Brain Imaging in Substance Abuse: Research, Clinical, and Forensic Applications (Forensic Science and Medicine)

462 Pages·2001·11.79 MB·English

by  Marc J. Kaufman

Brain Imaging in
Substance Abuse
Research, Clinical,
and Forensic Applications
Edited by
Marc J. Kaufman,
PhD
Humana Press
Brain Imaging in Substance Abuse
F O R E N S I C S C I E N C E A N D M E D I C I N E
Steven B. Karch, MD, SERIES EDITOR
BRAIN IMAGING IN SUBSTANCE ABUSE:Research, Clinical, and Forensic Applications
edited byMarc J. Kaufman,2001
TOXICOLOGYAND CLINICAL PHARMACOLOGYOF HERBAL PRODUCTS,
edited by Melanie Johns Cupp,2000
A PHYSICIAN'S GUIDE TO CLINICAL FORENSIC MEDICINE,
edited byMargaret M. Stark,2000
CRIMINAL POISONING:INVESTIGATIONAL GUIDEFOR LAW ENFORCEMENT, TOXICOLOGISTS, FORENSIC
SCIENTISTS,AND ATTORNEYS,
byJohn H. Trestrail, III,2000
Brain Imaging
in Substance Abuse
Research, Clinical, and Forensic Applications
Edited by
Marc J. Kaufman P D
H
Harvard Medical School and McLean Hospital, Belmont, MA
Foreword by
Joseph Frascella PHD
National Institute on Drug Abuse, Rockville, MD
Humana Press Totowa, New Jersey
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Library of Congress Cataloging in Publication Data
Brain imaging in substance abuse: research, clinical, and forensic applications/edited by Marc J. Kaufman.
p.; cm—(Forensic science)
Includes bibliographical references and index.
ISBN 0-89603-770-3 (alk. paper)
1. Substance abuse—Diagnosis. 2.Brain—Imaging. 3.Brain—Effect of drugs on. 4. Diagnostic imaging.
I. Kaufman, Marc J. II.Series.
[DNLM: 1.Substance-Related Disorders—diagnosis. 2. Brain—drug effects. 3.Brain—physiology.
4. Diagnostic Imaging. 5. Forensic Medicine. WM 270 B814 2000]
RC386.6.D52 B74 2000
616.86'0754—dc21
99-054063
Foreword
The last two decades have seen prodigious growth in the application of brain
imaging methods to questions of substance abuse and addiction. Despite considerable
advances in our understanding of the central effects of drugs provided by preclinical
data, relatively little direct evidence was known of how substances of abuse affect the
brain and other CNS processes in humans. Brain imaging techniques have allowed
access to the human brain and enabled the asking of questions never before imagined.
The positron emission tomography (PET) data of Volkow and her colleagues in
the late 1980s, showing the uptake and time course of cocaine’s binding in the human
brain, revealed for the first time the distinct sites of action of this drug. This work was
extremely important because it showed clearly, through imaging a drug in the brain of
a living human, that the time course of its action paralleled the behavioral state of
“high.” This study marked a turning point in our understanding of drug-brain-behav-
ior interactions in humans. Many more investigations of drug effects on the structure
and function of the human brain were soon to follow, leading to much better insights
into brain systems. Brain imaging allowed for the direct assessment of structural and
functional anatomy, biology, and chemistry in substance abusers. The effects of both
acute and chronic exposure could be assessed through imaging in the awake, behaving
human, and these drug-induced changes in brain processes could be correlated effec-
tively with increasingly more complex behavioral states. We now know much more
about the subtle as well as distinct ways in which drugs influence brain-behavior
interactions.
Despite the tremendous advances revealed over the last several years, most of
which are described in detail within this book, early applications of brain imaging
techniques were met with some skepticism. Questions were raised regarding the large
expense of such clinical studies. For example, early PET work was sometimes criti-
cized as being a very expensive autoradiographic method that could be done more
effectively in preclinical models. Experimenter control was seen as being somewhat
compromised because human drug abusers typically are not single-substance abusers;
thus, brain imaging findings might not be directly attributable to abuse of one drug.
Further, brain changes noted in imaging studies might have represented abnormalities
associated with a preexisting condition, rather than resulting from the effects of drug
use. Fortunately, clinical imaging researchers addressed these and other issues and
persisted through these early times. The field has blossomed to include other imaging
v
vi Foreword
methods, and now includes studies that integrate findings across multiple modalites.
The research findings detailed in this book are the product of this perseverance.
Brain Imaging in Substance Abuse: Research, Clinical, and Forensic Applica-
tionsis an outstanding and in-depth compilation of the state-of-the-science in the clinical
neurobiology of substance abuse. This book will be an extremely useful resource to
the field and will provide an excellent overview to the more casual reader. The review
chapters are comprehensive and include most abused substances for which findings
have been obtained. All major brain imaging techniques are covered in this book, and
importantly, the methods chapters are written in clear language so that even those
with nontechnical backgrounds will understand these highly complex technologies.
These methods chapters include discussions of strengths, weaknesses, and future
directions of each modality. The review chapters are critical examinations of the meth-
ods and findings, and include discussions of experimental design factors that compli-
cate clinical substance abuse research. Overall, what makes this book special and sets
it apart from the usual text is its organization. A remarkably complete and structured
bibliography with over 1350 citations is included. Detailed Tables of Contents and the
extensive index facilitate access to topics and findings of interest. Thus, in addition to
being a complete collection of critical reviews of the field, this book will serve as a
particularly useful reference.
Rapid developments in brain imaging technology, as well as the integration of
findings from individual brain imaging methods and combinations thereof, will lead
