TY - JOUR
T1 - Self-awareness of problematic drug use
T2 - Preliminary validation of a new fMRI task to assess underlying neurocircuitry
AU - Moeller, Scott J.
AU - Kundu, Prantik
AU - Bachi, Keren
AU - Maloney, Thomas
AU - Malaker, Pias
AU - Parvaz, Muhammad A.
AU - Alia-Klein, Nelly
AU - London, Edythe D.
AU - Goldstein, Rita Z.
N1 - Publisher Copyright:
© 2020
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Multiple psychopathologies feature impaired clinical insight. Emerging evidence suggests that insight problems may similarly characterize addiction, perhaps due to aberrant functioning of self-referential brain circuitry, including the rostral anterior cingulate and ventromedial prefrontal cortices (rACC/vmPFC). We developed a new fMRI task to probe whether rACC/vmPFC abnormalities in cocaine use disorder (CUD) constitute neural correlates of readiness to change, one facet of insight. Methods: Eighteen individuals with current CUD and 15 healthy controls responded about their own need to change their drug use and eating behavior (control condition) and the need for a named acquaintance to do the same (two additional control conditions). Measures of simulated drug-choice behavior, addiction severity, and neuropsychological function were collected outside the scanner. Results: CUD participants perceived a greater need for behavior change than controls (as expected, given their diagnosis), but fell short of “agreeing” to a need for change; in CUD, lower perceived need correlated with higher simulated drug-choice behavior, a proxy measure of drug-seeking. During drug-related insight judgments, CUD participants had higher activation than controls in an anatomically-defined region of interest (ROI) in the medial orbitofrontal cortex, part of the rACC/vmPFC. Although not showing group differences, activation in an anatomically-defined ACC ROI correlated with insight-related task behavior (in all participants) and memory performance (in CUD). Conclusions: As a group, individuals with current CUD appear to show mild insight problems and rACC/vmPFC abnormalities vis-à-vis readiness to change behavior. With replication and extension of these results, insight-related circuitry may emerge as a novel therapeutic target.
AB - Background: Multiple psychopathologies feature impaired clinical insight. Emerging evidence suggests that insight problems may similarly characterize addiction, perhaps due to aberrant functioning of self-referential brain circuitry, including the rostral anterior cingulate and ventromedial prefrontal cortices (rACC/vmPFC). We developed a new fMRI task to probe whether rACC/vmPFC abnormalities in cocaine use disorder (CUD) constitute neural correlates of readiness to change, one facet of insight. Methods: Eighteen individuals with current CUD and 15 healthy controls responded about their own need to change their drug use and eating behavior (control condition) and the need for a named acquaintance to do the same (two additional control conditions). Measures of simulated drug-choice behavior, addiction severity, and neuropsychological function were collected outside the scanner. Results: CUD participants perceived a greater need for behavior change than controls (as expected, given their diagnosis), but fell short of “agreeing” to a need for change; in CUD, lower perceived need correlated with higher simulated drug-choice behavior, a proxy measure of drug-seeking. During drug-related insight judgments, CUD participants had higher activation than controls in an anatomically-defined region of interest (ROI) in the medial orbitofrontal cortex, part of the rACC/vmPFC. Although not showing group differences, activation in an anatomically-defined ACC ROI correlated with insight-related task behavior (in all participants) and memory performance (in CUD). Conclusions: As a group, individuals with current CUD appear to show mild insight problems and rACC/vmPFC abnormalities vis-à-vis readiness to change behavior. With replication and extension of these results, insight-related circuitry may emerge as a novel therapeutic target.
KW - Addiction
KW - Behavior change
KW - Insight
KW - Orbitofrontal cortex
KW - Self-awareness
KW - fMRI
UR - http://www.scopus.com/inward/record.url?scp=85080109962&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2020.107930
DO - 10.1016/j.drugalcdep.2020.107930
M3 - Article
C2 - 32145661
AN - SCOPUS:85080109962
SN - 0376-8716
VL - 209
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
M1 - 107930
ER -