title: Neural responses to negative outcomes predict success in community-based substance use treatment.
abstract: OBJECTIVE
  Patterns of brain activation have demonstrated promise as prognostic indicators in substance dependent individuals (SDIs) but have not yet been explored in SDIs typical of community-based treatment settings.
  
  
  METHODS
  Prospective clinical outcome design, evaluating baseline functional magnetic resonance imaging data from the Balloon Analogue Risk Task (BART) as a predictor of 3-month substance use treatment outcomes.
  
  
  METHODS
  Community-based substance use programs in Bloomington, Indiana, USA.
  
  
  METHODS
  Twenty-three SDIs (17 male, aged 18-43 years) in an intensive outpatient or residential treatment program; abstinent 1-4 weeks at baseline.
  
  
  METHODS
  Event-related brain response, BART performance and self-report scores at treatment onset, substance use outcome measure (based on days of use).
  
  
  RESULTS
  Using voxel-level predictive modeling and leave-one-out cross-validation, an elevated response to unexpected negative feedback in bilateral amygdala and anterior hippocampus (Amyg/aHipp) at baseline successfully predicted greater substance use during the 3-month study interval (P ≤ 0.006, cluster-corrected). This effect was robust to inclusion of significant non-brain-based covariates. A larger response to negative feedback in bilateral Amyg/aHipp was also associated with faster reward-seeking responses after negative feedback (r(23)= -0.544, P = 0.007; r(23)= -0.588, P = 0.003). A model including Amyg/aHipp activation, faster reward-seeking after negative feedback and significant self-report scores accounted for 45% of the variance in substance use outcomes in our sample.
  
  
  CONCLUSIONS
  An elevated response to unexpected negative feedback in bilateral amygdala and anterior hippocampus (Amyg/aHipp) appears to predict relapse to substance use in people attending community-based treatment.
authors.affiliation: Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.|VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Forster
authors.affiliation: Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Finn
authors.affiliation: Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000679:Amygdala / Q000000981:diagnostic imaging / Q000503:physiopathology; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003156:Community Mental Health Services; D005246:Feedback; D005260:Female; D059907:Functional Neuroimaging; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012114:Residential Treatment; D012201:Reward; D019966:Substance-Related Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Amygdala; Balloon Analogue Risk Task; fMRI; naturalistic samples; negative feedback; prediction; relapse; stress reactivity; substance use disorders; treatment outcome