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Multifaceted impairments in impulsivity and brain structural abnormalities in opioid dependence and abstinence

Published online by Cambridge University Press:  25 July 2016

S. Tolomeo ,
S. Gray ,
K. Matthews ,
J. D. Steele  and
A. Baldacchino
S. Tolomeo
Affiliation:
School of Medicine (Neuroscience), Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
S. Gray
Affiliation:
NHS Fife Research and Development Department, Queen Margaret Hospital, Dunfermline, UK
K. Matthews
Affiliation:
School of Medicine (Neuroscience), Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
J. D. Steele
Affiliation:
School of Medicine (Neuroscience), Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
A. Baldacchino*
Affiliation:
School of Medicine (Neuroscience), Ninewells Hospital and Medical School, University of Dundee, Dundee, UK St Andrews University, School of Medicine, St Andrews, UK
*
*Address for correspondence: A. Baldacchino, School of Medicine, Medical and Biological Science, North Haugh, St Andrews University, St Andrews, KY16 9TF, UK. (Email: amb30@st-andrews.ac.uk)
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Abstract

Background

Chronic opioid exposure, as a treatment for a variety of disorders or as drug of misuse, is common worldwide, but behavioural and brain abnormalities remain under-investigated. Only a small percentage of patients who receive methadone maintenance treatment (MMT) for previous heroin misuse eventually achieve abstinence and studies on such patients are rare.

Method

The Cambridge Neuropsychological Test Automated Battery and T1 weighted magnetic resonance imaging (MRI) were used to study a cohort of 122 male individuals: a clinically stable opioid-dependent patient group receiving MMT (n = 48), an abstinent previously MMT maintained group (ABS) (n = 24) and healthy controls (n = 50).

Results

Stable MMT participants deliberated longer and placed higher bets earlier in the Cambridge Gambling Task (CGT) and showed impaired strategic planning compared with healthy controls. In contrast, ABS participants showed impairment in choosing the least likely outcome, delay aversion and risk adjustment on the CGT, and exhibited non-planning impulsivity compared with controls. MMT patients had widespread grey matter reductions in the orbitomedial prefrontal cortex, caudate, putamen and globus pallidus. In contrast, ABS participants showed midbrain–thalamic grey matter reductions. A higher methadone dose at the time of scanning was associated with a smaller globus pallidus in the MMT group.

Conclusions

Our findings support an interpretation of heightened impulsivity in patients receiving MMT. Widespread structural brain abnormalities in the MMT group and reduced brain structural abnormality with abstinence suggest benefit of cessation of methadone intake. We suggest that a longitudinal study is required to determine whether abstinence improves abnormalities, or patients who achieve abstinence have reduced abnormalities before methadone cessation.

Keywords

Abstinenceimpulsivityopioid dependencestructural magnetic resonance imaging.
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 13 , October 2016 , pp. 2841 - 2853
Copyright
Copyright © Cambridge University Press 2016 

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