A daily diary exploration of contexts and experiences associated with planned drinking decisions in young adults.

OBJECTIVE: Despite the potential for negative consequences, young adults continually engage in heavy alcohol use. Unplanned (vs. planned) drinking has been of particular interest in several studies, as it is theoretically suggested to be related to poor behavioral regulation and negative consequences. Ecological momentary assessment and daily diary (DD) studies have been used to examine the contexts and consequences of planned and unplanned drinking specifically, resulting in somewhat mixed findings surrounding the factors contributing to and consequences of planned drinking. The present DD study adds to this literature by studying rewarding incentives and physical contexts of planned versus unplanned alcohol use, as well as the experiences, or consequences, of planned drinking events. METHOD: Ninety-nine young adults took part in a mobile study investigating drinking decisions for the current day and day prior, reporting the rewarding incentives contributing to their decision, the context of drinking events, and the experience of each event. RESULTS: Planned drinking was associated with being influenced by social/party and alcohol incentives, as well as being at a bar and pregaming. There was a positive relationship between planned drinking and subjective level of intoxication, but not negative or positive experience. CONCLUSIONS: Planned drinking is likely associated with rewarding incentives and social contexts and may contribute to higher levels of subjective intoxication. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The event-based influence of incentivizing and physical contexts on daily alcohol initiation and consumption.

BACKGROUND: Young adults often decide to engage in heavy drinking. Learning more about the real-time factors that predict decisions to initiate a drinking episode and how much is consumed in any single drinking episode is necessary in developing our understanding of momentary alcohol use and discrete decisions surrounding alcohol use. METHODS: The current study examined the association between contextual factors and decisions to initiate and consume alcohol in 104 young adult individuals over 2 weeks via mobile daily diary. Participants responded to daily notifications about decisions to drink or not and the contextual factors surrounding each event. The contextual factors included the situation (e.g., bar setting and pregaming) and incentives (e.g., alcohol, social, and mood enhancement). RESULTS: Multilevel analyses revealed that incentives predicted both the initiation of drinking and the amount consumed. Event-based alcohol and mood incentives predicted the initiation of drinking, while alcohol, mood, and social/party incentives predicted how much was consumed at a specific event. However, context had a more complex association with drinking outcomes. Being in a bar, alone, or at a residence predicted decisions to initiate drinking, while being in a bar, pregaming situation, or other party situation with others who are drinking predicted how much a person drank. CONCLUSIONS: The results highlight the importance of studying event-specific predictors of drinking decisions and the complex association between context/location and the type of drinking decision or outcome.

The nomological network of drinker identity: A scoping review.

BACKGROUND: Despite the growing interest in the construct of drinker identity and empirical evidence for its role in drinking behavior, there is a paucity of papers that evaluate and integrate the results of studies on drinker identity, leaving a gap in our knowledge of the importance of the drinker identity construct. The current paper addresses this gap by reviewing and integrating the results of the studies of drinker identity. METHODS: The scoping review identified, retrieved, and evaluated the existing literature regarding drinker identity. English language studies from EBSCOHost, PubMed, ScienceDirect, and Scopus databases were reviewed. Studies were included in the review if they were data-based studies or theoretical publications with drinker identity as the primary topic published in peer-reviewed journals. Studies were reviewed and coded based on their reported methodology and findings and codes were used to integrate and present findings. RESULTS: This review advances this line of research in four ways. First, the operationalization of drinker identity is evaluated by examining the theoretical frameworks defining the construct. Second, the conceptualization and measurement of drinker identity is assessed, with suggestions for future measurement research. Third, an integrated framework of predictors, outcomes, moderators, and mediators is presented. Finally, the research gaps, future recommendations, and clinical implications are discussed. CONCLUSIONS: There is a need for continued research, specifically research which aims to standardize and improve measurement of drinker identity, considers longitudinal and developmental processes, and broadens the research samples and settings.

Social incentives are stronger predictors of drinking decisions than alcohol incentives in young adults: The role of alcohol use disorder.

