Error Detection and Error Awareness in Incarcerated Cocaine Dependent Individuals

描述（由申请人提供）：现实世界的经验和临床研究都表明，物质依赖的个体将继续使用药物，尽管他们经常强烈地希望停止服用药物。这表明依赖的一个主要特征是抑制功能失调行为模式的能力降低，尽管有明确的证据表明它们的不适应（Paulus等，2002）。越来越多的行为学、认知学、电生理学和神经影像学研究表明，可卡因依赖者对内部和外部产生的错误信号表现出核心不敏感。这种不敏感可能会降低指导适应性行为调节的能力，并可能促进对功能失调行为模式的持续增加，包括重复吸毒行为和共病犯罪。尽管这方面的工作越来越多，但这些错误监测缺陷的性质在很大程度上仍未得到区分。错误监控至少由两个潜在的独立过程组成：一个是自动错误检测系统，它监视目标导向行为中的错误，另一个是与该错误的有意识表征相关的不太自动的系统。大多数评估药物依赖人群错误监测的工作都集中在错误检测上，并报告了一致的损害。然而，目前对可卡因依赖人群的主观错误意识状况了解甚少，因此无法就这些错误监测缺陷的潜在性质得出明确结论。最近的发展已经确定了系统地询问错误检测和错误意识指数的方法。本研究旨在利用多模态成像（ERP/fMRI）来表征在押可卡因依赖者错误监测的自动和有意识组成部分的神经回路的完整性。为此，MIND研究所最近购置了一台最先进的移动核磁共振扫描仪，目前部署在新墨西哥州西部监狱。在过去的两个月里，我们在这个设施内完成了235次扫描，并且认为移动扫描仪提供了一个前所未有的机会来检查与监禁人群错误监测有关的神经认知系统。在这里，我们建议利用高分辨率电生理学和功能性磁共振成像来评估15名监禁可卡因依赖者、15名匹配的监禁非依赖者和15名匹配的非监禁健康对照者的错误监测系统的完整性。我们假设，被监禁的可卡因依赖者会表现出较低的错误意识，这种损害将预测相关的结果测量，包括药物使用的严重程度和共病犯罪活动的水平。我们的目标是利用I/START机制为一项协议提供支持，我们预计该协议将作为一项更大、更全面的研究工作的试点数据，重点研究神经认知对可卡因依赖者错误监测完整性的影响。药物成瘾的慢性和重复性表明，药物依赖者可能难以识别并从中学习其适应不良的行为模式。这些学习缺陷可能源于目标导向行为中识别和监测错误的过程中的核心缺陷，并可能导致持续吸毒和惯犯犯罪倾向。本研究将收集来自在押可卡因依赖个体的电生理（EEG）和功能磁共振成像（fMRI）数据，以便更好地表征这些错误监测缺陷的性质。这项工作的结果将有助于描述药物依赖和共病犯罪的机制，并将为针对药物依赖人群中认知能力受损的治疗提供更多的见解。

DESCRIPTION (provided by applicant): Real-world experience and clinical research converge in demonstrating that substance-dependent individuals will continue to use drugs despite an often strong desire to cease taking drugs. This suggests that a cardinal characteristic of dependency is reduced ability to inhibit dysfunctional action patterns despite clear evidence of their maladaptivity (Paulus et al., 2002). A growing body of behavioral, cognitive, electrophysiological and neuroimaging work suggests that cocaine-dependent individuals evidence core insensitivity to internally- and externally-generated signals of error. This insensitivity may reduce the ability to guide adaptive behavioral regulation, and may promote increased perseveration on dysfunctional action patterns, including repetitive drug-taking behavior and comorbid criminality. Despite this growing body of work, the nature of these error- monitoring deficits remains largely undifferentiated, however. Error-monitoring is composed of at least two potentially independent processes: an automatic error detection system that monitors for errors in goal-directed behavior and a less automatic system related to the conscious representation of that error. The majority of work evaluating error-monitoring in substance-dependent populations has focused on error-detection, and has reported consistent impairment. Little is currently understood regarding the state of subjective error-awareness in cocaine-dependent populations, however, which precludes firm conclusions regarding the underlying nature of these error-monitoring deficits. Recent developments have identified methods of systematically interrogating indices of error-detection and error-awareness, respectively. The present proposal seeks to use multi-modal imaging (ERP/fMRI) to characterize the integrity of neural circuits engaged in automatic and conscious components of error monitoring in incarcerated cocaine-dependent individuals. To this end, the MIND Institute has recently acquired a state-of-the-art mobile MRI scanner, currently deployed at the Western New Mexico Correctional Facility. In the last two months, we have completed 235 scanning sessions within this facility, and feel that the mobile scanner presents an unprecedented opportunity to examine the neurocognitive systems implicated in error- monitoring within incarcerated populations. Here we propose to utilize high-resolution electrophysiology and functional magntetic resonance imaging to assess the integrity of error-monitoring systems within 15 incarcerated cocaine-dependent individuals, 15 matched incarcerated non-dependent individuals, and 15 matched non-incarcerated healthy controls. We hypothesize that incarcerated cocaine-dependent individuals will show reduced error awareness, and that this impairment will predict relevant outcome measures including drug-use severity and level of comorbid criminal activity. Our goal is to use the I/START mechanism to provide support for a protocol we anticipate serving as pilot data for a larger, more comprehensive research endeavor focused on neurocognitive influences on error-monitoring integrity in cocaine-dependent individuals. The chronic and repetative nature of drug-addiction suggests that drug-dependent individuals may have difficulty identifying, and learning from, their maladaptive behavioral patterns. These learning deficits may arise from core impairment in processes underlying the identification and monitoring of errors in goal-directed behavior, and may lead to continued drug use, and recidivistic criminal tendencies. The present study will collect electrophysiological (EEG) and functional magnetic resonance imaging (fMRI) data from incarcerated cocaine-dependent individals in order to better characterize the nature of these error-monitoring deficits. The results of this work will aid delineation of mechanisms of dependency and comorbid criminality, and will provide increased insight into treatments capable of targeting those cognitive capacities damaged in drug-dependent populations.