Oxytocin and Brain Responses in Maternal Addiction

Maternal drug addiction constitutes a major public health problem for both women and affected
children, with long lasting consequences on children's social, emotional and cognitive
development. Current treatment strategies tend to focus on the mother and her current
addiction, rather than her relationship with her child, and developmental processes that may
perpetuate the addiction problems, such as unresolved childhood attachment trauma, neglect,
and chronic stress. Unlike mothers who find engaging with their own infant to be a uniquely
rewarding experience, mothers with addictions may be less able to respond appropriately to
their infant's cues, finding them less intrinsically rewarding or salient, and more stress
provoking.

Aim 1: To examine, in addicted mothers compared to non-addicted control mothers, the effect
of intranasal oxytocin (OT) on functional MRI brain responses to reward-related cues: own vs.
unknown happy infant faces.

Aim 2: To examine, in addicted mothers compared to non-addicted control mothers, the effect
of intranasal OT on brain responses to stress-related cues: own vs. unknown sad infant faces.

Aim 3: To examine the effect of intranasal OT on functional brain connectivity, including the
striatum, PFC and amygdala. Specifically, exploring whether, after receiving intranasal OT
compared to placebo, addicted mothers show increased functional connectivity between the
amygdala and (i) the ventromedial PFC for own-happy infant faces, and (ii) the dorsolateral
PFC and striatum for own-sad faces.

Aim 4: To explore how individual differences in adult attachment and mother-infant synchrony,
sensation-seeking/risk-taking and stress/trauma exposure are associated with OT brain
responses to infant faces.

Inclusion Criteria for addiction sample:

Drug-addicted subjects will be English speaking adult women who:

1. are being evaluated for treatment of their addiction or are currently enrolled in
treatment programs;

2. have an infant <12 months;

3. meet criteria for substance abuse or dependence in the past year, as assessed by MINI
International Neuropsychiatric Interview (MINI);

4. have a substance abuse history, including use during the most recent pregnancy;

5. are recommended at intake for drug-treatment services for substance abuse;

6. are 18 years and older; and

7. have been speaking English or enrolled in English-speaking school since age 8.

Inclusion Criteria for non-addicted mothers (controls):

Control subjects will be English-speaking adult women who:

1. have an infant <12 months of age;

2. do not meet criteria for past or present drug abuse or dependence;

3. are 18 years and older; and

4. have been speaking English or enrolled in English-speaking school since age 8.

Exclusion Criteria for addiction sample:

Potential drug-addicted subjects will be ineligible if they have:

1. severe psychiatric or substance-related symptoms requiring in-patient psychiatric
hospitalization or detoxification for suicidality, homicidality, grave disability,
physiological alcohol or drug withdrawal within the last 30 days;

2. past or present diagnosis of schizophrenia or other psychotic disorders;

3. metal implants or other contraindications for MRI scanning;

4. pending legal cases (e.g., outstanding arrest warrants or parental rights hearings)
prohibiting them from completing the study;

5. current pregnancy or plans to become pregnant during the course of the study;

6. infants with clinical evidence of in utero drug effects, such as opiate withdrawal
symptoms during the neonatal period, facial dysmorphism or intrauterine growth
restriction (IUGR) or microcephaly;

7. infants with birth weight less than 3 lb. 5 oz.;

8. infants who have significant vision, hearing or motor problems (such as cerebral
palsy) that cannot be corrected;

9. out-of-home placement of infant for the past month or more than 50% of child's life;

10. delivered more than one baby during most recent pregnancy (twins, triplets, etc.).

Exclusion criteria for non-addicted mothers:

Potential control subjects will be ineligible if they have:

1. positive drug toxicology screen at the time of study;

2. drug abuse or dependence based on MINI in the past year or lifetime;

3. use of tobacco products in the past 2 years;

4. current hazardous alcohol use as ascertained by AUDIT score > 8;

5. present or past history of ambulatory detoxification;

6. severe psychiatric symptoms requiring inpatient psychiatric hospitalization for
suicidality, homicidality, grave disability, physiological alcohol or drug withdrawal
within the past 30 days;

7. past or present diagnosis of schizophrenia or other psychotic disorders;

8. metal implants or other contraindications for MRI scanning;

9. current pregnancy or plans to become pregnant during the course of the study;

10. infants with birth weight less than 3 lb. 5 oz.;

11. infants who have significant vision, hearing or motor problems that cannot be
corrected (such as cerebral palsy);

12. out-of-home placement of infant for the past month or more than 50% of child's life;
and

13. delivered more than one baby during most recent pregnancy (twins, triplets, etc.).