The anterior insular cortex (AIC) and its interconnected brain regions have been associated with both addiction and decision‐making under uncertainty. However, the causal interactions in this uncertainty‐encoding neurocircuitry and how these neural dynamics impact relapse remain elusive. Here, we used model‐based fMRI to measure choice uncertainty in a motor decision task in 61 individuals with cocaine use disorder (CUD) and 25 healthy controls. CUD participants were assessed before discharge from a residential treatment program and followed for up to 24 weeks. We found that choice uncertainty was tracked by the AIC, dorsal anterior cingulate cortex (dACC) and ventral striatum (VS), across participants. Stronger activations in these regions measured pre‐discharge predicted longer abstinence after discharge in individuals with CUD. Dynamic causal modeling revealed an AIC‐to‐dACC‐directed connectivity modulated by uncertainty in controls, but a dACC‐to‐AIC connectivity in CUD participants. This reversal was mostly driven by early relapsers (<30 days). Furthermore, CUD individuals who displayed a stronger AIC‐to‐dACC excitatory connection during uncertainty encoding remained abstinent for longer periods. These findings reveal a critical role of an AIC‐driven, uncertainty‐encoding neurocircuitry in protecting against relapse and promoting abstinence.

中文翻译：

---

绝缘驱动网络可计算决策不确定性并促进可卡因长期使用者的戒酒

在不确定的情况下，前岛叶皮质（AIC）及其相互连接的大脑区域与成瘾和决策相关。但是，这种不确定性编码神经回路中的因果关系以及这些神经动力​​学如何影响复发仍然难以捉摸。在这里，我们使用基于模型的功能磁共振成像技术来测量61名可卡因使用障碍（CUD）和25名健康对照者的运动决策任务中的选择不确定性。对CUD参与者的评估是在其退出住院治疗计划之前进行的，随访时间长达24周。我们发现，参与者之间的AIC，背扣带前皮质（dACC）和腹侧纹状体（VS）跟踪了选择不确定性。在出院前测量的这些区域中较强的激活作用预计会导致CUD个体出院后戒断时间更长。动态因果模型揭示了AIC到dACC的连通性受到控件不确定性的调节，但CUD参与者中的dACC到AIC的连通性却受到控制。这种逆转主要是由早期复发者（<30天）引起的。此外，在不确定性编码过程中显示出更强的AIC与dACC兴奋性联系的CUD个人仍需较长时间戒断。这些发现揭示了由AIC驱动，不确定性编码的神经回路在预防复发和促进节欲方面的关键作用。在不确定性编码过程中显示出更强的AIC与dACC兴奋性联系的CUD个人将长期禁欲。这些发现揭示了由AIC驱动，不确定性编码的神经回路在预防复发和促进节欲方面的关键作用。在不确定性编码过程中显示出更强的AIC与dACC兴奋性联系的CUD个人将长期禁欲。这些发现揭示了由AIC驱动，不确定性编码的神经回路在预防复发和促进节欲方面的关键作用。