Elsevier

Biological Psychiatry

Volume 57, Issue 5, 1 March 2005, Pages 487-494
Biological Psychiatry

Original articles
Sex differences in brain activation during stress imagery in abstinent cocaine users: A functional magnetic resonance imaging study

https://doi.org/10.1016/j.biopsych.2004.11.048Get rights and content

Background

Because stress mediates drug seeking and relapse, and sex differences have been observed in stress and in the development of cocaine addiction, in this study we used functional neuroimaging to examine the effect of sex on stress responses in abstinent cocaine users.

Methods

In a functional magnetic resonance imaging session, 17 male and 10 female cocaine-dependent subjects participated in script-guided imagery of neutral or stress situations. Subjects rated imagery vividness, anxiety, and cocaine craving for each trial. Brain activation during the stress and neutral imagery periods relative to their own baseline was examined in individual subjects. Sex contrast was obtained in second-level group analysis.

Results

Female subjects demonstrated more activation, compared with male subjects, in left middle frontal, anterior cingulate, and inferior frontal cortices and insula, and right cingulate cortex during stress imagery. Region of interest analysis showed that the change of activity in left anterior cingulate and right posterior cingulate cortices both correlated inversely with the change of craving rating during stress imagery.

Conclusions

The greater left frontolimbic activity in women suggests that women might use more verbal coping strategies than do men while experiencing stress. The results also suggest a distinct role of the cingulate cortices in modulating stress-induced cocaine craving.

Section snippets

Subjects and script development

Twenty male and 10 female cocaine-dependent subjects participated in the study. Three male subjects had translational or rotational motion exceeding 3 mm in one or more dimensions in the scanner and were excluded, leaving us with 17 male and 10 female subjects in the data set. All subjects met criteria for current cocaine dependence as diagnosed by the Structured Clinical Interview for DSM-IV (First et al., 1995). They had a mean lifetime history of regular cocaine use (at least 3 times weekly)

Results

Figure 1 shows the average vividness rating and the average change from baseline to imagery period in heart rate, anxiety, and craving rating for both neutral and stress trials, separately for men and women. The results showed that neither male nor female cocaine users demonstrated changes from baseline in heart rate (women, .2 ± 1.2 beats/sec; men, .3 ± 2.3 beats/sec), anxiety rating (women, −.8 ± 1.1; men, −.8 ± .8), or craving rating (women, .6 ± 2.7; men, −.3 ± .9) during neutral trials.

Discussion

Both men and women cocaine users predominantly activated the temporal cortical areas during imagery of personal, real-life situations, whether stressful or neutral, which is consistent with literature on the retrieval of autobiographic memory (Fink et al., 1996; Piefke et al., 2003). When contrasting men and women during stressful imagery, women demonstrated greater activation in the left anterior and right posterior cingulate, left insula, and middle and inferior frontal cortices. These

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