This study investigated the influence of social incentives, alcohol incentives, and responsibility disincentives on decisions to attend and drink at party events in young adult college students (n = 82; 55 women, 27 men) where 36 (20 women; 16 men) had an Alcohol Use Disorder (AUD) and 46 (35 women; 11 men) were control participants without an AUD. In this within-subjects design, participants were presented with a series of hypothetical drinking event scenarios that varied in terms of social incentives (knowing many vs. few people), alcohol incentives (more vs. less alcohol available), and next-day responsibility disincentives (high vs. moderate vs. low). Participants were asked whether they would attend the event and how many drinks they would consume. Social incentives significantly predicted both decisions to attend party events and decisions about how much to drink for all participants. Participants were more likely to decide to attend and drink more at high social incentive party events (where they knew more people). However, while low social incentives generally discouraged attendance decisions, AUD participants were more likely than controls to decide to attend party events in low social incentive contexts. Alcohol incentives did not affect attendance decisions. However, alcohol incentives did increase drinking amount decisions for AUD participants. Finally, while disincentives decreased attendance and drinking amount decisions in general, AUD participants were less deterred by responsibility disincentives than controls. The results highlight the important influence of social rewards on drinking-related decisions and suggest individual differences in how incentives and disincentives affect drinking decisions in persons with an AUD.

An exploration of multivariate symptom clusters of cannabis use disorder in young adults.

AIMS: Since the release of the DSM-V, CUD has been understood as a unidimensional construct. However, continued research has identified separate symptom clusters relating to consumption, loss of control, and withdrawal within substance use disorder criteria that may pose separate risk factors and functional difficulties. The current study aims to examine how symptom clusters commonly manifest in young adults that use cannabis using a latent class analysis (LCA) and explore how these clusters are related to co-occurring psychological constructs. METHODS: 1174 (aged 18-34) participants completed a battery of assessments on substance use and other psychological constructs. LCA was conducted on 17 symptoms corresponding with DSM-V CUD criteria. Multinomial regressions were used to examine class membership and commonly co-occurring psychopathology and psychological constructs. RESULTS: LCA results identified a 'No problems' class, a 'Moderate consumption' class characterized by moderate probability of endorsing consumption items, a 'Consumption with Moderate Loss of Control' class, characterized by endorsing consumption and loss of control items but minimal endorsement of withdrawal items, a 'Consumption with Moderate Withdrawal' class characterized by moderate probability of endorsing all item types, and 'High Consumption, Loss of Control, Withdrawal' class characterized by high probability of endorsing all items. Multinomial regressions indicated some class differences in psychological constructs. CONCLUSIONS: Symptom clusters differed in terms of CUD criteria, especially for those in our sample with moderate/severe problems. Findings suggest intervention efforts may benefit from treatment targeted at various presentations of CUD.

Applying network analysis to investigate substance use symptoms associated with drug overdose.

BACKGROUND: Drug overdose deaths have been increasing over the last several decades. While single substance classes, such as opioids, have been implicated in this rise, less is known about the contributions of polysubstance use (PSU) and other combinations of specific substances and symptoms that may be a risk factor for drug overdose. METHODS: Symptoms of alcohol, cannabis, and other drug use disorders, as well as co-substance use indicators, were assessed and then examined via network analysis in a sample of young adults (N = 1540). Features of the estimated symptom network were investigated, including topology and node centrality, as well as bridge centrality, which further examines node centrality while accounting for the nodes belonging to discrete communities. RESULTS: Individual symptoms were more strongly associated with other symptoms within the same substance class than across substance classes. Tolerance and withdrawal symptoms were the most central items in the network. However, when accounting for symptoms belonging to discrete substance classes, drug overdose emerged as a strong bridge symptom, among others. CONCLUSIONS: As a strong bridge symptom, drug overdose had many connections with a variety of substances and symptoms, which might suggest that risk for drug overdose may be a function of overall substance use severity. Altogether, examining alcohol and substance use symptoms using a network analytic framework provided novel insights into the role PSU might play in conferring risk for drug overdose.

A New Perspective on "Drinking" Self: A Network Approach to Characterizing Drinking-Related Changes in Personality.

BACKGROUND: Previous research suggests that self-knowledge, particularly perceptions of oneself as a "drinker," may influence the development and progression of alcohol use and related problems, such as binge drinking. While existing studies have provided empirical evidence for the importance of assessing drinking self-perception within the five-factor model of personality framework, further examination with novel analytic methods, such as network analyses, could improve understanding of the drinker self-concept. Methods: Five factor traits of openness to experience, conscientiousness, extraversion, agreeableness, and emotional stability were assessed among a large sample of young adults (n = 423) across "general" and "drinking" contexts. Features of the personality networks were investigated, including topology, network centrality, stability of the network across "general" and "drinking" assessments, as well as differences in the network across the two assessments. Results: Individual personality items were more related to other items within the same trait than to other traits. There was no most central item in the networks, but item strength was uncorrelated to mean-level of the item. The network structure was stable across both assessments, although the overall strength of item relationships significantly increased in the drinking personality network. Conclusions: Examining drinking personality using a network analytic framework provided novel insights into drinker self-concept and the role drinking contexts might play in self-perception of personality in those contexts.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2022.2034874 .

