We aim to study gender-related differences in behavioral and drug addictions in order to improve prevention and treatment strategies. Urges or cravings are common to behavioral and drug addictions, generally precede participation in the addictive behavior, and thus represent important targets for interventions. An improved understanding of brain mechanisms underlying craving states thus has significant clinical implications. We have established, tested and published on fMRI paradigms investigating the neural correlates of cocaine cravings in cocaine dependence (CD) and gambling urges in pathological gambling (PG). However, these studies have involved predominantly or exclusively men, creating a deficiency in our understanding of craving in women. We propose extending our studies to involve women. We hypothesize that there will exist differences in the brain mechanisms underlying gambling urges in women and men with PG and cocaine cravings in women and men with CD. Specifically, we used fMRI and found relatively decreased activity in the ventral anterior cingulate (vAC) in men with PG during the induction of gambling urges and while performing an impulse control task. Based on our preliminary data, we hypothesize that when viewing gambling cues, women as compared to men with PG experience a greater decrease in vAC activity, a region implicated in multiple studies of impulse control and mood regulation. In our fMRI study of cocaine craving in a predominantly male CD group, we (and others) observed limbic activation (in AC) in the CD group viewing cocaine cues. Preliminary studies investigating cocaine cravings in women as compared to men with CD have found differences in limbic activations in the amygdala, adding to an emerging literature on sex-related amygdala activation differences in motivational and emotional states. We hypothesize that women and men with CD will show differences in AC and amygdala activation during viewing of cocaine cues. We will use our established fMRI paradigm and improved methodologies, including higher resolution imaging and concurrent heart rate monitoring, to investigate these hypotheses. Given our ongoing work to incorporate this fMRI paradigm into treatment trials, the results from the proposed investigation should not only improve the general understanding of the biologies of PG, CD and gender differences in addictions, but also help guide gender-informed prevention and treatment efforts.
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