Neural activation patterns of methamphetamine-dependent subjects during descision making predict relapse

Context: Relapse is a common clinical problem in individuals with substance dependence. Previous studies have implicated a multifactorial process underlying relapse; however, the contribution of specific neural substrates has not yet been examined. Objective: To determine whether results from functional magnetic resonance imaging (fMRI) shortly after drug cessation could predict relapse in stimulant-dependent individuals. Participants and Design: Treatment-seeking methamphetamine-dependent males (N = 46) under-went fMRI 3 to 4 weeks after cessation of drug use. Of the 40 subjects who were followed up a median of 370 days, 18 relapsed and 22 did not. Main Outcome Measure: Blood oxygen level-dependent fMRI activation during a simple 2-choice prediction task. Results: The fMRI activation patterns in right insular, posterior cingulate, and temporal cortex obtained early in recovery correctly predicted 20 of 22 subjects who did not relapse and 17 of 18 subjects who did. A Cox regression analysis revealed that the combination of right middle frontal gyrus, middle temporal gyrus, and posterior cingulate activation best predicted the time to relapse. Conclusion: To our knowledge, this is the first investigation to show that fMRI can be used to predict relapse in substance-dependent individuals.