Altered cingulate and insular cortex activation during risk-taking in methamphetamine dependence: losses lose impact.

AIMS: To determine if methamphetamine-dependent (MD) individuals exhibit behavioral or neural processing differences in risk-taking relative to healthy comparison participants (CTL).
DESIGN: This was a cross-sectional study comparing two groups' behavior on a risk-taking task and neural processing as assessed using functional magnetic resonance imaging (fMRI). SETTINGS: The study was conducted in an in-patient treatment center and a research fMRI facility in the United States. PARTICIPANTS: Sixty-eight recently abstinent MD individuals recruited from a treatment program and 40 CTL recruited from the community completed the study. MEASUREMENTS: The study assessed risk-taking behavior (overall and post-loss) using the Risky Gains Task (RGT), sensation-seeking, impulsivity and blood-oxygenation-level-dependent activation in the brain during the decision phase of the RGT.
FINDINGS: Relative to CTL, MD displayed decreased activation in the bilateral rostral anterior cingulate cortex (ACC) and greater activation in the left insula across risky and safe decisions (P < 0.05). Right mid-insula activation among CTL did not vary between risky and safe decisions, but among MD it was higher during risky relative to safe decisions (P < 0.05). Among MD, lower activation in the right rostral ACC (r = -0.39, P < 0.01) and higher activation in the right mid-insula (r = 0.35, P < 0.01) during risky decisions were linked to a higher likelihood of choosing a risky option following a loss.
CONCLUSIONS: Methamphetamine-dependent individuals show disrupted risk-related processing in both anterior cingulate and insula, brain areas that have been implicated in cognitive control and interoceptive processing. Attenuated neural processing of risky options may lead to risk-taking despite experiencing negative consequences.