title: Altered risk-related processing in substance users: imbalance of pain and gain.
abstract: BACKGROUND
  Substance use disorders (SUDs) can be conceptualized as a form of risk-taking behavior with the potential for highly aversive outcomes such as health or legal problems. Risky decision-making likely draws upon several related brain processes involved in estimations of value and risk, executive control, and emotional processing. SUDs may result from a dysfunction in one or more of these cognitive processes.
  
  
  METHODS
  We performed a systematic literature review of functional neuroimaging studies examining risk-related decision making in individuals with SUDs. A quantitative meta-analysis tool (GingerALE) and qualitative approach was used to summarize the imaging results.
  
  
  RESULTS
  Meta-analysis findings indicate that individuals with SUDs exhibit differences in neural activity relative to healthy controls during risk-taking in the anterior cingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex, striatum, insula, and somatosensory cortex. In addition, a qualitative review of the literature suggests that individuals with SUDs may have altered function in the amygdala and ventromedial prefrontal cortex.
  
  
  CONCLUSIONS
  The neuroimaging literature reveals that several neural substrates involved in the computation of risk may function suboptimally in SUDs. Future research is warranted to elucidate which computational processes are affected, whether dysfunctional risk-related processing recovers with sobriety, and whether different drugs of abuse have specific effects on risk-taking.
authors.affiliation: Laboratory of Biological Dynamics and Theoretical Medicine, University of California San Diego, La Jolla, CA 92093-0603, USA. jgowin@ucsd.edu
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Gowin
authors.forename: Scott
authors.initials: S
authors.lastname: Mackey
authors.forename: Martin P
authors.initials: MP
authors.lastname: Paulus
mesh_terms: D000818:Animals; D001921:Brain / Q000502:physiology; D004644:Emotions / Q000502:physiology; D006801:Humans; D016013:Likelihood Functions; D010146:Pain / Q000523:psychology*; D012309:Risk-Taking; D019966:Substance-Related Disorders / Q000523:psychology*
keywords: Addiction; Decision-making; Drug abuse; Neuroimaging; Risk-taking