Thirsty heroin addicts show different fMRI activations when exposed to water-related and drug-related cues

Relapse to drug use is frequently preceded or caused by craving, an intense desire for drug. Advances in functional brain imaging techniques make it possible to directly investigate this special mental state in vivo and non-invasively. Extant imaging studies on craving have been mostly on cocaine which is the dominant drug abused in the U.S. Employing functional MRI, we examined substance specificity of the neural circuitry underlying craving for heroin. Heroin is the primary drug abused in south-east Asia and has, particularly, become a serious social problem for China in recent years. Following abstinence from water and drug, 14 active heroin addicts (all male, mean age 33.2 years, average drug use history 7.1 years) underwent scanning inside a 1.5T Philips MR scanner during exposure to water-related, drug-related, and neutral cues. Water-related cues elicited anterior cingulate activation (Brodmann's area BA 32/24). Drug-related cues activated bilateral inferior frontal cortex (BA 44/45), confirming the critical role of prefrontal cortex in drug craving. Results suggest heroin craving may involve different neural substrates than do desire from basic physiological drives, such as thirst. As the first fMRI study of heroin craving, our study adds to the scant but much-needed brain imaging literature on heroin addiction.