The neural correlates of illness awareness in addiction: a pilot exploratory analysis of preliminary data from the cognitive dysfunction in the addictions (CDiA) research program.

Background: Impaired illness awareness or anosognosia is common in substance use disorders (SUDs), including alcohol use disorder (AUD), and is a significant barrier to treatment engagement. Neuroimaging studies of the neural correlates of impaired illness awareness in other conditions have observed functional differences in regions involved in self-referential processing, namely the frontoparietal and insular areas. This study aimed to extend this research to impaired illness awareness in SUDs. Methods: Twenty participants with AUD ( Results: Individuals with impaired illness awareness had significantly greater activation than individuals with intact illness awareness in the right insula in the AUD and SUD combined group and in the left PPA (i.e., supramarginal gyrus) in the AUD subgroup. These results were no longer significant after including illness severity as a covariate and controlling for substance category in the combined group. In the SUD subgroup, impaired illness awareness was associated with higher activation in the right dlPFC (i.e., medial superior frontal gyrus); however, this finding did not survive family-wise error correction. Conclusion: The results of this pilot exploratory study cautiously suggest that similar to other conditions that feature impaired illness awareness, subjective addiction awareness may be related to increased frontoparietal and insular brain activity during an fMRI illness awareness task. However, no findings were significant after correction for multiple testing, hence, further study in a larger sample is required to establish brain regions associated with subjective substance use awareness.