The Effects of Working Memory versus Adaptive Visual Search Control Training on Executive Cognitive Function.

There is considerable debate about whether Working Memory (WM) training specifically results in far-transfer improvements in executive cognitive function (ECF) rather than improvements on tasks similar to the training tasks. There has also been recent interest in whether WM training can improve ECF in clinical populations with clear deficits in ECFs. The current study examined the effects of WM training compared with non-WM adaptive Visual Search (VS) control training (15 sessions over 4 weeks) on various measures of ECF, including delay discounting (DD) rate, inhibition on flanker, color and spatial Stroop tasks, and drinking in a community-recruited sample with Alcohol Use Disorder (AUD, 41 men, 41 women, mean age = 21.7 years), who were not in treatment or seeking treatment, and non-AUD healthy controls (37 men, 52 women, mean age = 22.3 years). Both WM and VS training were associated with improvements on all ECF measures at 4 weeks and 1-month follow-up. WM and VS training were associated with reductions in both DD rates and interference on Stroop and Flanker tasks in all participants, as well as reductions in drinking in AUD participants that remained apparent one month post training. The results suggest that nonspecific effects of demanding cognitive training, as opposed to specific WM training effects, could enhance ECF, and that such enhancements are retained at least one-month post-training.

Slower rates of learning to inhibit behavior in alcohol use disorder.

OBJECTIVE: Alcohol use disorder (AUD) is associated with passive avoidance learning (PAL) deficits. This study investigated PAL deficits in AUD by using a novel growth model approach to quantify patterns of PAL as changes in false alarms over time, rather than the typical index of total false alarms in a PAL task. METHOD: Subjects, 112 (58 men; 54 women) with an AUD and 110 controls (44 men; 66 women), were administered a monetary incentive Go/No-Go task. Subjects could win $0.25 for a hit (response after a GO) or lose $0.25 for a false alarm. RESULTS: PAL rate was quantified as the slope of initial learning phase (across the first 5 blocks) on the Go/No-Go task. The PAL curves indicated rapid learning in first 5 blocks followed by a later slower learning across blocks 6-9 (consolidation phase). A piecewise growth model with random intercepts indicated that AUD status was significantly associated with a slower initial PAL (i.e. learning phase), with B = -0.69, p < 0.001 for the control group and a PAL slope of 0.13 higher for the AUD group indicating a slower learning rate in the AUD group. This effect was not observed in the consolidation phase. CONCLUSIONS: The results suggest that those with an AUD have greater difficulty learning to avoid negative consequences compared with controls. The results also suggest that measuring PAL rate by focusing on the rate of learning early in the task may be a better index of PAL learning than simply looking at overall false alarm rate. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Mobile assessment of decisions to drink in young adults: Examining the role of incentives and disincentives.

BACKGROUND: Research on decision-making (DM) biases in persons with alcohol use disorder have largely relied on behavioral economic DM tasks, which do not assess the dynamic multitude of factors associated with real-world decisions about drinking. The current study extends the literature on DM and alcohol use by using a mobile daily diary approach to investigate whether, and how, real-world incentives and disincentives are associated with actual drinking decisions in college students. METHODS: We assessed current drinking and lifetime alcohol problems in 104 young adults (61.5% female, 84.5% White) who, for 14 days, used a mobile daily diary to respond to questions about drinking decisions from the day prior. Mobile prompts assessed daily data on the timing of drinking decisions, alcohol quantity initially decided to drink, quantity actually decided to drink, and the incentives that influenced drinking decisions. RESULTS: Users of the app reported high usability, high compliance rates were observed, and incentive responses were reduced to three subtypes: alcohol, social/party, and mood. Daily mobile measures of drinking quantity were strongly correlated with self-reported drinking 2 weeks prior to the daily assessment. Lifetime alcohol problems were positively related to the average quantity decided to drink per event, drinking more than initially decided, and higher levels of self-reported drinking-decision incentives. "Alcohol" and "social/party" incentives were positively related to the quantity the participant decided to drink at drinking events. Mood incentives and disincentives showed little to no significant relationships with drinking decisions. CONCLUSIONS: The results suggest that mobile data collection can be useful for assessing aspects of real-world drinking decisions and the influence of multiple drinking decision incentives.

