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Patterns of Brain Activation During Craving in Heroin Dependents Successfully Treated by Methadone Maintenance and Abstinence-Based Treatments

Tabatabaei-Jafari, Hossein MD; Ekhtiari, Hamed MD; Ganjgahi, Habib MSc; Hassani-Abharian, Peyman MD, PhD; Oghabian, Mohammad-Ali PhD; Moradi, Afsaneh MA; Sadighi, Nahid MD; Zarei, Mojtaba MD, PhD

doi: 10.1097/ADM.0000000000000022
Original Research

Objective: Abstinence-based therapy (ABT) and methadone maintenance therapy (MMT) are common methods of treatment in heroin dependence as both suppress subjective feeling of drug craving. However, it is not clear whether the neural basis of craving suppression is similar in both types of treatments. In this study, we compared brain activation during pictorial presentation of heroin-related cues in ABT and MMT groups to understand the neural basis of drug craving in these groups.

Methods: Three groups of subjects (successful ABT and MMT clients and healthy control) underwent functional magnetic resonance imaging, while heroin-related cues and neutral cues were presented to them. In addition, subjective cue-elicited craving has been measured using drug drive questionnaire before and after imaging.

Result: Self-report of craving was not different between ABT and MMT groups before and after scanning. Anterior cingulate cortex and inferior frontal gyrus showed higher activations in ABT than in healthy control. Inferior frontal gyrus and superior temporal gyrus showed higher activity in ABT than in MMT. Lingual gyrus and cerebellum showed higher activity in MMT than in healthy control.

Conclusions: Heroin avoidance may be achieved by MMT or ABT; however, the neural mechanism underlying these therapeutic methods differs.

From the Neuroimaging and Analysis Group (HTJ, HE, HG, PHA, MAO, AM), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Neurocognitive Laboratory (HTJ, HE, HG, PHA, AM), Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran; Institute for Cognitive Sciences Studies (HE, PHA, MZ), Tehran, Iran; Interventional and Contemporary Radiology Research Center (MAO, NS), Tehran University of Medical Sciences, Tehran, Iran; and Department of Neurology (MZ), University of Nottingham, Nottingham, United Kingdom.

Send correspondence and reprint requests to Mohammad-Ali Oghabian, PhD, Neuroimaging and Analysis Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran. E-mail:

This study is funded by a grant by Tehran University of Medical Sciences.

The authors declare no conflicts of interest.

Received May 04, 2013

Accepted December 19, 2013

© 2014 American Society of Addiction Medicine