Changes in Addictive Behaviors After Brain Lesions

脑损伤后成瘾行为的变化

• 批准号: 8099033
• 负责人: ANTOINE BECHARA
• 金额: $ 46.55万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8099033
• 关键词: Addictive Behavior; Address; Adverse effects; Amygdaloid structure; Anterior; Area; Attention; Automobile Driving; Award; Basic Science; Behavior; Behavioral; Biological Neural Networks; Brain; Brain Injuries; Brain region; Cereals; Cognitive; Corpus striatum structure; Cues; Databases; Decision Making; Drug Addiction; Emotional; Emotions; Exploratory/Developmental Grant for Diagnostic Cancer Imaging; Functional Imaging; Funding; Gender; Goals; Habits; Handedness; Health; Human; Impairment; Individual; Insula of Reil; Iowa; Laboratories; Lead; Left; Lesion; Life; Light; Link; Literature; Location; Maintenance; Maps; Methods; Monitor; Motivation; Neurologic; Neurology; Nicotine; Nicotine Dependence; Patients; Pharmaceutical Preparations; Play; Prefrontal Cortex; Process; Prospective Studies; Relapse; Research; Retrospective Studies; Right-On; Role; Sample Size; Sampling; Sex Characteristics; Side; Smoke; Smoker; Smoking; Smoking Behavior; Stroke; Structure; Techniques; Therapeutic; Time; Universities; Ventral Striatum; Withdrawal; Woman; Work; addiction; cigarette smoking; cingulate cortex; clinically significant; cognitive function; drug craving; effective therapy; experience; follow-up; interest; men; neural circuit; novel strategies; novel therapeutic intervention; patient registry; prospective; psychologic; smoking cessation; social

DESCRIPTION (provided by applicant): A network of neural structures crucial for the cognitive and behavioral processes of drug addiction, including nicotine, includes the orbitofrontal cortex, anterior cingulate, insular cortices, the amygdala, and the striatum. However, no work has addressed how damage to different components of this neural network in humans may impact the maintenance of addiction to drugs. Under the tenure of an R21 awarded through CEBRA (Cutting- Edge Basic Research Awards), we began addressing this important issue in patients addicted to cigarette smoking and who had suffered a stroke that included any of these areas. It was found that although lesions of the ventromedial prefrontal cortex (VMPFC) were associated with a marked impairment of cue-induced urge in the laboratory, they were not associated with an increased likelihood of quitting smoking. In fact, lesions of the insular cortex were associated with an ability to quit smoking easily, immediately, without relapses and without a lasting urge to smoke. Although preliminary, these results suggest that, while VMPFC lesions may disrupt cue-induced urges, they do not disrupt smoking addiction. However, the insula, which also plays a key role in urges, seems most critical for maintaining smoking addiction and driving smoking behavior. The results also suggest that the insula functions in psychological processes that may contribute to the difficulty of quitting smoking. Encouraged by these intriguing, but preliminary, results, our primary aims are to (1) expand and confirm these findings in a larger sample, using more precise anatomical analyses to characterize the size and placement of lesions; (2) examine whether there are gender differences in terms of the ease to quit smoking after a lesion; and (3) conduct prospective studies on smokers who suffer strokes and monitor their smoking behavior for several years after the lesion onset. The proposed research is a beginning of a novel approach with potential for developing more effective therapies for breaking the vicious cycle of addiction. Specifically, one therapeutic approach called up by the proposed research would be to directly modulate the function of the insula. PUBLIC HEALTH RELEVANCE: A prune-sized region deep in the brain called the insula is intimately involved in smoking addiction, and damage to this structure can completely erase the body's urge to smoke. Obviously brain damage is not a treatment option for nicotine addiction, but if confirmed, these results may offer leads for therapies to help smokers kick the habit, or for monitoring smokers' progress while using existing therapies.

描述（由申请人提供）：对包括尼古丁在内的药物成瘾的认知和行为过程至关重要的神经结构网络，包括眶额皮质、前扣带回、岛叶皮质、杏仁核和纹状体。然而，目前还没有研究表明人类神经网络不同组成部分的损伤可能如何影响药物成瘾的维持。在 CEBRA（尖端基础研究奖）授予的 R21 任期内，我们开始解决吸烟成瘾和患有包括这些领域的中风的患者的这一重要问题。研究发现，尽管腹内侧前额叶皮层（VMPFC）的损伤与实验室中提示诱发的冲动的明显损害有关，但它们与戒烟可能性的增加无关。事实上，岛叶皮质的损伤与轻松、立即戒烟、不复吸且不产生持久吸烟冲动的能力有关。尽管是初步的，但这些结果表明，虽然 VMPFC 损伤可能会破坏提示诱发的冲动，但它们不会破坏吸烟成瘾。然而，在冲动中也发挥关键作用的脑岛似乎对于维持吸烟成瘾和驱动吸烟行为最为关键。研究结果还表明，岛叶在心理过程中的功能可能导致戒烟困难。受到这些有趣但初步结果的鼓舞，我们的主要目标是（1）在更大的样本中扩展并确认这些发现，使用更精确的解剖分析来表征病变的大小和位置； (2)考察病变后戒烟难易程度是否存在性别差异； (3) 对患有中风的吸烟者进行前瞻性研究，并在发病后数年内监测他们的吸烟行为。这项拟议的研究是一种新方法的开始，有可能开发出更有效的疗法来打破成瘾的恶性循环。具体来说，拟议研究提出的一种治疗方法是直接调节岛叶的功能。公共健康相关性：大脑深处一个李子大小的区域，称为岛叶，与吸烟成瘾密切相关，对该结构的损坏可以完全消除身体吸烟的冲动。显然，脑损伤不是尼古丁成瘾的治疗选择，但如果得到证实，这些结果可能会为帮助吸烟者戒除烟瘾的疗法提供线索，或者在使用现有疗法时监测吸烟者的进展。