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Brain Networks Underlying Vulnerability and Resilience to Drug Addiction

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Brain Networks Underlying Vulnerability and Resilience to Drug Addiction Brain networks underlying vulnerability and resilience to drug addiction Karen D. Erschea,b,1,2, Chun Menga,b,1,2, Hisham Ziauddeena,c, Jan Stochla,d, Guy B. Williamse, Edward T. Bullmorea,b,c, and Trevor W. Robbinsb,f aDepartment of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom; bBehavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom; cCambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge CB21 5EF, United Kingdom; dDepartment of Kinanthropology and Humanities, Charles University, 16252 Prague, Czech Republic; eDepartment of Clinical Neurosciences, University of Cambridge, Cambridge CB2 3EB, United Kingdom; and fDepartment of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom Edited by Joseph E. LeDoux, New York University, New York, NY, and approved May 8, 2020 (received for review February 11, 2020) Regular drug use can lead to addiction, but not everyone who Much of the neuroscientific research on resilience has been ex- takes drugs makes this transition. How exactly drugs of abuse amined in adolescence (10), which is a period of heightened interact with individual vulnerability is not fully understood, nor is vulnerability and neural plasticity (11). While studies of adoles- it clear how individuals defy the risks associated with drugs or cents are important to inform the development and imple- addiction vulnerability. We used resting-state functional MRI mentation of preventative strategies, we also need to understand (fMRI) in 162 participants to characterize risk- and resilience- how resilience operates in vulnerable adults as the compensatory related changes in corticostriatal functional circuits in individuals mechanisms that have been characterized in adolescents do not exposed to stimulant drugs both with and without clinically di- necessarily translate into adulthood. For example, the cognitive agnosed drug addiction, siblings of addicted individuals, and con- deficits frequently measured in adolescents with a family history trol volunteers. The likelihood of developing addiction, whether of addiction (12, 13) are not seen in adults with familial risk (14, due to familial vulnerability or drug use, was associated with sig- 15), which may suggest that adults manage to counteract their nificant hypoconnectivity in orbitofrontal and ventromedial pre- vulnerabilities more effectively than adolescents by recruiting frontal cortical-striatal circuits—pathways critically implicated in compensatory brain systems (16–18). Understanding how po- goal-directed decision-making. By contrast, resilience against a di- tentially vulnerable adults defy the risk of addiction may inform NEUROSCIENCE agnosis of substance use disorder was associated with hypercon- the development of more effective treatment strategies for in- nectivity in two networks involving 1) the lateral prefrontal cortex dividuals affected by the disorder. and medial caudate nucleus and 2) the supplementary motor area, A more compelling illustration of resilience to drug addiction superior medial frontal cortex, and putamen—brain circuits re- is demonstrated by individuals who regularly use highly addictive spectively implicated in top-down inhibitory control and the reg- ulation of habits. These findings point toward a predisposing Significance vulnerability in the causation of addiction, related to impaired goal-directed actions, as well as countervailing resilience systems Resting-state functional connectivity provides novel insight implicated in behavioral regulation, and may inform novel strate- into variations in neural networks associated with addiction to gies for therapeutic and preventative interventions. stimulant drugs in individuals with and without a family his- tory of addiction, and both with and without personal drug functional connectivity | cocaine | vulnerability | resilience | fMRI use. An increased risk for addiction, either because of drug use or genetic/psychosocial vulnerability, is associated with hypo- he use of addictive drugs is a growing global public health connectivity in frontostriatal networks, which may weaken Tproblem. Drug addiction develops with persistent drug use, goal-directed decision-making. Resilience against addiction and individuals who are vulnerable to developing addiction may development, by contrast, is characterized by hyperconnectivity do so as quickly as within their first year of use (1). Improving in two corticostriatal pathways, possibly reflecting compensa- our understanding of the brain systems that are implicated in tory responses in networks associated with regulatory control resilience to developing