Opioid use disorder (OUD) is characterized by emotional and cognitive impairements that are associated with poor treatment outcomes. The present study investigated the neural mechanism underlying emotion evaluation and inhibitory control using an affective go/no-go (AGN) task and its association with drug use severity and craving in patients with OUD. Twenty-six recently detoxified patients with OUD underwent functional magnetic resonance imaging (fMRI) while performing the AGN task that required response to frequently presented appetitive stimuli (“go”) and inhibition of response to infrequently presented aversive stimuli (“no-go”). The fMRI session was immediately followed by an injection of extended-release opioid antagonist naltrexone (XR-NTX). Participants’ opioid craving was assessed immediately before fMRI and 10 ± 2 days after XR-NTX injection. Multivariate pattern analysis (MVPA) showed that drug use severity was associated with distributed brain hypoactivity in response to aversive no-go stimuli, with particularly large negative contributions from the cognitive control and dorsal attention brain networks. While drug use severity and its associated MVPA brain response pattern were both correlated with opioid craving at baseline, only the brain response pattern predicted craving during XR-NTX treatment. Our findings point to widespread functional hypoactivity in the brain networks underlying emotional inhibitory control in OUD. Such a distributed pattern is consistent with the multifaceted nature of OUD, which affects multiple brain networks. It also highlights the utility of the multivariate approach in uncovering large-scale cortical substrates associated with clinical severity in complex psychiatric disorders and in predicting treatment response.

阿片类药物使用障碍 (OUD) 的特点是情绪和认知障碍，与不良治疗结果相关。本研究调查了使用情感进行/不进行（AGN）任务进行情绪评估和抑制控制的神经机制及其与 OUD 患者吸毒严重程度和渴望的关系。26 名最近戒毒的 OUD 患者在执行 AGN 任务时接受了功能性磁共振成像 (fMRI)，该任务需要对频繁出现的食欲刺激（“go”）做出反应并抑制对不频繁出现的厌恶刺激（“no-go”）的反应。功能磁共振成像检查后立即注射缓释阿片拮抗剂纳曲酮 (XR-NTX)。在 fMRI 之前和注射 XR-NTX 后 10 ± 2 天评估参与者的阿片类药物渴望。多变量模式分析（MVPA）表明，药物使用的严重程度与对厌恶的不进行刺激的分布式大脑活动减退有关，其中认知控制和背侧注意大脑网络的负面影响特别大。虽然药物使用严重程度及其相关的 MVPA 大脑反应模式均与基线时对阿片类药物的渴望相关，但只有大脑反应模式可以预测 XR-NTX 治疗期间的渴望。我们的研究结果表明，OUD 中情绪抑制控制的大脑网络存在广泛的功能减退。这种分布模式与 OUD 的多方面性质一致，它影响多个大脑网络。它还强调了多变量方法在发现与复杂精神疾病的临床严重程度相关的大规模皮质底物以及预测治疗反应方面的效用。