Brain scans show biological differences in brains of cocaine addicts with poor self-awareness

By Rob Goodier

NEW YORK (Reuters Health) - Functional magnetic resonance imaging reveals different activity in the brains of cocaine addicts who have a lack of self-awareness, a new study has found.

Compared with healthy controls and addicts who demonstrate normal self-awareness, the addicts with impaired insight had less activity in the rostral anterior cingulate cortex (rACC) when they made errors on a test.

"These abnormalities were correlated with increased cocaine use, possibly suggesting a more severe addiction in these individuals with impaired insight who might require additional therapeutic attention," said senior author Dr. Rita Goldstein, chief of the Neuropsychoimaging of Addiction and Related Conditions Research Program at the Icahn School of Medicine at Mount Sinai in New York.

"By identifying a targeted subgroup of addicted individuals as we have done here, we can hopefully ensure the most efficient use of scarce clinical resources," she told Reuters Health by email.

The findings were published online November 20 in JAMA Psychiatry.

The study first required the identification of cocaine addicts who have impaired insight versus those who do not. A study group of 33 addicts rated photos and then afterward estimated how they rated the photos. There were 18 whose estimates and actual scores were similar, and they were deemed to have normal self-awareness or insight. The other 15 had a wider discrepancy between the scores and they were classified as having impaired insight.

Both groups were also compared to 20 healthy, non-addicted control participants who had all passed the self-awareness test.

The participants took color-word Stroop tests while undergoing fMRI. The addicts with impaired insight not only showed quantifiable differences in activity in the rACC; they also had less gray matter in that region of the brain and scored lower on the Levels of Emotional Awareness Scale.

"Our findings challenge the long-held clinical assumption that addicted individuals continue their compulsive drug use because of denial, rationalization, insufficient willpower, or minimization of their problems. We think our findings could encourage physicians to interact with this admittedly difficult population with more empathy and compassion," Dr. Goldstein says.

The findings and this line of research could inspire future treatments for these patients, the researchers say. Those could include interviews before therapy to motivate an addict to seek treatment and mindful meditation to heighten the addict's awareness of triggers for cravings and relapses.

"The goal of these therapies would be to help counteract the anterior cingulate abnormalities, improve self-awareness and self-control, and ultimately decrease problematic drug abuse. Nevertheless, it is important to emphasize that such treatment options still need to be tested for efficacy in future studies," Dr. Goldstein says.

SOURCE: http://bit.ly/1glumEu

JAMA Psychiatry 2013.

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