title: Functional, structural, and emotional correlates of impaired insight in cocaine addiction.
abstract: OBJECTIVE
  Individuals with cocaine use disorder (CUD) have difficulty monitoring ongoing behavior, possibly stemming from dysfunction of brain regions mediating insight and self-awareness.
  
  
  OBJECTIVE
  To investigate the neural correlates of impaired insight in addiction using a combined functional magnetic resonance imaging and voxel-based morphometry approach.
  
  
  METHODS
  This multimodal imaging study was performed at the Clinical Research Center at Brookhaven National Laboratory. The study included 33 CUD cases and 20 healthy controls.
  
  
  METHODS
  Functional magnetic resonance imaging, voxel-based morphometry, Levels of Emotional Awareness Scale, and drug use variables.
  
  
  RESULTS
  Compared with the other 2 study groups, the impaired insight CUD group had lower error-induced rostral anterior cingulate cortex (rACC) activity as associated with more frequent cocaine use, less gray matter within the rACC, and lower Levels of Emotional Awareness Scale scores.
  
  
  CONCLUSIONS
  These results point to rACC functional and structural abnormalities and diminished emotional awareness in a subpopulation of CUD cases characterized by impaired insight. Because the rACC has been implicated in appraising the affective and motivational significance of errors and other types of self-referential processing, functional and structural abnormalities in this region could result in lessened concern (frequently ascribed to minimization and denial) about behavioral outcomes that could potentially culminate in increased drug use. Treatments that target this CUD subgroup could focus on enhancing the salience of errors (eg, lapses).
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Moeller
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York2Department of Psychology, Stony Brook University, Stony Brook, New York.
authors.forename: Anna B
authors.initials: AB
authors.lastname: Konova
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Parvaz
authors.affiliation: National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland.
authors.forename: Dardo
authors.initials: D
authors.lastname: Tomasi
authors.affiliation: Department of Psychiatry, University of Arizona, Tucson.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lane
authors.affiliation: Department of Psychiatry, University of Arizona, Tucson.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Fort
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rita Z
authors.initials: RZ
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D001364:Awareness / Q000502:physiology*; D001921:Brain / Q000502:physiology / Q000503:physiopathology*; D016022:Case-Control Studies; D019970:Cocaine-Related Disorders / Q000503:physiopathology* / Q000523:psychology; D004644:Emotions / Q000502:physiology*; D005260:Female; D059907:Functional Neuroimaging; D006179:Gyrus Cinguli / Q000502:physiology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D057190:Stroop Test