Competing Motivations: Proactive Response Inhibition Toward Addiction-Related Stimuli in Quitting-Motivated Individuals

Neural correlates of proactive avoidance deficits and alcohol use motives in problem drinking

Physical pain and negative emotions represent two distinct drinking motives that contribute to harmful alcohol use. Proactive avoidance, in contrast, can reduce consumption in response to these motives but appears to be impaired in those with problem drinking. Despite such evidence, proactive avoidance and its underlying neural deficits have not been assessed experimentally. How these deficits inter-relate with drinking motives to influence alcohol use also remains unclear. The current study leveraged neuroimaging data in forty-one problem and forty-one social drinkers who performed a probabilistic learning go/nogo task featuring proactive avoidance of painful outcomes. We identified the brain responses to proactive avoidance and contrasted the neural correlates of drinking to avoid negative emotions vs. physical pain. Behavioral results confirmed proactive avoidance deficits in problem drinking individuals' learning rate and performance accuracy, both which were associated with greater alcohol use. Imaging findings in the problem drinking group showed that negative emotions as a drinking motive predicted attenuated right anterior insula activation during proactive avoidance. In contrast, physical pain motive predicted reduced right putamen response. These regions' activations as well as functional connectivity with the somatomotor cortex also demonstrated a negative relationship with drinking severity and positive relationship with proactive avoidance performance. Path modeling further delineated the pathways through which physical pain and negative emotions influenced the neural and behavioral measures of proactive avoidance. Taken together, the current findings provide experimental evidence for proactive avoidance deficits in alcohol misuse and establish the link between their neural underpinnings and drinking behavior.

Deficits in proactive avoidance and neural responses to drinking motives in problem drinkers

Physical pain and negative emotions represent two distinct drinking motives that contribute to harmful alcohol use. Proactive avoidance which can reduce problem drinking in response to these motives appears to be impaired in problem drinkers. However, proactive avoidance and its underlying neural deficits have not been assessed experimentally. How these deficits inter-relate with drinking motives to influence alcohol use also remains unclear. The current study leveraged neuroimaging data collected in forty-one problem and forty-one social drinkers who performed a probabilistic learning go/nogo task that involved proactive avoidance of painful outcomes. We characterized the regional brain responses to proactive avoidance and identified the neural correlates of drinking to avoid physical pain and negative emotions. Behavioral results confirmed problem drinkers' proactive avoidance deficits in learning rate and performance accuracy, both which were associated with greater alcohol use. Imaging findings in problem drinkers showed that negative emotions as a drinking motive predicted attenuated right insula activation during proactive avoidance. In contrast, physical pain motive predicted reduced right putamen response. These regions' activations as well as functional connectivity with the somatomotor cortex also demonstrated a negative relationship with drinking severity and positive relationship with proactive avoidance performance. Path modeling further delineated the pathways through which physical pain and negative emotions, along with alcohol use severity, influenced the neural and behavioral measures of proactive avoidance. Taken together, the current findings provide experimental evidence for proactive avoidance deficits in problem drinkers and establish the link between their neural underpinnings and alcohol misuse.

Physical Exercise to Redynamize Interoception in Substance use Disorders

Physical exercise is considered a promising medication-free and cost-effective adjunct treatment for substance use disorders (SUD). Nevertheless, evidence regarding the effectiveness of these interventions is currently limited, thereby signaling the need to better understand the mechanisms underlying their impact on SUD, in order to reframe and optimize them. Here we advance that physical exercise could be re-conceptualized as an "interoception booster", namely as a way to help people with SUD to better decode and interpret bodily-related signals associated with transient states of homeostatic imbalances that usually trigger consumption. We first discuss how mismatches between current and desired bodily states influence the formation of reward-seeking states in SUD, in light of the insular cortex brain networks. Next, we detail effort perception during physical exercise and discuss how it can be used as a relevant framework for re-dynamizing interoception in SUD. We conclude by providing perspectives and methodological considerations for applying the proposed approach to mixed-design neurocognitive research on SUD.

