MEASURE OF LIMBIC SYSTEM ACTIVITY AND DRUG DREAMS IN DRUG-ADDICTED PATIENTS: A PRELIMINARY STUDY

Abstract

Drug dreams occur only in presence of repeated drugs exposure (i.e, presence of drug craving) and they are associated with symptoms of limbic irritabilty.

Full text

Measure of limbic system activity and drug dreams in
drug-addicted patients: a preliminary study
C. Colace1, M. Claps2, A. Antognoli3, R. Sperandio3, D. Sardi3, & A. Benedetti3
1AUSL Viterbo, U.O.C. Psicologia, Italy, 2AUSL Roma D, Servizio Dipendenze Patologiche, Italy,
3AUSL Viterbo, Servizio Dipendenze Patologiche, Civita Castellana, Italy
METHOD
Subjects. 47 polydrug addicted
patients (41 male, 6 female)
who arrived consecutively at
the Center for Drug Addiction
during a two-months period.
Their drug-addiction diagnosis
was based on DSM IV criteria
(see table I).
Control group. 11 subjects
were randomly recruited for
the control group. These were
occasional drug users (cocaine
and/or cannabis) and did not
have a criteria for the diagnosis
of drug addiction (e.g. no
presence of drug craving).
Procedure. All subjects were
standard interviewed in
individual sessions on the
presence/absence of drug
dreams in the previous week.
Drug dreams were transcribed
verbatim. Drug use/non-use in
the previous week was
evaluated by means of urine
tests. Limbic system activity
was assessed by means of the
Limbic System Checklist,
LSCL-3315
BACKGROUND
 Several studies have noticed that drug-addicted patients frequently report dreams the contents of
which are related to their abnormal urge to use the drug their are addicted to (i.e., drug craving)1-9.
Generally, in these “drug dreams” patients seek for and use the drug, or attempt to use it.
 Johnson’s neuropsychoanalytic hypothesis6 suggested that the mesolimbic-mesocortical
dopaminergic system, identified by Solms as essential in the generation of dreams, is exactly the one
that, when uperegulated by addictive drugs exposure, is responsible for drug craving10 and related
drug dreams.
 Consistent with the neuropsychoanalytic approach and with Johnson’s hypothesis, previous
studies on dreaming in addiction have often found that drug dreams occurrence is related with drug
craving intensification1, 11, 12.
The mesolimbic-mesocortical DA circuit includes projections from cell bodies of ventral
tegmentum to several limbic structures13,14.
 One limit of previous studies on dreaming in addiction was that they did not include any direct or
indirect measure of mesolimbic-mesocortical dopaminergic neural activity, nor of limbic functioning
of drug-addicted patients.
AIM
The aim of this study was to investigate the limbic activity, assessed by means of the Limbic System
Checklist, LSCL-3315, of drug-addicted patients in relation to their drug dreaming.
Limbic System Checklist,
LSCL-33
LSCL is a 33-items self-report
questionnaire designed to
measure temporo-limbic
activity. It was originally
devised to ascertain the
frequency of somatic, sensory,
behavioural and memory
symptoms suggestive of
temporal lobe epilepsy.
Subjects rated the frequency
of symptoms using a 4-point
Likert scale (never=0,
rarely=1, sometimes=2,
often=4). The patients with
temporal lobe epilepsy report
high scores (range 23-60),
while normal adults report
scores < 10. LSCL-33 is
correlated with other measures
of limbic dysfunction (e.g.,
Hopkins Symptom
Checklist)15.
RESULTS
1. LSCL-33 mean score in polydrug addicted patients was 26.85.
2. Patients who recalled drug dreams in the previous week were 11 (23%) (table II)
3. In the control group, none of the subjects had drug dreams.
4. Drug addicted patients who reported drug dreams had significantly higher LSCL-33 scores compared to the control
group (see fig. I)
5. Of the patients who reported drug dreams, 82% of subjects had remained abstinent from their primary drug of
abuse in the previous week (see fig. II )
CONCLUSIONS
 Our patients show a high LSCL-33 score, similar to the one obtained with alcoholic outpatients16 and those obtained
