Abstract
s / Drug and Alcohol Dependence 146 (2015) e34–e117 e109 Attenuated insular and frontocingulate decision-making related activation during an aversive interoceptive state in methamphetamine-dependent individuals Jennifer L. Stewart1, April C. May1, Natasha Poppa1, Paul W. Davenport2, Susan F. Tapert3,1, Martin P. Paulus3,1 1 Psychiatry, University of California, San Diego, La Jolla, CA, United States 2 Physiological Sciences, University of Florida, Gainesville, FL, United States 3 Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States Aims: Stimulant dependent individuals oftenmake drug-taking decisions when they do not feel well. Yet few studies have examined the influence of an aversive state on decision-making relatedneuralprocessing.We investigatebrainactivation toactionoutcome contingencies during an aversive interoceptive challenge in methamphetamine users using functional magnetic resonance imaging (fMRI). Methods: Abstinent methamphetamine dependent inpatients (MD; n=20) and healthy comparison subjects (CTL; n=22) performed a two-choice prediction task at three fixed error rates (20%= reward, 50%=uncertainty, 80%=punishment) while anticipating and experiencing episodes of inspiratory breathing load during fMRI. Participants rated breathing load unpleasantness/intensity using visual analog scales (VAS). Results: MD exhibited lower anterior insula (AI) and inferior frontal gyrus (IFG) activation thanCTLacross trials.MDalso showed lower posterior insula (PI) and anterior cingulate cortex (ACC) activation than CTL during breathing load independent of error rate. For the crucial error rate by interoception interaction, MD displayed lower dorsal ACC activation to punishment than CTL during breathing load. Within MD, higher VAS unpleasantness was linked to lowerdorsalACCactivation topunishmentduring loadedbreathing. Conclusions: AI/IFG attenuations in MD are suggestive of a global decision making deficit, reflecting reduced resources allocated to the processing of action-outcome contingencies. In contrast, PI/ACC reductions in MD appear specific to impairments in registering and evaluating interoceptive experiences. Taken together, inadequate activationof brain areas that are important for regulatinghowone feels during anaversive interoceptive statemay be the neural basis for poor decision-making by MD individuals. Financial support: NIDA 5P20DA027843-04. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.663 Evidence of gender-specific telescoping effects in chronic, regular heroin users Jonathan J. Stoltman, Eric A. Woodcock, Leslie Lundahl, Mark K. Greenwald Psychiatry, Wayne State University, Detroit, MI,
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