Is lower severity alcohol use disorder qualitatively different than more severe manifestations? An evaluation of multivariate symptom clusters.

BACKGROUND AND AIMS: Alcohol use disorder (AUD), since the release of DSM-V, is conceptualized and studied as a unidimensional construct. However, previous research has identified clusters of AUD symptoms related to excessive consumption/tolerance, loss of control/social dysfunction and withdrawal/craving that have shown differential genetic risks, personality associations and predictive ability. Although past 'variable-centered' (e.g. factor-analytic) studies have demonstrated the importance of these clusters, the current study aimed to examine how these clusters commonly manifest using a 'person-centered' approach (e.g. latent class). DESIGN: Cross-sectional in-person assessment. SETTING: Indiana, USA. PARTICIPANTS: A convenience sample of 1390 young adults (mean age = 21.43, SD = 2.47) recruited for an over-representation of alcohol problems (65% with AUD). MEASUREMENTS: Latent class analysis (LCA) was conducted on 23 criteria from the Semi-Structured Interview on the Genetics of Alcoholism (SSAGA) that align with DSM-V AUD symptoms. Identified latent classes were characterized using multinomial regressions to examine the association of class and measures of alcohol use, other externalizing psychopathology, internalizing problems and personality. FINDINGS: LCA results identified a 'Low Problems' class (34% of sample), a 'Heavy Consumption' class (26%) characterized by high endorsement probabilities of essentially only consumption/tolerance symptoms, a 'Consumption and Loss of Control' class (31%) characterized by endorsing consumption/tolerance and loss of control/social dysfunction symptoms, and finally a 'Consumption, Loss of Control and Withdrawal' class (9%) characterized by high endorsement probabilities of all symptom clusters. Multinomial regression results indicated an increasing spectrum of severity in terms of psychological impairment. CONCLUSIONS: AUD appears to manifest as different clusters of symptoms at different severity levels.

Neural bases of risky decisions involving nicotine vapor versus monetary reward.

Substantial effort has gone into neuroimaging studies of neural mechanisms underlying addiction. Human studies of smoking typically either give monetary reward during an fMRI task or else allow subjects to smoke outside the scanner, after the session. This raises a fundamental issue of construct validity, as it is unclear whether the same neural mechanisms process decisions about nicotine that process decisions about money. To address this, we developed a novel MR-compatible nicotine vaping device, such that access to nicotine vapor could be controlled and monitored. We recruited heavy smokers (Money: 45 subjects, 13 females and 32 males; Nicotine: 21 subjects, 4 females and 17 males) to perform a gambling task with nicotine and monetary reward on separate days. We collected BOLD fMRI data while they performed the task inside the scanner and analyzed it using general linear modeling, with inference based on cluster-size correction. This allowed a direct comparison between the neural mechanisms of choosing and receiving immediate drug vs. monetary reward. We found substantial differences in the neural mechanisms that underlie risky choices about money vs. drug reward, including a reversal of the well-known error effects in the medial prefrontal cortex.

The problems with delay discounting: a critical review of current practices and clinical applications.

Delay discounting paradigms have gained widespread popularity across clinical research. Given the prevalence in the field, researchers have set lofty expectations for the importance of delay discounting as a key transdiagnostic process and a 'core' process underlying specific domains of dysfunction (e.g. addiction). We believe delay discounting has been prematurely reified as, in and of itself, a core process underlying psychological dysfunction, despite significant concerns with the construct validity of discounting rates. Specifically, high delay discounting rates are only modestly related to measures of psychological dysfunction and therefore are not 'core' to these more complex behavioral problems. Furthermore, discounting rates do not appear to be specifically related to any disorder(s) or dimension(s) of psychopathology. This raises fundamental concerns about the utility of discounting, if the measure is only loosely associated with most forms of psychopathology. This stands in striking contrast to claims that discounting can serve as a 'marker' for specific disorders, despite never demonstrating adequate sensitivity or specificity for any disorder that we are aware of. Finally, empirical evidence does not support the generalizability of discounting rates to other decisions made either in the lab or in the real-world, and therefore discounting rates cannot and should not serve as a summary measure of an individual's decision-making patterns. We provide recommendations for improving future delay discounting research, but also strongly encourage researchers to consider whether the empirical evidence supports the field's hyper-focus on discounting.

