Longitudinal resting-state functional connectivity changes in the insular subdivisions of abstinent individuals with opioid use disorder

The insular cortex plays a critical role in reward circuitry involved with drug craving in substance use disorders. This study aimed to investigate whether opioid use disorder exhibit functional alterations in the insular circuitry after abstinence. Sixty-one opioid use disorder underwent resting-state and 3D-T1-weighted magnetic resonance imaging and completed craving questionnaires at baseline and after 8 months of abstinence. Changes in resting-state functional connectivity in the insular cortex and their correlations with craving were analyzed. Craving was reduced at follow-up compared with baseline. Compared with that at baseline, there was significantly increased resting-state functional connectivity between the right insular cortex and the superior frontal gyrus/anterior cingulate gyrus (family-wise error corrected) at follow-up. Changes in the functional connectivity of the right dorsal anterior insula/posterior insula with the bilateral superior frontal gyrus were negatively correlated with changes in craving. Our results demonstrated the presence of changes in functional connectivity of the insula in opioid use disorder after protracted abstinence, providing novel evidence of a correlation between craving changes and changes in the neurocircuitry of insular cortex subdivision after abstinence. This study reveals the possibility of neuroplasticity after protracted abstinence, providing insight for future abstinence therapies and rehabilitation procedures for patients with substance use disorders.