Chronic cocaine use is among the most difficult substance-use disorders to treat. High relapse rates are likely due to a combination of limbic and cognitive factors, including vulnerability to salient limbic cues and loss of executive control This may be due to elevated functional connectivity in limbic neural circuitry (e.g. between the medial prefrontal cortex (MPFC) and ventral striatum) and/or lower functional connectivity in executive control circuitry (e.g. between the dorsolateral prefrontal cortex (DLPFC) and dorsal striatum). The overarching goal of this longitudinal imaging study is to use the novel TMS/fMRI probe to determine the relationship between executive and limbic circuit integrity as it relates to immediate and extended outcomes after an intensive outpatient treatment program. This will be achieved by assessing functional connectivity in treatment-seeking cocaine users and non-drug using controls at baseline (Aim1) and the change in functional connectivity after a 28-day cognitive- behavioral treatment program (users only)(Aim 2). We will also determine the relationship between the integrity of these circuits and clinically meaningful outcome measures 60 days and 90 days after baseline (Aim 3). The fundamental neuroscience knowledge resulting from these aims regarding the importance of executive (e.g. DLPFC) and limbic (e.g. MPFC) circuit connectivity to addiction treatment outcomes. These data will provide a critical foundation from which the field can develop evidence-based brain stimulation treatment strategies (such as repetitive TMS) to amplify DLPFC connectivity among treatment-seeking individuals.

R01DA036617

2014-07-01

2021-05-31