title: Impaired insight in cocaine addiction: laboratory evidence and effects on cocaine-seeking behaviour.
abstract: Neuropsychiatric disorders are often characterized by impaired insight into behaviour. Such an insight deficit has been suggested, but never directly tested, in drug addiction. Here we tested for the first time this impaired insight hypothesis in drug addiction, and examined its potential association with drug-seeking behaviour. We also tested potential modulation of these effects by cocaine urine status, an individual difference known to impact underlying cognitive functions and prognosis. Sixteen cocaine addicted individuals testing positive for cocaine in urine, 26 cocaine addicted individuals testing negative for cocaine in urine, and 23 healthy controls completed a probabilistic choice task that assessed objective preference for viewing four types of pictures (pleasant, unpleasant, neutral and cocaine). This choice task concluded by asking subjects to report their most selected picture type; correspondence between subjects' self-reports with their objective choice behaviour provided our index of behavioural insight. Results showed that the urine positive cocaine subjects exhibited impaired insight into their own choice behaviour compared with healthy controls; this same study group also selected the most cocaine pictures (and fewest pleasant pictures) for viewing. Importantly, however, it was the urine negative cocaine subjects whose behaviour was most influenced by insight, such that impaired insight in this subgroup only was associated with higher cocaine-related choice on the task and more severe actual cocaine use. These findings suggest that interventions to enhance insight may decrease drug-seeking behaviour, especially in urine negative cocaine subjects, potentially to improve their longer-term clinical outcomes.
authors.affiliation: Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Moeller
authors.forename: Thomas
authors.initials: T
authors.lastname: Maloney
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Parvaz
authors.forename: Nelly
authors.initials: N
authors.lastname: Alia-Klein
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Woicik
authors.forename: Frank
authors.initials: F
authors.lastname: Telang
authors.forename: Gene-Jack
authors.initials: GJ
authors.lastname: Wang
authors.forename: Nora D
authors.initials: ND
authors.lastname: Volkow
authors.forename: Rita Z
authors.initials: RZ
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D016739:Behavior, Addictive; D002755:Choice Behavior; D003042:Cocaine / Q000652:urine*; D019970:Cocaine-Related Disorders / Q000523:psychology* / Q000652:urine; D032882:Comprehension; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012647:Self-Assessment
chemical_list: D003042:Cocaine
references.citation: J Anal Toxicol. 1993 Jul-Aug;17(4):241-5
references.pmid: 8371556
references.citation: Nat Neurosci. 2009 Dec;12(12):1494-6
references.pmid: 19881506
references.citation: Biol Psychiatry. 2009 Jul 15;66(2):169-76
references.pmid: 19358975
references.citation: Neuropsychopharmacology. 2009 Apr;34(5):1112-22
references.pmid: 18496524
references.citation: J Abnorm Psychol. 2008 May;117(2):428-34
references.pmid: 18489219
references.citation: Neuropsychopharmacology. 2007 Sep;32(9):1974-84
references.pmid: 17268406
references.citation: Am J Psychiatry. 2002 Oct;159(10):1642-52
references.pmid: 12359667
references.citation: Trends Cogn Sci. 2009 Sep;13(9):372-80
references.pmid: 19716751
references.citation: J Neurosci. 2006 Jun 14;26(24):6583-8
references.pmid: 16775146
references.citation: J Psychopharmacol. 2010 Feb;24(2):257-66
references.pmid: 18801822
references.citation: Nat Neurosci. 2008 Apr;11(4):514-20
references.pmid: 18311134
references.citation: Psychopharmacology (Berl). 2004 Mar;172(3):316-23
references.pmid: 14647955
references.citation: Am J Drug Alcohol Abuse. 2007;33(2):191-206
references.pmid: 17497542
references.citation: Philos Trans R Soc Lond B Biol Sci. 2008 Oct 12;363(1507):3125-35
references.pmid: 18640910
references.citation: Nat Neurosci. 2004 Mar;7(3):211-4
references.pmid: 15001989
references.citation: Neuroscientist. 2008 Apr;14(2):203-22
references.pmid: 18057389
references.citation: Curr Opin Neurol. 2009 Dec;22(6):606-11
references.pmid: 19809315
references.citation: Int Rev Neurobiol. 2004;62:159-93
references.pmid: 15530572
references.citation: Addict Behav. 1998 Jul-Aug;23(4):449-61
references.pmid: 9698974
references.citation: Am J Psychiatry. 2007 Jan;164(1):43-51
references.pmid: 17202543
references.citation: Nat Rev Neurosci. 2009 Jan;10(1):59-70
references.pmid: 19096369
references.citation: J Korean Med Sci. 2007 Feb;22(1):132-7
references.pmid: 17297266
references.citation: Exp Clin Psychopharmacol. 2001 Feb;9(1):3-13
references.pmid: 11519632
references.citation: J Pers Assess. 1990 Fall;55(1-2):124-34
references.pmid: 2231235
references.citation: J Behav Ther Exp Psychiatry. 1994 Mar;25(1):49-59
references.pmid: 7962581
references.citation: Psychophysiology. 2008 Sep;45(5):705-13
references.pmid: 18513362
references.citation: Addiction. 1999 Mar;94(3):327-40
references.pmid: 10605857
references.citation: Neuropsychopharmacology. 2009 Oct;34(11):2450-8
references.pmid: 19553917
references.citation: Am J Addict. 2009 Jan-Feb;18(1):81-6
references.pmid: 19219669
references.citation: Am J Psychiatry. 1999 Jan;156(1):19-26
references.pmid: 9892293