title: Young adults at risk for stimulant dependence show reward dysfunction during reinforcement-based decision making.
abstract: BACKGROUND
  While stimulant-dependent individuals continue to make risky decisions, in spite of poor outcomes, much less is known about decision-making characteristics of occasional stimulant users (OSU) at risk for developing stimulant dependence. This study examines whether OSU exhibit inefficient learning and execution of reinforced decision-outcome contingencies.
  
  
  METHODS
  Occasional stimulant users (n = 161) and stimulant-naïve comparison subjects (CTL) (n = 48) performed a Paper Scissors Rock task during functional magnetic resonance imaging. Selecting a particular option was associated with a predetermined probability of winning, which was altered repeatedly to examine neural and behavioral characteristics of reinforced contingencies.
  
  
  RESULTS
  Occasional stimulant users displayed greater anterior insula, inferior frontal gyrus, and dorsal striatum activation than CTL during late trials when contingencies were familiar (as opposed to being learned) in the presence of comparable behavioral performance in both groups. Follow-up analyses demonstrated that during late trials: 1) OSU with high cannabis use displayed greater activation in these brain regions than CTL, whereas OSU with low cannabis use did not differ from the other two groups; and 2) OSU preferring cocaine exhibited greater anterior insula, inferior frontal gyrus, and dorsal striatum activation than CTL and also displayed higher activation in the former two regions than OSU who preferred prescription stimulants.
  
  
  CONCLUSIONS
  Occasional stimulant users exhibit inefficient resource allocation during the execution of reinforced contingencies that may be a result of additive effects of cocaine and cannabis use. A critical next step is to establish whether this inefficiency predicts transition to stimulant dependence.
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA 92037, USA. j6stewart@ucsd.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Stewart
authors.forename: Taru M
authors.initials: TM
authors.lastname: Flagan
authors.forename: April C
authors.initials: AC
authors.lastname: May
authors.forename: Martina
authors.initials: M
authors.lastname: Reske
authors.forename: Alan N
authors.initials: AN
authors.lastname: Simmons
authors.forename: Martin P
authors.initials: MP
authors.lastname: Paulus
mesh_terms: D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D003657:Decision Making / Q000502:physiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007858:Learning / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D012054:Reinforcement, Psychology; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000503:physiopathology / Q000523:psychology*; D055815:Young Adult