title: Cocaine dependent individuals with attenuated striatal activation during reinforcement learning are more susceptible to relapse.
abstract: Cocaine-dependent individuals show altered brain activation during decision making. It is unclear, however, whether these activation differences are related to relapse vulnerability. This study tested the hypothesis that brain-activation patterns during reinforcement learning are linked to relapse 1 year later in individuals entering treatment for cocaine dependence. Subjects performed a Paper-Scissors-Rock task during functional magnetic resonance imaging (fMRI). A year later, we examined whether subjects had remained abstinent (n=15) or relapsed (n=15). Although the groups did not differ on demographic characteristics, behavioral performance, or lifetime substance use, abstinent patients reported greater motivation to win than relapsed patients. The fMRI results indicated that compared with abstinent individuals, relapsed users exhibited lower activation in (1) bilateral inferior frontal gyrus and striatum during decision making more generally; and (2) bilateral middle frontal gyrus and anterior insula during reward contingency learning in particular. Moreover, whereas abstinent patients exhibited greater left middle frontal and striatal activation to wins than losses, relapsed users did not demonstrate modulation in these regions as a function of outcome valence. Thus, individuals at high risk for relapse relative to those who are able to abstain allocate fewer neural resources to action-outcome contingency formation and decision making, as well as having less motivation to win on a laboratory-based task.
authors.affiliation: Laboratory of Biological Dynamics and Theoretical Medicine, Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037-0855, USA. Electronic address: j6stewart@ucsd.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Stewart
authors.affiliation: Laboratory of Biological Dynamics and Theoretical Medicine, Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037-0855, USA; Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA.
authors.forename: Colm G
authors.initials: CG
authors.lastname: Connolly
authors.affiliation: Laboratory of Biological Dynamics and Theoretical Medicine, Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037-0855, USA.
authors.forename: April C
authors.initials: AC
authors.lastname: May
authors.affiliation: Laboratory of Biological Dynamics and Theoretical Medicine, Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037-0855, USA; Psychiatry Service, VA San Diego Healthcare System, La Jolla, CA 92161, USA.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Tapert
authors.affiliation: Laboratory of Biological Dynamics and Theoretical Medicine, Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037-0855, USA; Psychiatry Service, VA San Diego Healthcare System, La Jolla, CA 92161, USA; Department of Empirical and Analytical Psychophysics, Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Wittmann
authors.affiliation: Laboratory of Biological Dynamics and Theoretical Medicine, Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037-0855, USA; Psychiatry Service, VA San Diego Healthcare System, La Jolla, CA 92161, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Paulus
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology; D002540:Cerebral Cortex / Q000503:physiopathology; D019970:Cocaine-Related Disorders / Q000503:physiopathology*; D003342:Corpus Striatum / Q000503:physiopathology*; D003657:Decision Making; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D007858:Learning; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012008:Recurrence; D012054:Reinforcement, Psychology; D012201:Reward; D019966:Substance-Related Disorders / Q000503:physiopathology
keywords: Abstinence; Cocaine dependence; Functional magnetic resonance imaging; Relapse; Reward