title: Effects of cue-exposure treatment on neural cue reactivity in alcohol dependence: a randomized trial.
abstract: BACKGROUND
  In alcohol-dependent patients, alcohol-associated cues elicit brain activation in mesocorticolimbic networks involved in relapse mechanisms. Cue-exposure based extinction training (CET) has been shown to be efficacious in the treatment of alcoholism; however, it has remained unexplored whether CET mediates its therapeutic effects via changes of activity in mesolimbic networks in response to alcohol cues. In this study, we assessed CET treatment effects on cue-induced responses using functional magnetic resonance imaging (fMRI).
  
  
  METHODS
  In a randomized controlled trial, abstinent alcohol-dependent patients were randomly assigned to a CET group (n = 15) or a control group (n = 15). All patients underwent an extended detoxification treatment comprising medically supervised detoxification, health education, and supportive therapy. The CET patients additionally received nine CET sessions over 3 weeks, exposing the patient to his/her preferred alcoholic beverage. Cue-induced fMRI activation to alcohol cues was measured at pretreatment and posttreatment.
  
  
  RESULTS
  Compared with pretreatment, fMRI cue-reactivity reduction was greater in the CET relative to the control group, especially in the anterior cingulate gyrus and the insula, as well as limbic and frontal regions. Before treatment, increased cue-induced fMRI activation was found in limbic and reward-related brain regions and in visual areas. After treatment, the CET group showed less activation than the control group in the left ventral striatum.
  
  
  CONCLUSIONS
  The study provides first evidence that an exposure-based psychotherapeutic intervention in the treatment of alcoholism impacts on brain areas relevant for addiction memory and attentional focus to alcohol-associated cues and affects mesocorticolimbic reward pathways suggested to be pathophysiologically involved in addiction.
authors.affiliation: Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany. s.vollstaedt-klein@zimannheim.de
authors.forename: Sabine
authors.initials: S
authors.lastname: Vollstädt-Klein
authors.forename: Sabine
authors.initials: S
authors.lastname: Loeber
authors.forename: Martina
authors.initials: M
authors.lastname: Kirsch
authors.forename: Patrick
authors.initials: P
authors.lastname: Bach
authors.forename: Anne
authors.initials: A
authors.lastname: Richter
authors.forename: Mira
authors.initials: M
authors.lastname: Bühler
authors.forename: Christoph
authors.initials: C
authors.lastname: von der Goltz
authors.forename: Derik
authors.initials: D
authors.lastname: Hermann
authors.forename: Karl
authors.initials: K
authors.lastname: Mann
authors.forename: Falk
authors.initials: F
authors.lastname: Kiefer
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000503:physiopathology / Q000628:therapy*; D001143:Arousal / Q000502:physiology; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D015928:Cognitive Behavioral Therapy; D003463:Cues; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007171:Implosive Therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome