Electrophysiological evidence of early attentional bias to drug-related pictures in chronic cannabis users

• Cannabis stimuli elicited craving in the marijuana dependent group.
• Cannabis users show an EAP response to drug cues over the left frontal scalp.
• Brain source imaging of the EAP revealed a left ventromedial PFC/medial OFC source.

Behavioral and electrophysiological correlates of attentional bias to cannabis-related cues were investigated in a marijuana dependent group and a non-user group employing a drug Stroop task in which cannabis-related, negative and neutral images were presented. Behaviorally, cannabis users were less accurate during drug-containing blocks than non-users. Electrophysiologically, in chronic marijuana-users, an early positive ERP enhancement over left frontal scalp (EAP, 200–350 ms) was present in response to drug-containing blocks relative to negative blocks. This effect was absent in the non-user group. Furthermore, drug-containing blocks gave rise to enhanced voltage of a posterior P300 (300–400 ms), and a posterior sustained slow wave (LPP, 400–700 ms) relative to negative blocks. However, such effects were similar between cannabis users and non-users. Brain source imaging in cannabis users revealed a generator for the EAP effect to drug stimuli in left ventromedial prefrontal cortex/medial orbitofrontal cortex, a region active in fMRI studies of drug cue-reactivity and a target of the core dopaminergic mesolimbic pathway involved in the processing of substances of abuse. This study identifies the timing and brain localization of an ERP correlate of early attentional capture to drug-related pictures in chronic marijuana users. The EAP to drug cues may identify a new electrophysiological marker with clinical implications for predicting abstinence versus relapse or to evaluate treatment interventions.