Neural mechanisms of sexual decision-making in women with alcohol use disorder.

RATIONALE: The co-occurrence of alcohol consumption and sexual activity is associated with increased risk for sexual assault, sexually transmitted disease, and unplanned pregnancy among young adult women with alcohol use disorder (AUD). There is considerable previous work demonstrating neural reactivity to alcohol cues in AUD. Because alcohol consumption and sexual behavior are both rewarding and tend to co-occur, sexual cues may produce similar neural reactivity in women with AUD, possibly indicating a shared mechanism underlying reactivity to both types of cues. Alternatively, reactivity to alcohol versus sexual cues may be distinct, suggesting domain-specific mechanisms. OBJECTIVES: We investigated whether the decision vulnerabilities in AUD women regarding sexual activity were related to differences in brain activation compared to control women. METHODS: Women with (n = 15) and without (n = 16) AUD completed a hypothetical decision-making task during fMRI that presented low- or high-risk scenarios involving visual sexual, appetitive, and neutral cues. RESULTS: Results showed that sexual cues were more often endorsed by women with AUD compared to controls and elicited differential brain activation patterns in frontal, visual, and reward regions. During high-risk decisions, women with AUD failed to downregulate activation, causing hyperactivation compared to controls. CONCLUSIONS: Visual sexual cues produced reactivity like that previously demonstrated for alcohol cues, suggesting a shared or domain-general mechanism for alcohol and sexual cue reactivity in women with AUD. Riskier sexual decisions in women with AUD may be a consequence of repeatedly pairing alcohol use and sexual activity, a characteristic behavior of this population.

Symptoms of anxiety, depression, and borderline personality in alcohol use disorder with and without comorbid substance use disorder.

OBJECTIVE: Alcohol use disorder (AUD) is highly comorbid with other substance use disorders (SUDs) as well as other psychiatric disorders, such as anxiety, depression, and Borderline Personality Disorder (BPD). However, studies of persons with AUD rarely account for its comorbidity with other SUDs. Some research suggests that BPD symptoms reflect an important connection between internalizing disorders and SUDs. The current study investigated: 1) the levels of trait anxiety and symptoms of depression and BPD in persons with an AUD as a function of comorbid SUDs (cannabis use disorder - CUD) and other substance use disorder (oSUD), and 2) the influence of BPD on the association between severity of overall lifetime SUD symptoms (AUD + CUD + oSUD) and both trait anxiety and symptoms of depression. METHOD: Trait anxiety and symptoms of depression and BPD were assessed in 671 young adults (351 men; 320 women; mean age 21 years) separated into four groups: Controls (n = 185), AUD-only (134), AUD + CUD (n = 210), and AUD + oSUD (n = 142). RESULTS: Trait anxiety and symptoms of depression and BPD were elevated in all AUD groups compared with controls, and in the AUD + oSUD group compared with all other groups as well. Structural models also indicated that BPD symptoms accounted for all of the variance in lifetime SUD symptoms associated with Trait Anxiety, and a significant portion of the variance in lifetime SUD symptoms associated with depression symptoms. CONCLUSION: Results indicate that when AUD is comorbid with oSUD, it is associated with more severe AUD symptoms and higher levels of trait anxiety and symptoms of both depression and BPD. The results also indicate that BPD symptoms account for the majority of the variance in SUD symptoms associated with both trait anxiety and depression, suggesting that a considerable amount of the internalizing symptomatology in AUD/SUDs is associated with BPD psychopathology.

Neural Modulation in Approach-Avoidance Conflicts in Externalizing Psychopathology.

Externalizing psychopathology (EXT) is characterized by poor decision-making in situations that involve simultaneous cues for approach and avoidance behavior (i.e. approach-avoidance conflicts). Previous studies of EXT have examined these deficits primarily using tasks involving decisions between positive reward and negative punishment, suggesting that EXT is characterized by a general bias towards high salience (e.g. temporally proximal or reward) cues relative to low salience (e.g. temporally distal or loss) cues. However, in order to better characterize decision-making in approach-avoidance conflicts, the present study utilized a novel task to examine neural activation in contexts involving both positive reward and negative punishment as well as positive punishment and negative reward by manipulating physical proximity of affective cues. Neuroimaging results indicated that EXT was associated with deficits related to cue prioritization based on salience, suggesting that failure to differentiate relevant from less relevant information contributes to poor decision-making among individuals with EXT.