Patients with Methamphetamine Use Disorder Show Highly Utilized Proactive Inhibitory Control and Intact Reactive Inhibitory Control with Long-Term Abstinence

Methamphetamine use disorder (MUD) is a chronic brain disorder that involves frequent failures of inhibitory control and relapses into methamphetamine intake. However, it remains unclear whether the impairment of inhibitory control in MUD is proactive, reactive or both. To address this issue, the current study used the conditional stop-signal task to assess proactive and reactive inhibitory control in 35 MUD patients with long-term abstinence and 35 matched healthy controls. The results showed that MUD patients with long-term abstinence had greater preparation costs than healthy controls, but did not differ in performance, implying a less efficient utilization of proactive inhibitory control. In contrast, MUD patients exhibited intact reactive inhibitory control; reactive but not proactive inhibitory control was associated with high sensation seeking in MUD patients with long-term abstinence. These findings suggest that proactive and reactive inhibitory control may be two different important endophenotypes of addiction in MUD patients with long-term abstinence. The current study provides new insight into the uses of proactive and reactive inhibitory control to effectively evaluate and precisely treat MUD patients with long-term abstinence.

Slower adaptation of control strategies in individuals with high impulsive tendencies

Flexible use of reactive and proactive control according to environmental demands is the key to adaptive behavior. In this study, forty-eight adults performed ten blocks of an AX-CPT task to reveal the strength of proactive control by the calculation of the proactive behavioral index (PBI). They also filled out the UPPS questionnaire to assess their impulsiveness. The median-split method based on the global UPPS score distribution was used to categorize participants as having high (HI) or low (LI) impulsiveness traits. The analyses revealed that the PBI was negatively correlated with the UPPS scores, suggesting that the higher is the impulsiveness, the weaker the dominance of proactive control processes. We showed, at an individual level, that the PBI increased across blocks and suggested that this effect was due to a smaller decrease in reactive control processes. Notably, the PBI increase was slower in the HI group than in the LI group. Moreover, participants who did not adapt to task demands were all characterized as high impulsive. Overall, the current study demonstrates that (1) impulsiveness is associated with less dominant proactive control due to (2) slower adaptation to task demands (3) driven by a stronger reliance on reactive processes. These findings are discussed in regards to pathological populations.

Video Game Addictive Symptom Level, Use Intensity, and Hedonic Experience: An Empirical Analysis of a Novel Survey Instrument (Preprint)

Background

The effects of behavioral addiction to video games has received increasing attention in the literature, given increased use intensity among subgroups of video game players.

Objective

This study seeks to empirically determine the relationship between intensity of video gaming and hedonic experience of the player.

Methods

We conducted a survey of 835 individuals who regularly play video games to determine the relationship between intensity of use and hedonic experience. We divided the sample into quartiles by self-reported video game addictive symptom level (from the Internet Gaming Disorder Scale) and conducted polynomial regressions separately for each quartile.

Results

We found that the higher video game addictive symptom level groups experienced a U-shaped (curvilinear) relationship between hedonic experience and intensity of play, whereas groups with lower video game addictive symptom levels exhibited no such relationship. The coefficients for the highest addictive symptom level group (quartile 4) for marginal effects for hours played per week and hours played per week squared were significantly negative (P=.005) and significantly positive (P=.004), respectively.

Conclusions

Our results are consistent with sensitization and tolerance theories, which suggest that high-symptom groups experience frustration and disappointment until they achieve excessive dopamine release, at which point their hedonic experience is expected to improve with additional play. Conversely, low-symptom groups experience no such fall-and-rise pattern. This result is consistent with the outcome that members of the latter group play the game for the direct experience, such that their hedonic experience is more directly related to events occurring in the game than to the increasingly elusive pursuit of excessive dopamine release. We also find that high-symptom groups spend substantially more time and money to support video game use and are much more likely to engage in video game use at the expense of other important activities, such as working, sleeping, and eating.

Blunted prefrontal signature of proactive inhibitory control in cocaine use disorder

BACKGROUND

Impulsivity is an established risk factor for substance use disorder (SUD). Integral to SUD recovery is proactive control (leveraging information about a potential need for behavioral restraint to marshal increased cognitive resources toward inhibition) when cues for drug use are unavoidable. However, proactive control is little studied in SUD, and is merely inferred from post-error performance adjustments.