with temporal lobe epilepsy patients15
 Several studiese.g.,17-18 have showed that the rewarding effects of drugs are mediated by the activation of VTA with
DA cell which projects in several limbic structures (e.g., nucleus accumbens, amygdala etc.). From this point of view,
the limbic system hyperactivity shown by drug-addicted patients may be considered as a direct expression of activation
and upregulation of mesolimbic-mesocortical dopamine (DA) circuits due to drug exposure
 In this study, drug dreams occur only in presence of two conditions: drug craving and limbic dysfunction. Where
these conditions are not present (control group) drug dreams do not occur
 Our results are consistent with the neuropsychoanalytic hypothesis on the role of the upregulation of the
mesolimbic-mesocortical dopaminergic system in drug dream generation6
 Consistent with our results, some authors have shown that limbic hyperactivity is associated with a strong
emotional/ motivational connotation of dream contents 19-21.
 We believe that the association between limbic hyperfunction and the occurrence of dreams in which drug addicts
crave for drugs provide a clinical example of the neuropsychoanalytic hypothesis on dreaming about the active role of
the mesolimbic-mesocortical dopaminergic system (i.e., “seeking” or “wanting” system) in the triggering of dream
processes19,22.
 Drug dreams are a clear example of infantile wish-fulfilment dreams in adults, which is consistent with Freud’s
dream theory 23, for review see 3.
 Previous studies and our results show that drug dream onset may be fovoured by a temporary increase of drug
craving during abstinence state 3, 24-26. Furthermore, drug dream frequency is correlated with drug craving degree 1, 11, 12.
These data, taken together, have suggested the hypothesis that drug dreams might be instigated by an increase of drug
craving/DA release “not discharged”27(fig. III).
The Authors wish to thank Carl M. Anderson,
Assistant Professor of Psychiatry, Harvard Medical
School & The Brain Imaging Center, for the
introduction to Limbic System Checklist (LSCL-33).
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Example of drugd dreams
1.“ The dream is composed of two scenes. In the first scene, I see a friend who proposes to go and get some heroin. Then I don’t
remember what has happened. In the second scene, I am playing football and the coach approaches me and says something like “I
know you use heroin." I didn't recall anything else about the dream but I was sure I had used the drug in the dream. I had feelings
of guilt and shame.” 2.“ I dreamed I was driving to Rome with a friend of mine to get some heroin. I don't remember the details,
however I remember the scene when I sniffed the drug. The dream was pleasant and there was no guilt or anxiety associated with
its use. While I was sniffing it, I remember an intensely pleasant feeling as if it was a real life situation. On waking up in the
morning I didn't feel any particular emotion nor any feeling of guilt”.
28,64
10,09
0
1 0
2 0
3 0
4 0
5 0
Drug-addicted
patients who
reports drug
dreams
Control group
LSCL-33 Mean scores
Figure II. Use of drug in patient who report
drug dreams
2
9
Abstinent Regular drug use
U.O.C. Psicologia
t-test = 2.933 (df 20), p = .008 (χ2 = 4.455, (df = 1), p = .03)
Claudio Colace
AUSL Viterbo – U.O.C Psychology - Italy
Correspondence address:
Claudio Colace
via Luigi Volpicelli, 8 - 0133 Roma, Italy
Tel. 3336148977 – Fax 067808878 -
e-mail: claudio65@infinito.it
Table I. Patterns of Drug use in patients
Polydrug addicted patients
Heroin 100%
Cocaine 49%
Alcohol 17%
Cannabis 100%
Psychoactive drugs 15%
Figure I. LSCL mean scores in patients and control group
Table II. Types of drug dreams
Number of dreams
Using drugs 4
Seeking drugs 5
Refusing drugs 2
10
10th
th
International Neuropsychoanalysis Congress – Paris, 26 – 29 June 2009
International Neuropsychoanalysis Congress – Paris, 26 – 29 June 2009
Figure III. An Hypothesis of Drug Dreams Onset Mechanism