Timing of Cocaine Relapse Pinpointed

Megan Brooks

September 08, 2016

Cocaine addicts are most vulnerable to relapse between 1 and 6 months after abstinence, a time frame that coincides with the window of discharge from most addiction treatment programs.

"Results of this study are alarming in that they suggest that many people struggling with drug addiction are being released from treatment programs at the time they need the most support," principal investigator Rita Goldstein, PhD, Icahn School of Medicine at Mt. Sinai in New York City, said in a statement.

"Our results could help guide the implementation of alternative, individually tailored and optimally timed intervention, prevention, and treatment strategies," she added.

The study was published online September 7 in JAMA Psychiatry.

"Clinically Crucial" Results

The researchers studied 76 adults addicted to cocaine who had experienced periods of abstinence of varying duration: 19 had been abstinent for 2 days, 20 for 1 week, 15 for 1 month, 12 for 6 months, and 10 for 1 year.

The researchers recorded the late positive potential (LPP) component of electroencephalography (EEG) while the participants looked at different types of pictures, including pictures that depicted cocaine and individuals preparing, using, and simulating use of cocaine.

The LLP is "an objective and temporally precise marker" of cue-induced craving, they explain in their article. Participants self-rated their level of craving at baseline using the Cocaine Craving Questionnaire. Immediately after EEG, they rated on a Likert scale their level of cocaine wanting and liking with respect to the different cocaine-related pictures.

The results show that craving initially increased from 2 days to 1 week of cocaine abstinence and peaked at 1 month to 6 months before declining by 1 year of abstinence.

"It's really a U-shaped trajectory that we see in these data, and these results actually replicate really well findings from animal models," lead author Muhammad Parvaz, PhD, told Medscape Medical News.

In contrast, subjective measures of cue-induced craving (ie, ratings for cue-induced liking and wanting) showed a gradual decrease with increasing duration of abstinence.

This suggests that subjective measures of craving, "which are used clinically to assess treatment outcome, may not be comprehensively assessing objectively quantified cue reactivity," the researchers write.

The results, they add, are also "clinically crucial as they highlight an abstinence period (ie, 1-6 months) during which individuals addicted to controlled substances may be most vulnerable to relapse and may benefit most from a targeted intervention, thereby providing clinicians with better treatment planning. This period of vulnerability may occur without conscious awareness, and may perhaps be associated with reduced vigilance of one's heightened reactivity to drug cues, which may contribute to relapse."

Craving Remains High

Authors of an accompanying editorial note that this human translational study provides empirical support for a hypothesis regarding the time course of cue-induced craving for cocaine, namely, that cue-induced cocaine craving increases progressively during early abstinence and remains high during extended periods.

The study also "introduces the late LPP component of EEG as a measure of the time course of drug cue reactivity and craving in humans and supports the translational utility of the rodent model of incubation of drug craving," write Yavin Shaham, PhD, of the National Institute on Drug Abuse, Baltimore, Maryland, and colleagues.

The data, they add, "have important implications for the duration of treatments for relapse prevention and for the time course of vulnerability to cocaine relapse."

The study was supported by multiple grants from the National Institute on Drug Abuse. The authors have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online September 7, 2016. Abstract, Editorial

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