addiction, or “substance use disorder” over habitual behaviors. It is thus conceivable that defying the according to the Diagnostic and Statistical Manual DSM-5 (2), risk of developing stimulant drug addiction requires increased would offer new opportunities for its prevention and treatment, efforts to control behavior—a hypothesis that may open up new particularly in young people at risk for addiction. pathways for therapeutic and preventative strategies. Over the past decade, a large body of work has elucidated how addictive drugs affect brain function, specifically that of different Author contributions: K.D.E., E.T.B., and T.W.R. designed research; K.D.E. performed re- striatal subsystems that have been critically implicated in the search; C.M., J.S., and G.B.W. analyzed data and described the procedures; and K.D.E., development of addictive behavior (3). Importantly, not every- H.Z., and T.W.R. wrote the paper with help from E.T.B. one who uses drugs, even highly addictive drugs such as am- Competing interest statement: T.W.R. discloses consultancy with Cambridge Cognition, phetamines or cocaine, makes the transition to addiction (1). A Greenfield Bioventures, and Unilever; he receives royalties for the Cambridge Neuropsy- chological Test Automated Battery from Cambridge Cognition and editorial honoraria family history of drug addiction has been shown to confer an from Springer Verlag and Elsevier. eightfold increased risk of developing addiction (4), and this This article is a PNAS Direct Submission. likely relates to a combination of genetic (5) and environmental This open access article is distributed under Creative Commons Attribution License 4.0 (6) risk factors. However, relatively little is known about factors (CC BY). that protect people from developing addiction: i.e., confer Data deposition: All data described in this paper (demographics, fMRI), including any resilience. The term “resilience” refers to protective factors that accession codes, unique identifiers, or web links have been deposited in the University help individuals to successfully cope with or overcome exposure of Cambridge’s institutional repository, Apollo (https://doi.org/10.17863/CAM.53188). to significant risk, adversity, or potentially harmful environments 1K.D.E. and C.M. contributed equally to this work. (7). These factors may include personality traits and attitudes, 2To whom correspondence may be addressed. Email: [email protected] or [email protected]. supportive environments (8), and neural systems that are more uk. robust to, or able to compensate for, adverse exposures (9). www.pnas.org/cgi/doi/10.1073/pnas.2002509117 PNAS Latest Articles | 1of9 Downloaded by guest on September 24, 2021 drugs like cocaine but do not succumb to addiction and maintain Results successful lives (19). These individuals have been described as Group characteristics are shown in Table 1. Three of the six highly intelligent (20), well-educated, affluent, and socially well- striatal seed regions, the ventromedial caudate (vmCAU), ven- integrated (21). They use drugs in a manner that avoids conflict trolateral putamen (vlPUT), and posterior/dorsolateral putamen with their private and professional commitments (21). These (pdlPUT) revealed significant group differences in resting-state recreational users are less visible and thus less well-studied than functional connectivity (RSFC) within distinct anatomical path- their addicted counterparts, who already have a diagnosis of ways (Table 2). The topographies of the identified networks are substance use disorder and are generally recruited through re- consistent with prior work by DiMartino et al. (30) and the ferrals from treatment services. The available evidence, however, widely described corticostriatal circuitries (31) (Fig. 1). indicates that the recreational users function at a comparable level to control participants by recruiting compensatory brain Vulnerability-Related Functional Dysconnectivity. Familial risk of systems, which appears to buffer the impact of their drug use (22, addiction was associated with significantly reduced functional 23). It is thus conceivable that this ability to recruit compensa- connectivity in frontostriatal pathways between the vmCAU seed tory brain systems represents a resilience factor to developing with the rostral anterior cingulate cortex (rACC), medial, though drug addiction. However, to date, very little is known about the mainly lateral, OFC, and medial prefrontal cortex (mPFC). These mechanisms by which drugs of abuse interact with addiction connections survived cluster-level correction (within the whole brain) and (for extracted scores) post hoc statistical correction vulnerability. β = − = Alteration of dopamine signaling in the basal ganglia is using a mixed-effect model ( 0.189, P 0.045). As
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