Structural brain changes associated with cocaine use and digital cognitive behavioral therapy in cocaine use disorder treatment

• Published in: Drug and alcohol dependence reports Vol. 11; p. 100246
• Main Authors: McCurdy, Li Yan, DeVito, Elise E., Loya, Jennifer M., Nich, Charla, Zhai, Zu Wei, Kiluk, Brian D., Potenza, Marc N.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2024; Elsevier
• Subjects: Addictive behaviors; Cocaine use disorder; Computerized cognitive-behavioral therapy; Full Length Report; Middle temporal gyrus; Voxel-based morphometry; Cocaine use disorder; Middle temporal gyrus; Computerized cognitive-behavioral therapy; Addictive behaviors; Voxel-based morphometry
• ISSN: 2772-7246; 2772-7246
• DOI: 10.1016/j.dadr.2024.100246

Few studies have investigated changes in brain structure and function associated with recovery from cocaine use disorder (CUD), and fewer still have identified brain changes associated with specific CUD treatments, which could inform treatment development and optimization. In this longitudinal study, T1-weighted magnetic resonance imaging scans were acquired from 41 methadone-maintained individuals with CUD (15 women) at the beginning of and after 12 weeks of outpatient treatment. As part of a larger randomized controlled trial, these participants were randomly assigned to receive (or not) computer-based training for cognitive behavioral therapy (CBT4CBT), and galantamine (or placebo). Irrespective of treatment condition, whole-brain voxel-based morphometry analyses revealed a significant decrease in right caudate body, bilateral cerebellum, and right middle temporal gyrus gray matter volume (GMV) at post-treatment relative to the start of treatment. Subsequent region of interest analyses found that greater reductions in right caudate and bilateral cerebellar GMV were associated with higher relative and absolute levels of cocaine use during treatment, respectively. Participants who completed more CBT4CBT modules had a greater reduction in right middle temporal gyrus GMV. These results extend previous findings regarding changes in caudate and cerebellar GMV as a function of cocaine use and provide the first evidence of a change in brain structure as a function of engagement in digital CBT for addiction. These data suggest a novel potential mechanism underlying how CBT4CBT and CBT more broadly may exert therapeutic effects on substance-use-related behaviors through brain regions implicated in semantic knowledge. •Adults in treatment for cocaine use disorder exhibit gray matter volume reductions.•Higher cocaine use is associated with caudate and cerebellar volume reductions.•Digital therapy engagement is associated with middle temporal gyrus volume reduction.