Reward Coherence: A Multi-Method Examination of Insight and Reward Processing in Individuals with Cannabis Use Disorder

Abstract

As drug-seeking behaviors become increasingly habitual and disordered, drugs and their cues become more rewarding relative to natural rewards as self-awareness of drug-related problems decreases (i.e., impaired clinical insight). Previous studies suggest that monitoring of drug-related choice behavior (behavioral insight) may be related to clinical insight, however the underlying neural and behavioral mechanisms involved in these processes remain unclear. The current study aimed to test self-awareness of drug and non-drug reward responsivity as a mechanism of insight using a multi-method approach. Participants aged 18-50 with a Cannabis Use Disorder (CUD) diagnosis were recruited to participate in a lab session, during which they rated their emotional response to cannabis, pleasant, unpleasant, and neutral pictures while undergoing simultaneous EEG recording of the Late Positive Potential (LPP). Participants completed a validated probabilistic learning choice task to measure behavioral insight. Finally, participants completed self-report measures of cannabis use-related problem recognition and motivation to change at the lab session. Results showed that picture type did not have a moderating effect on the relationship between any insight variables and coherence between neurophysiological and subjective measures of emotional arousal but that, contrary to theory, participants with impaired behavioral insight showed more coherence. Further, results did not provide support for the hypothesized relationship between reduced behavioral and clinical insight. These findings do not support reward coherence as a mechanism of behavioral or clinical insight in people with CUD but add to the growing literature on the role of insight in CUD maintenance.