Treatments & prevention 

One in four people entering treatment for cocaine addiction will still be using on a weekly basis 5 years after treatment (Simpson et al., 2002). The obvious question would be why the majority of abstainers show protracted resistance to relapse while a significant minority will continue to be at high risks of recidivism after long periods of time. Furthermore, how do we identify those individuals most likely to relapse, in order to give them additional or even a different course of treatment?

To address this issue, Bell et al., 2014 used functional magnetic resonance imaging to examine brain regions associated with inhibitory control –cortical response inhibition circuit (RIC)- and compulsivity associated with drug seeking (such as the ventral and dorsal striatum) in abstinent cocaine dependent (CD) individuals and non-using control. While no significant differences were found between groups regarding activation, at the individual participant level, abstinent CD individuals displayed an association between cocaine cue-related neural activations in the right ventral striatum and compulsive cocaine craving scores. Furthermore, CD individuals also showed a positive association between motor impulsiveness and neural activations in regions within the RIC. 

In conclusion, while former users as a group did not shown deficits in inhibitory function or cocaine-cue reactivity, participant-level results pointed to activation patterns in a minority of these individuals that likely contributes to enduring relapse vulnerability  (Bell et al., 2014). These findings might shed light on a potential relapse phenotype and contribute to the identification of “high-probability” relapse individuals.

References:

Bell RP, Garavan H & Foxe JJ (2014). Neural correlates of craving and impulsivity in abstinent former cocaine users: towards biomarkers of relapse risk. Neuropharmachology, 2014, 85:461-470.

Simpson DD, Joe GW, Broome KM. (2002). A national 5-year follow-up of treatment outcomes for cocaine dependence. Arch. Gen. Psychiatry 59, 538-544.