Abstract
Previous studies suggest that psychopathic traits commonly present as comorbid with substance use disorders. Moreover, neuroimaging and psychometric findings suggest that psychopathic traits may predispose individuals to a sensitized reward response to drugs. Given that substance use disorders are characterized by a neurocognitive bias toward drug-reward relative to non-drug reward, it is possible that heightened psychopathic characteristics may further predispose to this processing bias. To evaluate this possibility, we assessed psychopathic traits (measured using the PCL-R; Hare, 2003) in 105 probationers/parolees and evaluated the relationship between PCL-R scores, lifetime duration of drug use, and biases in neural response to drug- compared to food-related videos. Psychopathic traits (potentially driven by interpersonal/affective traits) were positively correlated with drug > food reactivity within the right insula and left amygdala. In addition, psychopathic traits modulated the relationship between drug use and drug > food reactivity within the left dorsomedial prefrontal cortex, right insula, and left caudate nucleus. Specifically, lifetime duration of drug use correlated positively with drug > food reactivity in participants with lower levels of psychopathic traits and correlated negatively with drug > food reactivity in individuals with higher levels of psychopathic traits. These results help reconcile prior studies on psychopathy and drug-stimulus processing and provide neurocognitive support for the notion that psychopathic traits serve as an underlying risk factor for substance use disorders. These results suggest that different treatment regimens for substance abuse for individuals with higher or lower levels of psychopathy may be beneficial and suggest that reduction of neurocognitive biases to drug-related stimuli may offer useful targets for future treatment protocols.
Highlights
Within adults with psychopathic traits, this dysfunction appears to manifest as consistently heightened sensitivity to a wide variety of rewarding stimuli within the ventral striatum, including monetary (Buckholtz et al, 2010; Bjork et al, 2012; Carré et al, 2013; Pujara et al, 2013) and drug-related (Buckholtz et al, 2010) rewards (though we note that children/adolescent with heightened callous-unemotional traits often show a normal [(Murray et al, 2017; Byrd et al, 2018) or hypersensitive (Veroude et al, 2016) ventral striatal response to reward]
Given that between-group analyses confirmed that cocainedependent individuals were characterized by a depicting people preparing or using cocaine/crack (DRUG) > FOOD processing bias compared to Non-dependent participants, we evaluated the extent to which psychopathic traits and substance use history would relate to this processing bias
Results indicated that Psychopathy Checklist-Revised (PCL-R) scores, but not Major Drug Use, were positively correlated with activity within several regions, including right insula and left amygdala regions of interest (ROIs)
Summary
Psychopathic individuals have frequently been characterized as impulsive and irresponsible risk takers, with an altered sensitivity to reward and reward-related stimuli (Cleckley, 1941; Mitchell et al, 2002; Hare, 2003; Ross et al, 2007; Wallace et al, 2009; Morgan et al, 2011; Hopley and Brunelle, 2012; Beszterczey et al, 2013; Dean et al, 2013; Salim et al, 2015). Psychopathic traits have been associated with increased functional connectivity between the ventral striatum and the dorsomedial prefrontal cortex (DMPFC) in response to monetary rewards (Geurts et al, 2016)
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