# Brain-to-brain neurofeedback during naturalistic dynamic stimuli to reduce craving in heroin addiction

> **NIH NIH R21** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2024 · $211,250

## Abstract

The opioid epidemic remains a major public health crisis in the US, with relapse rates and overdose-related
fatalities continuing to rise. However, the mechanistic explorations of viable interventions in individuals with
opioid use disorder have been particularly scarce. Here we will explore a novel brain-based intervention to
decrease craving in individuals with heroin use disorder (iHUD) in early treatment. A core characteristic of drug
addiction is an enhanced reactivity to drug related cues and reduced processing of other reinforcers in the natural
environment, as reliably observed across numerous brain networks and associated with enhanced craving (a
predictor of drug use outside the lab). Our recent studies in iHUD suggest that this brain-behavior cue-induced
biased pattern improves with abstinence/treatment. Therefore, we will test whether preemptively changing such
neural cue reactivity could expedite the recovery process as measured with reduced drug craving. Specifically,
we hypothesize that training can help iHUD achieve an intentional modulation of their cue reactivity signal. Using
one’s own brain signal, real-time fMRI neurofeedback (rt-fMRI NF) allows participants to volitionally modulate
brain activity in targeted brain regions shown in smokers and heavy alcohol drinkers to be effective in reducing
drug cue neural reactivity, as associated with abstinence/decreases in craving. However, the permeability of this
approach is not uniform. Here for the first time, we will test whether the NF effect can be enhanced by using the
signal derived from the brains of others (i.e., brain-to-brain neural transmission). Specifically, our first aim in this
cutting-edge exploratory application is to identify the brain regions that distinguish between early (abstinent for
<1 month) as compared to later (abstinent for >3 months) time-in-treatment in iHUD. Our second aim is to use
the unique multivariate neural patterns derived later in treatment as NF provided to a newly recruited sample of
iHUD in early treatment, with the goal of increasing neuronal coupling between both groups. To increase
ecological validity and better approximate actual real-world experiences in iHUD, the stimulus is a dynamic,
narrative-based, and context-rich movie. Our working hypothesis is that, as compared to iHUD in early treatment
where drug cue reactivity is more automatic and harder to control (impacting non drug processing), recovering
individuals are better able to regulate it allowing them to reduce craving (and curtail, or entirely eliminate, drug-
seeking) even in potent drug-related situations. Therefore, during rt-fMRI NF, we expect greater recovery (and
lower cue-induced craving) in the new sample of iHUD early in treatment who show the most neural
coupling/alignment with the neural patterns of those in later recovery. In short, in this innovative R21 proposal
we will answer the following question: Can the neural patterns of addicted individuals in later recove...

## Key facts

- **NIH application ID:** 10932929
- **Project number:** 5R21DA058801-02
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Rita Z Goldstein
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $211,250
- **Award type:** 5
- **Project period:** 2023-09-30 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10932929

## Citation

> US National Institutes of Health, RePORTER application 10932929, Brain-to-brain neurofeedback during naturalistic dynamic stimuli to reduce craving in heroin addiction (5R21DA058801-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10932929. Licensed CC0.

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