How the Brains of People Seeking Cannabis Use Disorder Treatment Respond to Cannabis Cues
Treatment-seeking adults with cannabis use disorder showed increased brain activation in executive function and reward regions when viewing cannabis images, with an unexpected finding that higher craving correlated with lower reward area activation.
Quick Facts
What This Study Found
In 65 treatment-seeking participants with moderate or severe CUD, viewing cannabis images (vs neutral) activated bilateral prefrontal cortex, anterior cingulate, visual cortex, and striatum. Functional connectivity increased between the medial prefrontal cortex and both the amygdala and visual cortex. Unexpectedly, self-reported craving negatively correlated with left ventral striatum activation, suggesting that higher craving was associated with reduced reward area response to cues.
Key Numbers
65 participants (37 from varenicline trial, 28 from rTMS trial). 32% female. Mean age: 30.4 years. Craving negatively correlated with left ventral striatum (R2=-0.32, p=.01). No significant differences between study cohorts.
How They Did This
Secondary analysis of 65 participants from two clinical trials (varenicline and rTMS for CUD). fMRI cue-reactivity task comparing cannabis vs neutral images after 24 hours of abstinence. Craving measured with Marijuana Craving Questionnaire. 32% female, mean age 30.4 years.
Why This Research Matters
Understanding how the brain responds to cannabis cues in treatment-seeking individuals could help predict treatment success and develop targeted interventions. The negative correlation between craving and reward area activation challenges simple models of addiction.
The Bigger Picture
The finding that higher craving correlates with lower, not higher, reward area activation may reflect desensitization in heavy users or a disconnect between subjective craving and neural reward processing. This has implications for how brain-based biomarkers might be used in treatment.
What This Study Doesn't Tell Us
Secondary analysis of two separate trials. Cross-sectional design. 24-hour abstinence may not fully eliminate acute effects. Visual cue-reactivity may not capture all forms of craving. Cannot determine causation.
Questions This Raises
- ?Why does higher craving correlate with lower reward activation?
- ?Could cue-reactivity patterns predict treatment outcomes?
- ?Would longer abstinence change the brain activation pattern?
Trust & Context
- Key Stat:
- Higher craving = lower reward area activation (inverse pattern)
- Evidence Grade:
- Moderate: largest treatment-seeking CUD cue-reactivity sample to date, replicated across two cohorts, but cross-sectional and secondary analysis.
- Study Age:
- Published in 2025.
- Original Title:
- Exploring the Utility of a Functional Magnetic Resonance Imaging Cannabis Cue-Reactivity Paradigm in Treatment-Seeking Adults With Cannabis Use Disorder.
- Published In:
- Biological psychiatry. Cognitive neuroscience and neuroimaging, 10(5), 522-530 (2025)
- Authors:
- Sahlem, Gregory L(2), Dowdle, Logan T, Baker, Nathaniel L(12), Sherman, Brian J, Gray, Kevin M, McRae-Clark, Aimee L, Froeliger, Brett, Squeglia, Lindsay M
- Database ID:
- RTHC-07550
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
How does cannabis addiction affect the brain?
This fMRI study found that people seeking treatment for cannabis use disorder show heightened brain responses to cannabis images in executive function and reward regions, with increased connectivity between emotional and visual processing areas.
Can brain scans predict cannabis addiction severity?
This study found an unexpected pattern: higher self-reported craving was associated with lower, not higher, reward area activation, suggesting a more complex relationship between brain activity and addiction than simple reward-seeking models predict.
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Cite This Study
https://rethinkthc.com/research/RTHC-07550APA
Sahlem, Gregory L; Dowdle, Logan T; Baker, Nathaniel L; Sherman, Brian J; Gray, Kevin M; McRae-Clark, Aimee L; Froeliger, Brett; Squeglia, Lindsay M. (2025). Exploring the Utility of a Functional Magnetic Resonance Imaging Cannabis Cue-Reactivity Paradigm in Treatment-Seeking Adults With Cannabis Use Disorder.. Biological psychiatry. Cognitive neuroscience and neuroimaging, 10(5), 522-530. https://doi.org/10.1016/j.bpsc.2024.09.006
MLA
Sahlem, Gregory L, et al. "Exploring the Utility of a Functional Magnetic Resonance Imaging Cannabis Cue-Reactivity Paradigm in Treatment-Seeking Adults With Cannabis Use Disorder.." Biological psychiatry. Cognitive neuroscience and neuroimaging, 2025. https://doi.org/10.1016/j.bpsc.2024.09.006
RethinkTHC
RethinkTHC Research Database. "Exploring the Utility of a Functional Magnetic Resonance Ima..." RTHC-07550. Retrieved from https://rethinkthc.com/research/sahlem-2025-exploring-the-utility-of
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.