Doubling down: increased risk-taking behavior following a loss by individuals with cocaine use disorder is associated with striatal and anterior cingulate dysfunction.
BACKGROUND
Cocaine use disorders (CUDs) have been associated with increased risk-taking behavior. Neuroimaging studies have suggested that altered activity in reward and decision-making circuitry may underlie cocaine user's heightened risk-taking. It remains unclear if this behavior is driven by greater reward salience, lack of appreciation of danger, or another deficit in risk-related processing.


METHODS
Twenty-nine CUD participants and forty healthy comparison participants completed the Risky Gains Task during a functional magnetic resonance imaging scan. During the Risky Gains Task, participants choose between a safe option for a small, guaranteed monetary reward and risky options with larger rewards but also the chance to lose money. Frequency of risky choice overall and following a win versus a loss were compared. Neural activity during the decision and outcome phase were examined using linear mixed effects models.


RESULTS
Although the groups did not differ in overall risk-taking frequency, the CUD group chose a risky option more often following a loss. Neuroimaging analyses revealed that the comparison group showed increasing activity in the bilateral ventral striatum as they chose higher-value, risky options, but the CUD group failed to show this increase. During the outcome phase, the CUD group showed a greater decrease in bilateral striatal activity relative to the comparison group when losing the large amount, and this response was correlated with risk-taking frequency after a loss.


CONCLUSIONS
The brains of CUD individuals are hypersensitive to losses, leading to increased risk-taking behaviors, and this may help explain why these individuals take drugs despite aversive outcomes.
Psychiatry, University of California San Diego, La Jolla, CA; Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD.
Joshua L
JL
Gowin
Psychiatry, University of California San Diego, La Jolla, CA.
April C
AC
May
Psychiatry, University of California San Diego, La Jolla, CA; Empirical and Analytical Psychophysics, Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany.
Marc
M
Wittmann
Psychiatry, University of California San Diego, La Jolla, CA; Psychology Service, VA San Diego Healthcare System, La Jolla, CA.
Susan F
SF
Tapert
Psychiatry, University of California San Diego, La Jolla, CA; Psychiatry Service, VA San Diego Healthcare System, La Jolla, CA; Laureate Institute for Brain Research, Tulsa, OK.
Martin P
MP
Paulus
Cocaine dependence; error signal; fMRI; neuroimaging; reward; striatum