Importantly, in humans this neural–behavioural dissociation can be validated by comparing patients’ self-reports with those of informants137 such as family members or treatment providers, or with objective measures of performance on neuropsychological tests143. It is important to remember that self-report measures provide an important glimpse into such dissociations, but given the limitations of self-reports, the development of more objective measures of insight and awareness is crucial for both research and clinical purposes. Two promising measures are error awareness and affect matching. Error awareness in a go/no-go task was found to be reduced in young marijuana abusers and this was associated with reductions in bilateral DLPFC and right ACC, and with greater current drug use144. In metham-phetamine-dependent subjects, the bilateral ventrolateral PFC was hypoactive during affect matching and this was associated with more self-reported alexithymia145. As better awareness of the severity of drug use predicted actual abstinence for up to 1 year after treatment in alcoholics146, this budding line of research could greatly enhance our understanding of relapse in drug addiction, potentially improving currently available intervention approaches, for example, by targeting addicted individuals who have reduced self awareness for tailored interventions.
