This article documents the unique brain responses
experienced by cocaine addicts to a variety of cues related to cocaine
use. This research adds to the growing evidence that addiction to
mind altering drugs is a brain disease.
of General Psychiatry
Drug Craving in Cocaine Addiction
D. Kilts, PhD; Julie B. Schweitzer, PhD; Colin K. Quinn, MD; Robin E.
Gross, BA; Tracy L. Faber, PhD; Faheemah Muhammad; Timothy D. Ely, BA;
John M. Hoffman, MD; Karen P. G. Drexler, MD
Background Crack cocaine dependence and addiction
is typically associated with frequent and intense drug wanting or
craving triggered by internal or environmental cues associated with past
Methods Water O 15 positron emission tomography
(PET) studies were used to localize alterations in synaptic activity
related to cue-induced drug craving in 8 crack cocaine–dependent
African American men. In a novel approach, script-guided imagery of
autobiographical memories were used as individualized cues to internally
generate a cocaine craving state and 2 control (ie, anger and neutral
episodic memory recall) states during PET image acquisition.
Results The mental imagery of personalized drug use
and anger-related scripts was associated with self-ratings of robust
drug craving or anger, and comparable alterations in heart rate.
Compared with the neutral imagery control condition, imagery-induced
drug craving was associated with bilateral (right hemisphere amygdala
activation greater than left) activation of the amygdala, the left
insula and anterior cingulate gyrus, and the right subcallosal gyrus and
nucleus accumbens area. Compared with the anger control condition,
internally generated drug craving was associated with bilateral
activation of the insula and subcallosal cortex, left hippocampus, and
anterior cingulate cortex and brainstem. A brain-wide pixel-by-pixel
search indicated significant positive and negative correlations between
imagery-induced cocaine craving and regional cerebral blood flow (rCBF)
in distributed sites.
Conclusions The collected findings suggest the
craving-related activation of a network of limbic, paralimbic, and
striatal brain regions, including structures involved in stimulus-reward
association (amygdala), incentive motivation (subcallosal gyrus/nucleus
accumbens), and anticipation (anterior cingulate cortex).
Arch Gen Psychiatry. 2001;58:334-341