…investigators recruited 17 men and women who were participating in a trial of an antidepressant—sertraline—that is being evaluated as a possible treatment for cocaine addiction. The participants reported abusing cocaine 20 days, on average, during the month before the study. All met standard clinical criteria for cocaine addiction and had abused the drug for 6 years, on average. Most were new to treatment.
After being cocaine-free for 5 days, on average, each participant underwent functional magnetic resonance imaging (fMRI) while watching two 4-minute videotapes. The first minute of each tape reported on vegetable prices, and the participants’ brain activity while hearing this emotionally neutral information served as a baseline for comparison. During the last 3 minutes, an actor pretended to smoke cocaine and experience a “rush.” Immediately after viewing the tapes, each participant rated peak cocaine craving intensity on a scale from 0 to 10. After the imaging session, participants began taking either sertraline or a placebo daily and completed 2 weeks of residential treatment. During the 10-week outpatient phase of the trial, they were to continue their medication regimen, receive weekly individual cognitive-behavioral therapy, and submit urine samples three times a week.
Nine of the 17 participants relapsed, defined by the investigators as submitting fewer than 15 of a possible 30 cocaine-free samples during the study and not completing outpatient treatment. Participants taking sertraline were just as likely as those taking the placebo to relapse. Relapsers and nonrelapsers reported cue-induced cravings of comparable intensity. The two groups differed, however, on brain activation during the first 30 seconds of the cocaine-cue videotapes. Relapsers showed greater cue-induced activation than nonrelapsers in several areas of the cortex: the left precentral (movement control), right superior temporal (auditory processing), right lingual and right inferior occipital (visual processing), and the left posterior cingulate cortices. The cingulate cortex is integral to attention, response inhibition, emotional regulation, and decisionmaking.
The definition of relapse inspires a lot of confidence, no?