Persons with opioid use disorder (OUD) often experience anhedonia and demoralization, yet there is relatively little research on the pathophysiology of anhedonia and demoralization in OUD treatment and recovery. In the current study, persons maintained on methadone (N = 29) underwent a natural reward-cue paradigm during functional near-infrared spectroscopy (fNIRS) imaging. Natural reward cues included highly palatable food, positive social interactions (e.g., a happy family at the dinner table), and emotional intimacy (e.g. couples embracing or kissing, but no erotic images). Participants also self-reported symptoms of anhedonia on the Snaith-Hamilton Pleasure Scale (SHPS) and demoralization on the Demoralization Scale II (DS-II). Participants who reported clinically-significant anhedonia on the SHPS displayed decreased neural activity in the right prefrontal cortex (PFC) in response to natural reward cues (F(1,25) = 3.612, p = 0.027, η_p² = 0.302). In linear regression models of positive social cues, decreased neural activity in the right VMPFC was associated with increased SHPS total score (F(1,27) = 7.131, R² = 0.209, p = .013), and decreased neural activity in an area encompassing the right lateral VMPFC and DLPFC was associated with increased DS-II total score (F(1,27) = 10.641, R² = 0.283, p = 0.003). This study provides initial evidence that the prefrontal cortex is involved in the pathophysiology of anhedonia and demoralization in persons in recovery from OUD. Anhedonia and demoralization are important treatment outcomes that should be queried along with a constellation of physical and mental health outcomes, to assess areas of needed improvement in methadone maintenance and other OUD treatment modalities.

阿片类药物使用障碍（OUD）患者常出现快感缺失和士气低落，但对OUD治疗和恢复过程中快感缺失和士气低落的病理生理学研究相对较少。在目前的研究中，使用美沙酮的人 (N = 29) 在功能性近红外光谱 (fNIRS) 成像期间经历了自然的奖赏提示范式。自然奖励线索包括高度可口的食物、积极的社交互动（例如，餐桌上的幸福家庭）和情感亲密（例如，情侣拥抱或接吻，但没有色情图片）。参与者还自我报告了 Snaith-Hamilton 快乐量表 (SHPS) 上的快感缺乏症状和士气低落量表 II (DS-II) 上的士气低落。_p ²  = 0.302)。在积极社会线索的线性回归模型中，右侧 VMPFC 中神经活动减少与 SHPS 总分增加（F(1,27) = 7.131，R ²  = 0.209，p = .013）和神经活动减少相关包含右侧 VMPFC 和 DLPFC 的区域与 DS-II 总分增加相关（F(1,27) = 10.641，R ² = 0.283，p = 0.003）。这项研究提供了初步证据，表明前额叶皮层参与了从 OUD 恢复的人的快感缺失和士气低落的病理生理学。快感缺失和士气低落是重要的治疗结果，应与一系列身心健康结果一起查询，以评估美沙酮维持和其他 OUD 治疗方式中需要改进的领域。