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Self-awareness of problematic drug use: Preliminary validation of a new fMRI task to assess underlying neurocircuitry.

  • Author(s): Moeller, Scott J
  • Kundu, Prantik
  • Bachi, Keren
  • Maloney, Thomas
  • Malaker, Pias
  • Parvaz, Muhammad A
  • Alia-Klein, Nelly
  • London, Edythe D
  • Goldstein, Rita Z
  • et al.

Published Web Location

https://pubmed.ncbi.nlm.nih.gov/32145661/
No data is associated with this publication.
Abstract

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.

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