a Monash Institute of Cognitive and Clinical Neurosciences , Monash University , Clayton, Melbourne , VIC , Australia.
b School of Psychology , Deakin University , Burwood , VIC , Australia.
Am J Drug Alcohol Abuse. 2019;45(1):108-114. doi: 10.1080/00952990.2018.1511725. Epub 2018 Sep 5.
Individuals with cocaine use disorder (CUD) often display behaviours that are paradoxically misaligned with their situation. Typical examples include poor treatment motivation and inconsistent self-reported craving. These behaviours may reflect impairments in the awareness of one's own behaviour.
We examined whether impaired self-awareness of addiction-related frontostriatal dysfunction (i.e., symptoms of apathy, disinhibition, and executive dysfunction) was associated with treatment motivation and craving.
Sixty-five outpatients with CUD (57 male) and their informants (those who knew the patient well) completed parallel self and informant versions of the Frontal Systems Behaviour Scale. Self-awareness was indexed through the discrepancy between self and informant scores in the three sub-scales; apathy, disinhibition and executive dysfunction. The University Rhode Island Change Assessment Scale assessed treatment motivation. Self-reported craving was assessed using a visual analogue scale. Multiple linear regression models examined associations between self-awareness and treatment motivation and craving, adjusting for sociodemographic factors and lifetime drug use.
We found an inverse relationship between self-awareness of symptoms of disinhibition and treatment motivation maintenance. Although impaired awareness of disinhibition was also correlated with craving, this association was not significant after adjusting for sociodemographic factors and drug use. The apathy and executive dysfunction awareness scores were not associated with treatment motivation or craving.
We show that people with lower insight into their disinhibition problems (e.g., impulsivity, mood instability) have more problems maintaining motivation when initiating treatment. Findings suggest that self-awareness interventions could be useful to prevent premature treatment dropout and improve addiction treatment outcomes.
可卡因使用障碍（CUD）患者的行为常常表现出与其情况相悖的矛盾特征。典型的例子包括治疗动机差和自我报告的渴望不一致。这些行为可能反映了对自身行为的意识受损。
我们研究了与成瘾相关的额眶部皮质功能障碍的自我意识受损（即冷漠、抑制障碍和执行功能障碍的症状）是否与治疗动机和渴望有关。
65 名可卡因使用障碍患者（57 名男性）及其知情人（那些了解患者的人）完成了《额叶系统行为量表》的自我和知情人平行版本。自我意识通过三个子量表（冷漠、抑制和执行功能障碍）中的自我和知情人得分之间的差异来衡量。《罗德岛大学改变评估量表》评估了治疗动机。自我报告的渴望使用视觉模拟量表进行评估。多元线性回归模型调整了社会人口因素和终生药物使用后，检验了自我意识与治疗动机和渴望之间的关联。
我们发现，自我对抑制症状的意识与治疗动机维持呈负相关。尽管自我对抑制的意识受损也与渴望有关，但在调整了社会人口因素和药物使用后，这种关联并不显著。冷漠和执行功能障碍的意识评分与治疗动机或渴望无关。
我们表明，对自身抑制问题（如冲动、情绪不稳定）认识较低的人在开始治疗时维持动机的问题更多。研究结果表明，自我意识干预可能有助于预防过早的治疗退出，并改善成瘾治疗的结果。
