Abstract / Summary
Impulsivity and neural reward reactivity are considered important factors in the development and maintenance of substance use disorders (SUDs) and may be predictive of treatment response. However, relationships between treatment response, impulsivity, and reward reactivity are understudied in women with SUDs. Our study aimed to characterize relationships between neural responses to reward anticipation and changes in behavioral and clinical outcomes following treatment. In a sample of adult women ( N = 83) who completed a criminal diversion program that included comprehensive treatment for SUDs, nucleus accumbens (NAc) reactivity to reward and loss anticipation during a monetary incentive delay (MID) task was examined early in treatment (baseline) and one year later (follow-up). At baseline, more severe substance use symptoms were associated with elevated NAc reward anticipation while greater PTSD symptoms were associated with lower NAc loss anticipation. Symptoms of PTSD, substance use, and urgency significantly decreased by one-year follow-up ( η p 2 ≥0.22). Increases in NAc reward anticipation over time were associated with lower urgency at follow-up, regardless of PTSD symptom levels ( η p 2 ≥0.03). Whole-brain analyses also showed that increased striatal reward anticipation over time was associated with lower positive urgency at follow-up. PTSD symptom severity moderated the relationship between changes in NAc loss anticipation and negative urgency. Findings suggest that NAc reactivity to anticipation of non-drug outcomes may offer a potential neural target for enhancing SUDs treatment outcomes for women, while loss-related reactivity may be particularly relevant in the presence of co-occurring PTSD.