title: Insular and cingulate attenuation during decision making is associated with future transition to stimulant use disorder.
abstract: OBJECTIVE
  To understand processes placing individuals at risk for stimulant (amphetamine and cocaine) use disorder.
  
  
  METHODS
  Longitudinal study.
  
  
  METHODS
  University of California, San Diego Department of Psychiatry, CA, USA.
  
  
  METHODS
  Occasional stimulant users (OSU; n = 184) underwent a baseline clinical interview and a functional magnetic resonance imaging (fMRI) session. On the basis of a follow-up clinical interview completed 3 years later, OSU (n = 147) were then categorized as problem stimulant users (PSU: n = 36; those who developed stimulant use disorders in the interim) or desisted stimulant users (DSU: n = 74; those who stopped using). OSU who did not meet criteria for PSU or DSU (n = 37) were included in dimensional analyses.
  
  
  METHODS
  fMRI blood oxygen level-dependent (BOLD) contrast percentage signal change from baseline collected during a Paper-Scissors-Rock task was examined during three decision-making conditions, those resulting in: (1) wins, (2) ties and (3) losses. These data were used as dependent variables in categorical analyses comparing PSU and DSU, as well as dimensional analyses including interim drug use as predictors, controlling for baseline drug use.
  
  
  RESULTS
  PSU exhibited lower anterior cingulate, middle insula, superior temporal, inferior parietal, precuneus and cerebellum activation than DSU across all three conditions (significant brain clusters required > 19 neighboring voxels to exceed F(1,108)= 5.58, P < 0.01 two-tailed; all Cohen's d > 0.83). Higher interim marijuana use was linked to lower pre-central and superior temporal activation during choices resulting in wins (> 19 neighboring voxels to exceed t = 2.61, P < 0.01 two-tailed; R2change > 0.11).
  
  
  CONCLUSIONS
  Individuals who transition from stimulant use to stimulant use disorder appear to show alterations in neural processing of stimulus valuation and outcome monitoring, patterns also evident in chronic stimulant use disorder. Attenuated anterior cingulate and insular processing may constitute a high-risk neural processing profile, which could be used to calculate risk scores for individuals experimenting with stimulants.
authors.affiliation: Department of Psychology, Queens College, City University of New York, Flushing, NY, USA.|Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Stewart
authors.affiliation: Department of Psychology, Queens College, City University of New York, Flushing, NY, USA.
authors.forename: Mamona
authors.initials: M
authors.lastname: Butt
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: April C
authors.initials: AC
authors.lastname: May
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Tapert
authors.affiliation: Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.|Laureate Institute of Brain Research, Tulsa, OK, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Paulus
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology* / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods*; D002140:California; D000697:Central Nervous System Stimulants; D002540:Cerebral Cortex / Q000502:physiology*; D003657:Decision Making / Q000502:physiology*; D005260:Female; D006179:Gyrus Cinguli / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D012306:Risk; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants
keywords: Addiction; anterior cingulate; functional neuroimaging; insula; marijuana; reward; stimulants