passively viewing a drug stressor image. Results suggest that after participation in treatment, there was some differential brain activation that favored increased cognitive control capacity in the presence of stressful drug cue imagery, when there was no explicit cognitive prompt to prime effortful control. A significant treatment goal is to facilitate "reorganization" of implicit reactivity processes in ways that diminish their influence on behavior (e.g., decrease the risk of urges leading to relapse), and that the ACC and orbitofrontal cortex were activated in the passive watch condition at post-treatment, but not pre-treatment, suggests a promising direction in treatment gains.
Understanding the ways in which psychosocial interventions act on brain structures to change behavioral response is deeply relevant to our person-in-environment perspective; thus, social workers should be interested in new developments that may advance social work practice. fMRI technology can enhance our understanding of how participation in treatment programs restore brain region capacity and strengthen neural pathways that impact recovery trajectories. Such discoveries could have a transformative influence on community-based service delivery systems by improving behavioral health treatments for substance abuse populations.