The relationship between craving and insular morphometry in regular cocaine users: Does sex matter?

Area of Science:

• Neuroscience
• Addiction Research
• Neuroimaging

Background:

• Cocaine use disorder (CUD) affects individuals differently based on sex, with women potentially driven by stress-relief craving and men by reward craving.
• Neural underpinnings of these sex-specific craving patterns in CUD remain largely unexplored.

Purpose of the Study:

• To investigate sex-dependent differences in insular morphometry and its association with craving in regular cocaine users (CUs).
• To explore potential sex-specific neural mechanisms underlying CUD and relapse.

Main Methods:

• Structural magnetic resonance imaging (MRI) was used to assess insular morphometry (volume, thickness, surface area).
• Participants included regular cocaine users (CUs) and non-drug using controls (non-CUs).
• Associations between insular morphometry and reward/stress-relief craving were analyzed, stratified by sex.

Main Results:

• No significant sex-specific differences in overall insular morphometry were found between male and female CUs.
• Significant sex-specific associations emerged between right insular morphometry and stress-relief craving.
• Right insular volume and surface area showed inverse relationships with stress-relief craving in women compared to men.

Conclusions:

• The study provides novel evidence for sex-specific associations between insular morphometry and stress-relief craving in individuals with CUD.
• These findings suggest distinct neural pathways influencing craving and relapse vulnerability in male and female cocaine users.
• Alterations in insular morphometry may contribute to higher stress-induced craving and relapse risk in women with CUD.