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Neuroimaging in Addiction

edited by Bryon Adinoff, , M.D., and Elliot A. Stein , Ph.D. West Sussex, United Kingdom, Wiley-Blackwell, 2011, 372 pp., $165.50.

Reviewed by Joseph T. Sakai, M.D.
Am J Psychiatry 2013;170:344-345. doi:10.1176/appi.ajp.2013.13010009
View Author and Article Information

Dr. Sakai has received reimbursement for completing a policy review for the WellPoint Office of Medical Policy and Technology Assessment, WellPoint, Inc., Thousand Oaks, Calif. He also serves as a board member of the ARTS Foundation and is supported by National Institute on Drug Abuse grants R01DA031761, P60DA011015, and R01DA029258 and the Kane Family Foundation.

Aurora, Colo.
Dr. Sakai is Associate Professor, Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colo.

Accepted January , 2013.

Over the past few decades, a growing number of tools and methods have become broadly available to study the workings of the human brain in vivo. Subsequent to these methodological advances, researchers have made strides toward better describing and understanding the biological underpinnings of numerous disorders, including addiction. While many questions remain, Neuroimaging in Addiction represents a well-organized and well-written review of progress to date in the field. The text, written by eminent researchers working at the intersection of neuroimaging and substance use disorders research, includes descriptions of the current literature of this specialized field at a level of detail not found in comprehensive general psychiatry or addiction treatment texts.

While the text clearly recognizes and reviews substance-specific research (e.g., opioids and cannabinoids specifically), overall the text discusses the neural circuitry of addiction in general terms and even includes a chapter on “behavioral addictions,” such as pathological gambling, near the end. Given that different substance use disorders may cluster within individuals (1) and some early risk factors may predispose individuals generally to substance dependence (2, 3), a focus on neural circuitry common across substance use disorder diagnoses appears to have some merit. In addition, the text carefully presents information about how drugs of abuse affect brain structure and function, while also presenting information about what brain differences pre-exist and may predispose individuals to a substance abuse trajectory.

The field of addiction research has several methodological strengths, and two are highlighted in early chapters of the text. First, while development of animal models for many psychiatric illnesses may present hurdles, in the field of addictions, there are very strong animal models of compulsive drug taking. Chapter 2, drawing on that animal literature, along with human studies, provides a conceptual framework for understanding what brain processes may be critical for transitioning to compulsive out-of-control drug use. Second, in addiction research, the effects of drugs can be directly studied through drug administration. Chapter 4 reviews neuroimaging work on administration of psychostimulants, alcohol, cannabinoids, and opioids.

Subsequent chapters review work on reward processing, craving, impulsivity, cognitive function, and stress, areas covered in influential models of addiction (4, 5). These middle chapters of the text highlight both the complexity of brain systems involved in addiction and the multiple critical roles played by some brain regions; for example, these chapters show the critical importance of prefrontal cortical regions in decision making, impulse control, and cognitive control of emotional dysregulation and stress.

The book concludes with two chapters focused on future hopes for the field of neuroimaging in addiction. The first discusses the intersection of genetics and imaging and reviews some early studies, while also outlining potential obstacles. The final chapter of the text, titled “the Diagnostic and Therapeutic Potential of Neuroimaging in Addiction Medicine,” highlights one of the main future goals for the field. As outlined in chapter 1, while the advances in neuroimaging methodologies have been rapid, they have sprinted ahead of the clinical application in addictions treatment, and early hopes that imaging would quickly have a major effect on addiction medicine have gone, as yet, unrealized. The field, therefore, continues to rely on “descriptive, symptomatic checklist criteria” for diagnosis. In the final chapter of the text, the authors outline early research showing some utility of imaging procedures in predicting prognosis and discuss the hope that imaging techniques may one day be brought to the bedside in addiction treatment, allowing clinicians to predict risk for development of later substance dependence problems, to more accurately and objectively diagnose, to select individualized treatments, to monitor treatment progress, or perhaps even to conduct neurofeedback. Despite the promise of addiction research and progress in understanding the neurobiology of addiction, this is not a treatment text. This underscores the progress still needed in the field.

The text appears to be best suited for those conducting research in the field but includes an early chapter on functional and structural imaging procedures, which is widely valuable and makes the subsequent material more accessible to those without an imaging background. While it is inevitable that a text written by multiple authors will have some between-chapter overlap, the editors should be commended for minimizing such problems in this text. Although each chapter stands on its own as an outstanding review of the area of interest, the text still hangs together as a comprehensive well-organized work. In summary, Neuroimaging in Addictions is a timely, well-organized, thorough review of the important progress at the intersection of neuroimaging and addiction research.

Stinson  FS;  Grant  BF;  Dawson  DA;  Ruan  WJ;  Huang  B;  Saha  T:  Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Drug Alcohol Depend 2005; 80:105–116
[CrossRef] | [PubMed]
 
Moffitt  TE;  Arseneault  L;  Belsky  D;  Dickson  N;  Hancox  RJ;  Harrington  H;  Houts  R;  Poulton  R;  Roberts  BW;  Ross  S;  Sears  MR;  Thomson  WM;  Caspi  A:  A gradient of childhood self-control predicts health, wealth, and public safety.  Proc Natl Acad Sci USA 2011; 108:2693–2698
[CrossRef] | [PubMed]
 
Tarter  RE;  Kirisci  L;  Mezzich  A;  Cornelius  JR;  Pajer  K;  Vanyukov  M;  Gardner  W;  Blackson  T;  Clark  D:  Neurobehavioral disinhibition in childhood predicts early age at onset of substance use disorder.  Am J Psychiatry 2003; 160:1078–1085
[CrossRef] | [PubMed]
 
Volkow  ND;  Wang  GJ;  Fowler  JS;  Tomasi  D:  Addiction circuitry in the human brain.  Annu Rev Pharmacol Toxicol 2012; 52:321–336
[CrossRef] | [PubMed]
 
Goldstein  RZ;  Volkow  ND:  Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications.  Nat Rev Neurosci 2011; 12:652–669
[CrossRef] | [PubMed]
 
References Container
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References

Stinson  FS;  Grant  BF;  Dawson  DA;  Ruan  WJ;  Huang  B;  Saha  T:  Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Drug Alcohol Depend 2005; 80:105–116
[CrossRef] | [PubMed]
 
Moffitt  TE;  Arseneault  L;  Belsky  D;  Dickson  N;  Hancox  RJ;  Harrington  H;  Houts  R;  Poulton  R;  Roberts  BW;  Ross  S;  Sears  MR;  Thomson  WM;  Caspi  A:  A gradient of childhood self-control predicts health, wealth, and public safety.  Proc Natl Acad Sci USA 2011; 108:2693–2698
[CrossRef] | [PubMed]
 
Tarter  RE;  Kirisci  L;  Mezzich  A;  Cornelius  JR;  Pajer  K;  Vanyukov  M;  Gardner  W;  Blackson  T;  Clark  D:  Neurobehavioral disinhibition in childhood predicts early age at onset of substance use disorder.  Am J Psychiatry 2003; 160:1078–1085
[CrossRef] | [PubMed]
 
Volkow  ND;  Wang  GJ;  Fowler  JS;  Tomasi  D:  Addiction circuitry in the human brain.  Annu Rev Pharmacol Toxicol 2012; 52:321–336
[CrossRef] | [PubMed]
 
Goldstein  RZ;  Volkow  ND:  Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications.  Nat Rev Neurosci 2011; 12:652–669
[CrossRef] | [PubMed]
 
References Container
+
+

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