Aversion processing in opioid use disorder and the clinical implications

• Applicant: Professorin Dr. Karen Ersche
• Subject Area: Biological Psychiatry
• Term: since 2025
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 570071079

Opioids are amongst the most addictive drugs on the drug market and opioid use disorder poses a global threat to public health. Although in Germany the use of opioids has been fairly stable for many years, there has been a progressive increase in opioids-related deaths, which rarely makes headlines. One account for this stark increase is the relatively high number of opioid-dependent patients discontinuing their treatment prematurely. Previous studies have shown that young men, in particular, are at risk of dropping out of treatment early, but the causal factors for the drop out are still elusive. Clinical observations point towards patients’ exaggerated avoidance behavior which is likely to play a role in their decision to discontinue treatment. Yet, this hypothesis has, to the best of our knowledge, not yet been systematically investigated. The present study therefore aims to i) investigate aversion processing in opioid use disorder, ii) determine the underlying neuropsychological and endocrine mechanisms, and iii) clarify the clinical implications. In a two-stage process, we will first assess emotional processing in a representative and diagnostically diverse sample of patients with opioid use disorder undergoing substitution therapy. A subgroup of male patients will then be invited for an additional session to investigate the neural substrates and endocrine mechanisms underlying altered fear and safety learning using neuroimaging technology and endocrine markers. The proposed study will characterise and document the clinical needs of patients with opioid use disorder, based on scientific evidence. The use of neuroimaging technology and selective experimental tasks will help us determine optimal mechanistic approaches to improve treatment retention and clinical outcome of these patients.

• DFG Programme: Research Grants
• International Connection: United Kingdom
• Co-Investigator: Professor Dr. Bernd Lenz
• Cooperation Partner: Dr. Tsen Vei Lim