Individuals with cocaine use disorder (CUD) have difficulty monitoring ongoing behavior, possibly stemming from dysfunction of brain regions subserving insight and self-awareness [e.g., anterior cingulate cortex (ACC)].
To test the hypothesis that CUD with impaired insight (iCUD) would show abnormal (A) ACC activity during error processing, assessed with functional magnetic resonance imaging during a classic inhibitory control task; (B) ACC gray matter integrity assessed with voxel-based morphometry; and (C) awareness of one’s own emotional experiences, assessed with the Levels of Emotional Awareness Scale (LEAS). Using a previously validated probabilistic choice task, we grouped 33 CUD according to insight [iCUD: N=15; unimpaired insight CUD: N=18]; we also studied 20 healthy controls, all with unimpaired insight.
Multimodal imaging design.
Clinical Research Center at Brookhaven National Laboratory.
Thirty-three CUD and 20 healthy controls.
Main Outcome Measure
Functional magnetic resonance imaging, voxel-based morphometry, LEAS, and drug use variables.
Compared with the other two study groups, iCUD showed lower (A) error-induced rostral ACC (rACC) activity as associated with more frequent cocaine use; (B) gray matter within the rACC; and (C) LEAS scores.
These results point to rACC functional and structural abnormalities, and diminished emotional awareness, in a subpopulation of CUD characterized by impaired insight. Because the rACC has been implicated in appraising the affective/motivational significance of errors and other types of self-referential processing, functional and structural abnormalities in this region could result in lessened concern (frequently ascribed to minimization and denial) about behavioral outcomes that could potentially culminate in increased drug use. Treatments targeting this CUD subgroup could focus on enhancing the salience of errors (e.g., lapses).