The neural correlates of cue-induced craving in cocaine-dependent women.
OBJECTIVE
Drug use reminders are associated with localized changes in brain activity related to intense drug wanting or craving in cocaine-dependent men. While cocaine dependence is prevalent and disabling in women, and certain clinically relevant sex differences exist, there is an absence of knowledge related to the neural correlates of cocaine craving in cocaine-dependent women.


METHODS
The differential neural response to imagery depicting cocaine use and neutral imagery was defined by using [15O]H2O positron emission tomography (PET) imaging in eight cocaine-dependent women. Results were compared with a matched group of eight cocaine-dependent men.


RESULTS
Cocaine-related imagery was associated with relative increases in cocaine craving and increases in regional cerebral blood flow in the superior temporal gyrus, dorsal anterior and posterior cingulate cortex, nucleus accumbens area, and the central sulcus. Compared with the results of an identical PET study in matched cocaine-dependent men, conditioned cocaine craving in women was associated with less activation of the amygdala, insula, orbitofrontal cortex, and ventral cingulate cortex and greater activation of the central sulcus and widely distributed frontal cortical areas.


CONCLUSIONS
These findings suggest the presence of sex differences in the functional anatomy of cue-induced cocaine craving associated with drug dependence. Such differences may reflect sex differences in conditioned associations to cocaine use, in affective and other corollaries of cocaine craving, or in their volitional regulation and may underlie apparent sex differences in the effects of cocaine abstinence and the expectations of treatment outcome. Some support for the need for sex-specific strategies for treatment of cocaine dependence is also furnished by the findings of this study.
Kilts
Clinton D
CD
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA. sdpcdk@emory.edu
Gross
Robin E
RE
Ely
Timothy D
TD
Drexler
Karen P G
KP
D000328:Adult; D000679:Amygdala / Q000098:blood supply / Q000378:metabolism; D001921:Brain / Q000098:blood supply* / Q000378:metabolism* / Q000473:pathology; D002540:Cerebral Cortex / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D019970:Cocaine-Related Disorders / Q000209:etiology* / Q000523:psychology*; D003463:Cues; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006179:Gyrus Cinguli / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007092:Imagination; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation; D017397:Prefrontal Cortex / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D014055:Tomography, Emission-Computed