We aim to study the neural mechanisms of behavioral treatment of cocaine dependence. Although multiple behavioral treatments including cognitive behavioral therapy (CBT) and contingency management (CM) have been shown to be effective in the treatment of cocaine dependence and other addictive disorders, little is known regarding the brain changes underlying their mechanisms of action. We propose integrating functional magnetic resonance imaging (fMRI) measures into a NIDA-funded behavioral treatment trial of CBT and CM to investigate brain function before and after treatment. We propose using at study onset and following 12 weeks of treatment three imaging paradigms that assess cocaine craving, reward processing and cognitive control, respectively. We propose using similar measures in a non-addicted control grouped imaged twice twelve weeks apart as an important comparison group. We predict that prior to treatment, cocaine dependent subjects will differ from controls on these fMRI and cognitive measures. We also predict that cocaine dependent subjects will show changes in fMRI and cognitive/behavioral functioning following treatment, and that control subjects will not show similar changes when imaged 12 weeks apart. Neural predictors and correlates of effective behavioral treatment for cocaine dependence for CBT and CM will be explored as these would have significant potential for refining therapies, and targeting specific therapies to specific forms of cocaine dependence (e.g., those with specific neural activation patterns). Successful completion of this project would lay the foundation for future studies (e.g., those combining behavioral and pharmacological treatments) in cocaine dependence and other addictive disorders.
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