Archival ReportDoubling Down: Increased Risk-Taking Behavior Following a Loss by Individuals With Cocaine Use Disorder Is Associated With Striatal and Anterior Cingulate Dysfunction

BackgroundCocaine use disorders (CUDs) have been associated with increased risk-taking behavior. Neuroimaging studies have suggested that altered activity in reward and decision-making circuitry may underlie cocaine users' heightened risk-taking. It remains unclear if this behavior is driven by greater reward salience, lack of appreciation of danger, or another deficit in risk-related processing.MethodsTwenty-nine CUD participants and 40 healthy comparison participants completed the Risky Gains Task during a functional magnetic resonance imaging scan. During the Risky Gains Task, participants choose between a safe option for a small, guaranteed monetary reward and risky options with larger rewards but also the chance to lose money. Frequency of risky choice overall and following a win versus a loss were compared. Neural activity during the decision and outcome phases was examined using linear mixed effects models.ResultsAlthough the groups did not differ in overall risk-taking frequency, the CUD group chose a risky option more often following a loss. Neuroimaging analyses revealed that the comparison group showed increasing activity in the bilateral ventral striatum as they chose higher value, risky options, but the CUD group failed to show this increase. During the outcome phase, the CUD group showed a greater decrease in bilateral striatal activity relative to the comparison group when losing the large amount, and this response was correlated with risk-taking frequency after a loss.ConclusionsThe brains of CUD individuals are hypersensitive to losses, leading to increased risk-taking behaviors, and this may help explain why these individuals take drugs despite aversive outcomes.