METHODS

We probed covert neurocircuit signatures of proactive control in persons with SUD, as well as the moderating effects of incentives for successfully exerting proactive control. We administered a Monetary Incentive Stop Task (MIST) during functional magnetic resonance imaging of adults with cocaine use disorder (CUD; n = 21) and healthy controls (n = 21). The MIST blended the reward and loss-anticipatory cues of the Monetary Incentive Delay (MID) Task with a variant of the Stop-Signal Task, in which target color signaled whether or not withholding a response might be necessary.

RESULTS

In controls, but not in CUD participants, targets that signaled a potential need to stop (as a contrast with targets that signaled no need to stop) activated portions of right operculum akin to activation commonly elicited by stop signals, despite no actual stop signal. Across all participants, this proactive control activation did not relate to task behavior or to questionnaire impulsivity. Anticipatory incentive cues did not recruit ventral striatum.

CONCLUSIONS

These data suggest that persons with CUD show blunted covert signatures of attention and proactive control. This potentially accounts in part for the role of poor executive function in relapse vulnerability.

Spatiotemporal brain signal associated with high and low levels of proactive motor response inhibition

Proactive motor response inhibition is used to strategically restrain actions in preparation for stopping. In this study, we first examined the event related potential (ERP) elicited by low and high level of proactive response inhibition, as assessed by the stop-signal task. Corroborating previous studies, we found an increased amplitude of the contingent negative variation (CNV) in the high level of proactive inhibition. As the main goal of the present study, swLORETA was used to determine the neural generators characterising CNV differences between low and high levels of proactive inhibition. Results showed that the higher level of proactive inhibition involved numerous generators, including within the middle and medial frontal gyrus. Importantly, we observed that the lower level of proactive inhibition also involved a specific neural generator, within the frontopolar cortex. Altogether, present findings identified the specific brain sources of ERP signals involved in the later phase of motor preparation under low or high levels of proactive motor response inhibition.

Proactive engagement of cognitive control modulates implicit approach-avoidance bias

Implicit social-affective biases-reflected in a propensity to approach positive and avoid negative stimuli-have been documented in humans with paradigms, such as the Approach-Avoidance Task (AAT). However, the degree to which preemptively engaging cognitive control can help to down-regulate those behavioral tendencies remains poorly understood. While undergoing functional magnetic resonance imaging (fMRI), 24 healthy participants completed a cued version of the AAT, in which they responded to pictures of happy or angry faces by pulling a joystick toward themselves (approach) or pushing the joystick away (avoidance) based on the color of the stimulus frame. On some trials, they were cued to reverse the frame color/joystick action instructions. Before stimulus onset, a reverse cue was associated with deactivation of a visuo-spatial and motor planning network and subsequent slowing down in response to stimuli. During the stimulus phase, a reverse cue was associated with a) activation of cognitive control areas, including the right inferior frontal gyrus (IFG) and right inferior parietal lobule (IPL); and b) reduced right precentral gyrus activation when having to push (avoid) a happy face. Overall, these results suggest that proactively engaging cognitive control can help fine-tune behavioral and neural adjustment to emotionally incongruent behavioral conditions.

Reduced response inhibition after exposure to drug-related cues in male heroin abstainers

RATIONALE

Deficits in response inhibition associated with heroin use could last several months after abstinence in heroin users, and their response inhibition can also be interfered with task-irrelevant drug-related cues. However, it is unclear whether exposure to drug-related cues affects subsequent response inhibition in heroin users following abstinence.

OBJECTIVES

The present study aimed to investigate how drug-related cues with different durations between stimulus presentations, referred to as stimulus onset asynchronies (SOAs), affect subsequent response inhibition in heroin abstainers (HAs) with different length of abstinence.

METHODS

Sixty-seven male HAs performed a modified Go/NoGo task in which a motor response to frequent Go targets and no response to rare NoGo targets were required and a Go or NoGo target was displayed after either a heroin-related or a neutral picture presented for the 200 ms and 600 ms SOAs.

