Sex differences in cue-evoked drug-seeking tendencies among abstinent individuals with heroin use disorder: insight as a moderator

Abstract Background Impaired insight is increasingly recognized as an important feature of substance use disorders and has been associated with poorer treatment outcomes. However, whether the association between insight and drug-seeking tendency differs by sex remains unclear. This study used a behavioral paradigm to examine sex differences in this association among abstinent individuals with heroin use disorder. Methods Methods: Seventy-eight abstinent individuals with heroin use disorder (27 males and 51 females) completed the BIM task. Drug-seeking tendency was indexed by the relative frequency of selecting drug-related pictures compared with positive, negative, and neutral pictures. Insight was classified as intact or impaired based on the congruence between participants’ self-reported and objectively determined most frequently selected picture categories. Results Female participants with intact insight selected fewer drug-related pictures than positive and neutral pictures and showed a lower drug-seeking tendency than those with impaired insight. Among male participants, the analyses did not provide clear evidence of differences in picture-selection patterns or drug-seeking tendency between the intact- and impaired-insight groups. Male participants also tended to show a greater overall drug-seeking tendency and a higher prevalence of impaired insight than female participants. Conclusions Intact insight may be associated with a lower drug-seeking tendency among abstinent females with heroin use disorder, whereas the corresponding pattern appeared less pronounced among males. These preliminary findings suggest that sex may be relevant to the role of insight in behavioral regulation and support further investigation of sex-sensitive interventions for substance use disorders.