The Influence of Harm Avoidance and Impulsivity on Delay Discounting Rates.

High rates of delay discounting are associated with a range of disorders characterized by behavioral disinhibition, such as substance abuse and childhood behavioral problems. The current study extends the research of the personality correlates of delay discounting by examining its association with two domains of disinhibited personality, impulsivity and low harm avoidance. Trait measures of impulsivity and harm avoidance as well as a delay discounting task were administered to 669 young adult subjects (350 male, 319 female). The primary hypothesis was that a combination of high impulsivity and low harm avoidance would be associated with the highest delay discounting rates. Delay discounting rates were significantly associated with high levels of impulsivity. Counterintuitively, the highest rates of delay discounting were associated with high rates of impulsivity and high rates of harm avoidance. Results suggest that those high in impulsivity and harm avoidance are more sensitive to immediate rewards. These results are novel and suggest more complex processes involved when considering a choice between an immediate and a delayed reward that may require longer waiting periods, which itself may be anxiety providing and perceived as potentially harmful.

Examining the Utility of a General Substance Use Spectrum Using Latent Trait Modeling.

BACKGROUND: Polysubstance use (PSU; lifetime use of multiple substances) is common among individuals with problematic alcohol/substance use and is associated with poor prognosis and poor physical/mental health. Furthermore, simultaneous co-use of substances, such that drug effects overlap, is also common and related to unique risks (e.g. overdose). Despite the importance of PSU, current diagnostic systems continue to conceptualize problems with alcohol/substances as class-specific constructs (e.g. Stimulant Use Disorder), which essentially ignore many unique PSU processes. METHODS: The current study modeled problems with alcohol, cannabis, stimulants, sedatives, opiates, and simultaneous co-use of these substances as a manifestation of a general substance use continuum versus as correlated class-specific constructs in a sample of young-adults(n = 2482) using confirmatory factor analysis. Utility of the models was evaluated by examining associations between the general substance use spectrum and class-specific latent factors with measures of anxiety, ADHD, adult antisocial problems, borderline symptoms, neuroticism, and intelligence in a subset of the sample(n=847). RESULTS: Findings supported the conceptualization of problems with all substances, including co-use of substances, as being manifestations of a general substance use spectrum, as class-specific constructs were not differentially associated with other measures of psychological dysfunction. Examination of this general substance use spectrum indicated that all substances, separately and co-use, were robustly informative of this spectrum, but tended to discriminate between different severity levels. DISCUSSION: The general substance use spectrum allows for integration of information from the use and co-use of all substances to provide better assessment of overall problems with substances compared to class-specific constructs.

Atypical Cortical Activation During Risky Decision Making in Disruptive Behavior Disordered Youths With Histories of Suicidal Ideation.

BACKGROUND: Suicidality is a leading cause of death among adolescents. In addition to other psychiatric conditions, youths with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs) are at heightened risk for suicide. Decision-making deficits are a hallmark symptom of ADHD and DBDs and are also implicated in suicidal behavior. We examined behavioral and neural differences in decision making among youths with ADHD and DBDs with (SI+) and without (SI-) histories of suicidal ideation. METHODS: The Balloon Analog Risk Task, a risky decision-making task, was completed by 57 youths with ADHD and DBDs (38% SI+) during functional magnetic resonance imaging. Mean stop wager (mean wager at which youths bank money) was the primary measure of risk taking. We conducted whole-brain and region-of-interest analyses in the anterior cingulate cortex and orbitofrontal cortex (OFC) during choice (win vs. inflate) and outcome (inflate vs. explode) contrasts using parametric modulators accounting for probability of balloon explosion. RESULTS: There were no differences between SI+ and SI- youths in Balloon Analog Risk Task performance. SI+ youths showed decreasing activation in the right medial frontal gyrus when choosing inflate as explosion probability increased compared with SI- youths. During explosions, SI- youths showed increasing activation in the left OFC as explosions became more likely. SI+ showed increasing left medial OFC activity in response to inflations as explosion probability increased. CONCLUSIONS: SI+ youths may show heightened sensitivity to immediate reward and decreased sensitivity to potential loss as evidenced by medial frontal gyrus activity. OFC findings suggest that SI+ youths may be drawn to reward even when there is high probability of loss.