RESULTS

The HAs responded significantly faster to Go targets following the neutral pictures for the 600 ms SOA compared to other conditions. They also made more commission errors following heroin-related pictures compared to neutral pictures regardless of the SOAs. The shorter-term HAs made more commission errors compared to the longer-term HAs following the 200 ms SOA, and it was only a trend when the SOA was 600 ms. Additionally, negative correlations between the duration of current abstinence and commission errors were observed following cues with the 200 ms SOA.

CONCLUSIONS

Impaired response inhibition in HAs can be improved through protracted drug abstinence. However, that effect can be reduced by exposure to drug-related cues, which may increase the risk of relapse.

Isolating Proactive Slowing from Reactive Inhibitory Control in Heavy Drinkers

Background: Impaired inhibitory control is thought to contribute to alcohol (mis)use. However, current definitions of inhibitory control are over-simplified by a failure to distinguish reactive inhibitory control from proactive slowing. Objectives: To distinguish "reactive" inhibitory control and proactive slowing in heavy drinkers, and characterize associations between both constructs and individual differences in alcohol consumption. Methods: Sixty heavy drinkers completed self-reported measures of alcohol consumption, followed by two modified Stop-Signal tasks and an AX-continuous performance task in a laboratory setting. Results: Heavy drinkers demonstrated proactive slowing when inhibition was more likely but individual differences in proactive slowing and reactive stopping were unrelated to individual differences in alcohol consumption. Conclusions/Importance: Within a sample of heavy drinkers, individual differences in reactive inhibitory control and proactive slowing are unrelated to individual differences in alcohol consumption.

Examining neural reactivity to gambling cues in the age of online betting

Purpose of Review

The goal of this review is to provide new insights as to how and why functional magnetic resonance imaging (fMRI) research on gambling cue reactivity can contribute to significant progress towards the understanding of gambling disorder. After having offered a detailed description of experimental paradigms and a comprehensive summary of findings related to gambling cue reactivity, the present review suggests methodological avenues for future research.

Recent Findings

The fMRI literature on problem gambling has identified the main neural pathways associated with reactivity to gambling cues. Yet, the current knowledge on the key factors underlying cue reactivity in gambling is still very incomplete. Here, we suggest that the recent expansion of online sports betting calls for a new line of research offering a fine-grained and up-to-date approach of neural cue reactivity in gambling disorder.

Summary

Experimental designs that investigate individual-specific and study-specific factors related to sports betting have the potential to foster progress towards efficient treatment and prevention of gambling disorder.

Bias Toward Drug-Related Stimuli Is Affected by Loading Working Memory in Abstinent Ex-Methamphetamine Users

Background: There is a trade-off between drug-related impulsive process and cognitive reflective process among ex-drug abusers. The present study aimed to investigate the impulsive effects of methamphetamine-related stimuli on working memory (WM) performance by manipulating WM load in abstinent ex-methamphetamine users. Methods: Thirty abstinent ex-methamphetamine users and 30 nonaddict matched control participants were recruited in this study. We used a modified Sternberg task in which participants were instructed to memorize three different sets of methamphetamine-related and non-drug-related words (three, five, or seven words) while performing a secondary attention-demanding task as an interference. Results: Repeated-measures ANOVA revealed that reaction times of abstinent ex-methamphetamine users increased during low WM load (three words) compared to the control group (p = 0.01). No significant differences were observed during high WM loads (five or seven words) (both p's > 0.1). Besides, reaction times of the experimental group during trials with high interference (three, five, or seven words) were not significantly different compared to the control group (p > 0.2). Conclusion: These findings imply that increasing WM load may provide an efficient buffer against attentional capture by salient stimuli (i.e., methamphetamine-related words). This buffer might modify the effect of interference bias. Besides, presenting methamphetamine-related stimuli might facilitate the encoding phase due to bias toward task-relevant stimuli. This finding has an important implication, suggesting that performing concurrent demanding tasks may reduce the power of salient stimuli and thus improve the efficiency of emotional regulation strategies.

