Abstract
Addiction is considered a disorder that drives individuals to choose drugs at the expense of healthier alternatives. However, chronic cocaine users (CCUs) who meet addiction criteria retain the ability to choose money in the presence of the opportunity to choose cocaine. The neural mechanisms that differentiate CCUs from non-cocaine using controls (Controls) while executing these preferred choices remain unknown. Thus, therapeutic strategies aimed at shifting preferences towards healthier alternatives remain somewhat uninformed. This study used BOLD neuroimaging to examine brain activity as fifty CCUs and Controls performed single- and cross-commodity intertemporal choice tasks for money and/or cocaine. Behavioral analyses revealed preferences for each commodity type. Imaging analyses revealed the brain activity that differentiated CCUs from Controls while choosing money over cocaine. We observed that CCUs devalued future commodities more than Controls. Choices for money as opposed to cocaine correlated with greater activity in dorsal striatum of CCUs, compared to Controls. In addition, choices for future money as opposed to immediate cocaine engaged the left dorsolateral prefrontal cortex (DLPFC) of CCUs more than Controls. These data suggest that the ability of CCUs to execute choices away from cocaine relies on activity in the dorsal striatum and left DLPFC.
Highlights
A hallmark of addiction is choosing drugs at the expense of healthier alternatives [1]
The average (±SD) number of cigarettes smoked by Controls was 2.1 (±3.6) per day and did not differ from 4.5 (±4.2) cigarettes smoked by cocaine users (CCUs), t(48) = 0.18, P > 0.05
The distribution of Controls and CCUs collected at the two experimental locations did not differ from expected values (BCM: Controls = 14, CCUs = 20; Virginia Tech Carilion Research Center (VTCRI): Controls = 11, CCUs = 5), χ2 (1, n = 50) = 3.309, P > 0.05
Summary
A hallmark of addiction is choosing drugs at the expense of healthier alternatives [1]. Much scientific evidence supports the hypothesis that the neural systems that balance immediate desires with long-term gains [3,4,5] function suboptimally in CCUs [6,7,8] and the very mechanisms evolved to protect are compromised in ways that drive addicts to choose cocaine. While this narrative organizes a wealth of experimental data, it deemphasizes an important observation: not all decisions made by CCUs are unhealthy choices for drugs. A logical question becomes, Journal of Addiction “What if cocaine users are choosing money with the intent to obtain cocaine and/or other commodities later?” If so, these individuals are planning for the future and executing an advantageous preference away from an available drug of abuse
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