Shared gray matter alterations in subtypes of addiction: a voxel-wise meta-analysis

Numerous studies based on voxel-based morphometry (VBM) have revealed gray matter (GM) alterations in multiple brain regions for addiction. However, findings are poorly replicated, and it remains elusive whether distinct diagnoses of addiction are underpinned by shared abnormalities. Our aim was to conduct a quantitative meta-analysis of structural neuroimaging studies investigating GM abnormalities in two main categories of addiction: substance use disorders (SUD) and behavioral addictions (BA).

A systematic database search was conducted in several databases from Jan 1, 2010, to Oct 23, 2020, to identify eligible VBM studies. Meta-analysis was performed with the seed-based d mapping software package to compare alternations between individuals with addiction-related disorders and healthy controls (HC).

A total of 59 VBM studies including 2096 individuals with addiction-related disorders and 2637 HC met the inclusion criteria. Individuals with addiction-related disorders showed shared GM volume decrease in bilateral prefrontal cortex, bilateral insula, bilateral rolandic operculum, left superior temporal gyrus, and right Heschl gyrus and GM increase in right lingual gyrus and right fusiform gyrus comparing with HC (p < 0.005). Subgroup analysis found heterogeneity between SUD and BA mainly in left inferior occipital gyrus and right striatum (p < 0.005). Meta-regression revealed that GM atrophy in right anterior cingulate (r = 0.541, p = 0.03 (uncorrected)) and left inferior frontal gyrus (r = 0.595, p = 0.015) were positively correlated with higher impulsivity.

This meta-analysis identified a concordance across subtypes of addiction in terms of the brain structural changes in prefrontal and insula areas, which may relate to higher impulsivity observed across addiction diagnoses. This concordance provides an organizing model that emphasizes the importance of shared neural substrates in addiction.