Effects of Cocaine and HIV Decision Making Involving Potential Losses
Of the 1.1 million Americans who are living with HIV/AIDS, half report illicit drug use in the past year and half experience HIV-associated neurocognitive impairment. HIV-infected persons who abuse drugs, particularly stimulant drugs like cocaine, are at high risk for engaging in behaviors associated with HIV infection and transmission. Drug addiction impacts several key areas of the brain involved in reward processing and decision making, and previous research has found that drug addicted persons tend to over-value immediate rewards and discount potential future losses. HIV infection is also associated with changes in brain structure and functioning that may contribute to poor decision making related to HIV risk behavior. While previous research has focused on how drug addiction affects reward processing, much less is known about how drug addiction affects the processing of potential losses.
This project focuses on loss aversion, a powerful determinant of decision making that has received little attention in the addictions field. Loss aversion is a behavioral economics construct that describes the tendency for individuals to avoid potential losses more than they seek potential gains. Our preliminary work suggests that cocaine users are more loss averse than non drug users, and that loss aversion is associated with increased HIV risk behavior.
The project will investigate the unique and additive effects of cocaine dependence and HIV infection on behavioral loss aversion and its underlying neural processes, and test whether loss aversion mediates the relationship between cocaine dependence and HIV risk behavior. To accomplish these aims, we will combine neuroimaging and neurobehavioral techniques to examine loss aversion in 80 adults who differ on cocaine and HIV status (20/group). The multidisciplinary investigative team brings together expertise in cognitive neuroscience, computational modeling, behavioral neuroeconomics, MR physics, and clinical psychology and has extensive experience conducting patient-oriented research on HIV risk behavior in persons with drug dependence and/or HIV infection. This integrated approach to understanding the mechanisms underlying risk behavior has the potential to provide unique insights into the mechanisms that contribute to impaired decision making and risky behavior, and ultimately to improve health outcomes and reduce the spread of HIV in these vulnerable populations.
The overall impact of this research is to provide new information on how decision making contributes to real-world HIV risk behavior, to identify neuroimaging and neurobehavioral markers of impaired decision making, and to inform the development of novel interventions that directly target the neurocognitive deficits underlying risky decision making.