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.

中文翻译：

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有问题的药物使用的自我意识：一项新的fMRI任务的初步验证，以评估潜在的神经回路。

背景技术多种精神病理学特征损害了临床洞察力。新兴证据表明，洞察力问题可能同样是成瘾的特征，这可能是由于自指脑回路功能异常，包括前额扣带和腹侧前额叶皮层（rACC / vmPFC）。我们开发了一项新的功能磁共振成像任务，以探讨可卡因使用障碍（CUD）中的rACC / vmPFC异常是否构成了随时准备改变的神经相关性，这是有见识的一个方面。方法有18个当前CUD的个体和15个健康对照者对自己改变药物使用和饮食行为（对照条件）的需求以及对指定熟人进行相同改变的需求（另外两个对照条件）做出了回应。模拟药物选择行为，成瘾严重程度，并在扫描仪外部收集神经心理功能。结果CUD参与者感觉到行为改变的需求比对照者更大（正如预期的那样，考虑到他们的诊断），但是没有“同意”改变需求。在CUD中，较低的感知需求与较高的模拟药物选择行为相关，这是药物寻找的一种替代指标。在与药物相关的洞察力判断过程中，CUD参与者在内侧眶额叶皮层（rACC / vmPFC的一部分）的解剖学定义的目标区域（ROI）中的激活程度高于对照。尽管未显示组间差异，但在解剖定义的ACC ROI中的激活与洞察力相关的任务行为（在所有参与者中）和记忆力（在CUD中）相关。结论作为一个整体，当前有CUD的人似乎表现出轻度的洞察力问题和rACC / vmPFC异常，以应对改变行为的准备。通过复制和扩展这些结果，与洞察力相关的电路可能会成为一种新型治疗靶标。