Correlation of stable elevations in striatal mu-opioid receptor availability in detoxified alcoholic patients with alcohol craving: a positron emission tomography study using carbon 11-labeled carfentanil.
BACKGROUND
The pleasant effects of food and alcohol intake are partially mediated by mu-opiate receptors in the ventral striatum, a central area of the brain reward system. Blockade of mu-opiate receptors with naltrexone reduces the relapse risk among some but not all alcoholic individuals.


OBJECTIVE
To test the hypothesis that alcohol craving is pronounced among alcoholic individuals with a high availability of mu-opiate receptors in the brain reward system.


METHODS
Patients and comparison sample. The availability of central mu-opiate receptors was measured in vivo with positron emission tomography (PET) and the radioligand carbon 11-labeled carfentanil in the ventral striatum and compared with the severity of alcohol craving as assessed by the Obsessive Compulsive Drinking Scale (OCDS).


METHODS
Hospitalized care.


METHODS
Volunteer sample of 25 male alcohol-dependent inpatients assessed after detoxification of whom 12 underwent PET again 5 weeks later. Control group of 10 healthy men.


METHODS
After 1 to 3 weeks of abstinence, the availability of mu-opiate receptors in the ventral striatum, including the nucleus accumbens, was significantly elevated in alcoholic patients compared with healthy controls and remained elevated when 12 alcoholic patients had these levels measured 5 weeks later (P<.05 corrected for multiple testing). Higher availability of mu-opiate receptors in this brain area correlated significantly with the intensity of alcohol craving as assessed by the OCDS.


CONCLUSIONS
Abstinent alcoholic patients displayed an increase in mu-opiate receptors in the ventral striatum, including the nucleus accumbens, which correlated with the severity of alcohol craving. These findings point to a neuronal correlate of alcohol urges.
Heinz
Andreas
A
Department of Psychiatry, Charité University Medicine Berlin, Campus Charité Mitte, Berlin, Germany.
Reimold
Matthias
M
Wrase
Jana
J
Hermann
Derik
D
Croissant
Bernhard
B
Mundle
Götz
G
Dohmen
Bernhard M
BM
Braus
Dieter F
DF
Braus
Dieter H
DH
Schumann
Gunter
G
Machulla
Hans-Jürgen
HJ
Bares
Roland
R
Mann
Karl
K
D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control / Q000523:psychology; D000437:Alcoholism / Q000000981:diagnostic imaging / Q000378:metabolism / Q000534:rehabilitation*; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism*; D016739:Behavior, Addictive / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D002250:Carbon Radioisotopes; D005283:Fentanyl / Q000031:analogs & derivatives*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000494:pharmacology / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D049268:Positron-Emission Tomography; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D017450:Receptors, Opioid, mu / Q000032:analysis / Q000187:drug effects / Q000378:metabolism*; D012720:Severity of Illness Index; D013695:Temperance / Q000523:psychology
D002250:Carbon Radioisotopes; D009292:Narcotic Antagonists; D017450:Receptors, Opioid, mu; D009271:Naltrexone; C017114:carfentanil; D005283:Fentanyl