The effect of alcohol cue exposure and acute intoxication on inhibitory control processes and ad libitum alcohol consumption

RATIONALE

Alcohol intoxication and alcohol cue exposure impair 'reactive' inhibitory control and increase motivation to drink. However, inhibitory control is a multi-component process that also comprises signal detection and proactive control. It is unknown whether intoxication and cue exposure selectively influence these subprocesses in heavy drinkers.

OBJECTIVES

In two pre-registered studies, we investigated whether exposure to alcohol-related cues (study 1) and alcohol priming (study 2) impair each of these subprocesses of inhibitory control and increase motivation to drink.

METHODS

In study 1, 64 heavy drinkers completed a modified stop-signal task in an alcohol context (with embedded alcohol cues) and a neutral context (with embedded neutral cues) followed by a subjective measure of craving and a bogus taste test to measure ad libitum alcohol consumption. In study 2, 36 heavy drinkers consumed an alcoholic beverage (0.6 g/kg body weight), an alcohol-placebo beverage, and water on a within-subjects basis, followed by the modified stop-signal task and a bogus taste test.

RESULTS

In study 1, alcohol cue exposure did not impair inhibitory control subprocesses. Reactive control was unexpectedly better following alcohol cue exposure (compared to neutral cue exposure). However, craving and ad libitum consumption increased as expected. In study 2, reactive control was significantly impaired following the alcohol and control primes, relative to the placebo, but there was no effect on proactive slowing or signal detection. As expected, intoxication increased motivation to drink and ad libitum consumption (compared to placebo and control).

CONCLUSIONS

Alcohol intoxication and cue exposure increase motivation to drink in the absence of impairments in subcomponents of inhibitory control.

Facing temptation: The neural correlates of gambling availability during sports picture exposure

Nowadays, sports betting has become increasingly available and easy to engage in. Here we examined the neural responses to stimuli that represent sporting events available for betting as compared to sporting events without a gambling opportunity. We used a cue exposure task in which football (soccer) fans (N = 42) viewed cues depicting scheduled football games that would occur shortly after the scanning session. In the "betting" condition, participants were instructed to choose, at the end of each block, the game (and the team) they wanted to bet on. In the "watching" condition, participants chose the game they would prefer to watch. After the scanning session, participants completed posttask rating questionnaires assessing, for each cue, their level of confidence about the team they believed would win and how much they would enjoy watching the game. We found that stimuli representing sport events available for betting elicited higher fronto-striatal activation, as well as higher insular cortex activity and functional connectivity, than sport events without a gambling opportunity. Moreover, games rated with more confidence towards the winning team resulted in greater brain activations within regions involved in affective decision-making (ventromedial prefrontal cortex), cognitive inhibitory control (medial and superior frontal gyri) and reward processing (ventral and dorsal striatum). Altogether, these novel findings offer a sensible simulation of how the high availability of sports betting in today's environment impacts on the reward and cognitive control systems. Future studies are needed to extend the present findings to a sample of football fans that includes a samilar proportion of female and male participants.

Proactive and Reactive Motor Inhibition in Top Athletes Versus Nonathletes

We examined proactive (early restraint in preparation for stopping) and reactive (late correction to stop ongoing action) motor response inhibition in two groups of participants: professional athletes ( n = 28) and nonathletes ( n = 25). We recruited the elite athletes from Belgian national taekwondo and fencing teams. We estimated proactive and reactive inhibition with a modified version of the stop-signal task (SST) in which participants inhibited categorizing left/right arrows. The probability of the stop signal was manipulated across blocks of trials by providing probability cues from the background computer screen color (green = 0%, yellow =17%, orange = 25%, red = 33%). Participants performed two sessions of the SST, where proactive inhibition was operationalized with increased go-signal reaction time as a function of increased stop-signal probability and reactive inhibition was indicated by stop-signal reaction time latency. Athletes exhibited higher reactive inhibition performance than nonathletes. In addition, athletes exhibited higher proactive inhibition than nonathletes in Session 1 (but not Session 2) of the SST. As top-level athletes exhibited heightened reactive inhibition and were faster to reach and maintain consistent proactive motor response inhibition, these results confirm an evaluative process that can discriminate elite athleticism through a fine-grained analysis of inhibitory control.