us to a much better understanding of the neurobiology of substance abuse and addic-
tion. The science presented in this book will form a firm foundation for future suc-
cesses in this research endeavor.
Joseph Frascella, PHD
Chief, Clinical Neurobiology Branch
Division of Treatment Research and Development
National Institute on Drug Abuse
Preface
Brain imaging techniques are increasingly being used by clinical researchers,
physicians, forensics experts, and lawyers to evaluate mechanisms and consequences
of brain changes associated with acute and chronic substance abuse. Because of the
technical nature and high costs historically associated with most brain imaging
modalities, access to these technologies, and their practical applications in substance
abuse research have been limited. However, the number of clinical research sites imple-
menting brain imaging modalities is multiplying, and the techniques themselves are
becoming less invasive and less expensive. This evolution will ensure expanded use
of brain imaging in substance abuse-related research, diagnosis, and litigation.
The goal of Brain Imaging in Substance Abuse: Research, Clinical, and Foren-
sic Applicationsis to describe the methods and to review the research findings gener-
ated by clinical brain imaging modalities most commonly used in the study of substance
abuse and dependence. These include electroencephalography, emission tomography,
and magnetic resonance. By themselves, each of these powerful techniques has the
ability to measure a number of parameters that indicate brain function, including elec-
trical activity, metabolism, hemodynamics, receptor and neurotransmitter levels, neu-
rochemistry, and structure. It is the consensus of the contributors to this volume that
the most comprehensive view of the mechanisms and consequences of drug abuse and
dependence will be achieved by those who can understand and synthesize the research
findings from all of these brain imaging modalities.
Pursuit of an integrated understanding of the literature from all of these fields is
by no means a trivial goal, since each modality has numerous technical complexities.
This book has been organized to assist in this effort. The first three chapters of the
book describe the technical foundations for electroencephalography, emission tomog-
raphy, and magnetic resonance. These chapters also discuss the strengths and weak-
nesses of each method. Chapters 1–3 are written so that readers with nontechnical
backgrounds will be able to appreciate how these technologies work.
Chapters 4–6 present comprehensive reviews of the electroencephalographic,
emission tomographic, and magnetic resonance research findings in substance abuse,
and also discuss the methodological factors that complicate the interpretation of
results from studies of chronic substance abusers. These factors include the confounds
of polydrug abuse, medical and/or psychiatric comorbidity, premorbid disease, and
genetic or sociologic predisposition to substance abuse. A concise, comprehensive list
vii
viii Preface
of the many confounds that confront all clinical brain imaging studies of chronic sub-
stance abusers is presented as a part of Chapter 4.
Chapter 7 focuses on the neuropsychology of substance abuse. While neuropsy-
chological assessment is not strictly a form of brain imaging, it offers standardized
and reliable methods for relating neuroimaging findings to higher levels of brain func-
tion. Accordingly, it is increasingly being required by peer-review committees, jour-
nal referees, and courts, to provide functional context for neuroimaging findings. This
chapter reviews the extensive neuropsychology literature in substance abuse, lists and
describes the most commonly used neuropsychological tests, and also discusses the
strengths and weaknesses of this discipline.
There is a nexus between substance abuse and crime, and as a result, it is expected
that brain imaging findings will see expanded use (and misuse) in legal contexts. Chapter
8 discusses these issues and proposes guidelines for appropriate use of brain imaging
findings in the courtroom. This chapter also contains a discussion of the scientific and
legal definitions of “evidence,” and of how differences in these definitions between
the professions contribute to problems when science (and scientists) enter the court-
room. This chapter is particularly relevant to judges who must render legal decisions
based on legal andscientific precedents, because, according to Supreme Court rulings
regarding the presentation of scientific evidence, they must serve as “gatekeepers,”
scrutinizing the relevance of expert scientific testimony.
The last part of the book is a comprehensive bibliography of clinical brain imag-
ing and neuropsychological research in substance abuse. The bibliography is struc-
tured by technique and by substance abuse topic, and has a detailed table of contents
to facilitate rapid access to topics of interest.
It is my hope that Brain Imaging in Substance Abuse: Research, Clinical, and
Forensic Applicationswill help to foster a more complete understanding of the effects
of substance abuse on the human brain, by providing better access to the methods and
findings in this field.
A
CKNOWLEDGMENTS
I am grateful to my distinguished colleagues who contributed chapters to this
volume, and to the following individuals for their contributions:
J. T. Arnold, PHD
Linda Chang, MD
Bruce M. Cohen, MD, PHD
Eileen Connolly, RTR
Lyn Dietrich, MSLS, AHIP
Kerstin Dostal, BA
Richard R. Ernst, PHD
Thomas Ernst, PHD
Joseph Frascella, PHD
Håkan Hall, PHD
Arnold R. Kriegstein, MD, PHD
Paul C. Lauterbur, PHD
Preface ix
Edythe D. London, PHD
Peter R. Martin, MD
Nancy K. Mello, PHD
Jack H. Mendelson, MD
Rabbi Donald J. Pollock, DAPA
John J. Resnik, JD
Anne M. Smith, RTR
Edith B. Stern
Lawrence L. Wald, PHD
I would also like to thank the National Institute on Drug Abuse for generous
grant support.
Additionally, I would like to acknowledge Bertha K. Madras, PHD, for a decade
of wonderful mentorship, friendship, and insight.
Finally, I am indebted to my wife Rebekah, who spent many hours assisting in the
preparation of this volume. My life and work have always benefited from her touch.
Marc J. Kaufman, PHD