Alcohol use and interoception – A narrative review

Wiśniewski, Paweł; Maurage, Pierre; Jakubczyk, Andrzej; Trucco, Elisa M.; Suszek, Hubert

doi:10.1016/j.pnpbp.2021.110397

Cited by 24 publications

(11 citation statements)

References 154 publications

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“…Alcohol use disorder is closely connected with many psychiatric symptoms and personality traits, which can affect decision-making and HBP (Koffarnus & Kaplan, 2018; Verdejo-Garcia et al, 2012, 2018). Some of the traits related to substance use vulnerability (such as impulsivity, novelty-seeking, alexithymia, and emotion dysregulation) have been linked to interoception impairment and risky decision-making (Koffarnus & Kaplan, 2018; Verdejo-Garcia et al, 2012, 2018; Wisniewski et al, 2021). A relationship between IA and anxiety and depressive symptoms has been reported (Domschke et al, 2010; Furman et al, 2013; Limmer et al, 2015; Pollatos et al, 2009; Zoellner & Craske, 1999).…”

Section: Discussionmentioning

confidence: 99%

Relationship of Interoceptive Accuracy With Risky Decision-Making and Treatment Outcomes in Male Patients With Alcohol Use Disorder

Sönmez

Meriç

Sübay

et al. 2023

Journal of Psychophysiology

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Abstract. Lower levels of interoceptive awareness (IA) may be present in individuals with substance use disorder (SUD), and damage to related brain regions caused by substance use may disrupt IA. Disturbance in the bodily feedback system may fail to engage in effective decision-making. This study focused on the premise that interoceptive accuracy (IAc), as the primary construct of IA, is implicated in SUD and that poor IAc is linked to risky decision-making and adversely affects treatment outcomes. Eighty-five patients with alcohol use disorder (AUD) (current severity: moderate or severe) and 87 healthy control subjects were enrolled in the present study. All participants performed the heart rate tracking task and a computerized version of the Iowa gambling task (IGT). Characteristics of patients’ addiction profiles were assessed with the Addiction Profile Index (API) Clinical Form. IAc and IGT scores of patients with AUD were lower than healthy controls. IGT scores of patients with low IAc were lower than those of patients with high IAc and decreased IAc is predictive of decreased IGT scores. No significant differences were determined in treatment outcomes at 3, 6, and 12 months after hospitalization between the low-IAc and high-IAc patient groups. Our results suggest that IAc is implicated in AUD and that poor IAc is predictive of increased risky decision-making. Risky decision-making that results in substance use may be partly related to a deficit in the interoceptive ability to guide behavior. Focus on IAc without reference to complex clinical case presentations in AUD makes it difficult to draw any definitive conclusions about the role of IAc in clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Relationship of Interoceptive Accuracy With Risky Decision-Making and Treatment Outcomes in Male Patients With Alcohol Use Disorder

Sönmez

Meriç

Sübay

et al. 2023

Journal of Psychophysiology

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“…5,9 Altogether with the PLG, the ALG constitutes the posterior insula: where information from the viscera is processed, providing an objective representation of the physiological condition of the body. 5,9 One main possible implication related to this severe ALG shrinkage could be that interoceptive processes impairments (e.g., reduced interoceptive accuracy) observed in AUD 49 thalamic nuclei (i.e., posterior and basal ventral medial nuclei). 6,7 There is major empirical evidence for thalamic alterations in both patients with KS and sAUD.…”

Section: Discussionmentioning

confidence: 99%

“…Altogether with the PLG, the ALG constitutes the posterior insula: where information from the viscera is processed, providing an objective representation of the physiological condition of the body 5,9 . One main possible implication related to this severe ALG shrinkage could be that interoceptive processes impairments (e.g., reduced interoceptive accuracy) observed in AUD 49 might be caused by failure of the first and more basic processing steps in the posterior insula, impeding the efficient processing of raw interoceptive signals. Such failure could happen directly through ALG damage and/or because the ALG receives already impaired interoceptive signals.…”

Section: Discussionmentioning

confidence: 99%

Insular volumetry in severe alcohol use disorder and Korsakoff's syndrome through an anatomical parcellation: Let us go back to basics

Billaux,

Maurage,

Cabé

et al. 2023

Addiction Biology

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Functional neuroimaging has demonstrated the key role played by the insula in severe alcohol use disorder (sAUD), notably through its involvement in craving and body signals processing. However, the anatomical counterpart of these functional modifications in sAUD patients with and without neurological complications remains largely unexplored, especially using state‐of‐the‐art parcellation tools. We thus compared the grey matter volume of insular subregions (form anterior to posterior: anterior inferior cortex, anterior short gyrus, middle short gyrus, posterior short gyrus, anterior long gyrus, posterior long gyrus) in 50 recently detoxified patients with sAUD, 19 patients with Korsakoff's syndrome (KS) and 36 healthy controls (HC). We used a mixed linear model analysis to explore group differences in the six subregions grey matter volume and lateralization differences. Insular macrostructure was globally affected to the same extent in sAUD with and without KS, indicating that these brain abnormalities may be related to alcohol consumption per se, rather than to the presence of alcohol‐related neurological complications. Insular atrophy showed a right‐sided lateralization effect and was especially marked in the posterior insula, a region associated with visceral information processing and the embodiment effect of a substance, from which craving arises. Anatomical damages might thus underlie the previously reported altered insular activations and their behavioural counterparts.

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“…A common interpretation of the association of alexithymia with addictive behaviors in such research is that alexithymic people have difficulty self-regulating their emotions, and thus often turn to maladaptive coping strategies to alleviate distress. In other words, people who have difficulty identifying and describing their emotions would likely find it difficult to cope with negative moods via self-regulatory strategies such as problem-focused coping, reappraisal, attention shifting, or activating positive emotions (Wiśniewskiet al, 2021 ), and may learn to rely on substance use or other externalized behaviors to cope with distress. For example, Lyvers et al ( 2018a ) reported that alexithymia was linked to risky drinking through the specific drinking motive of drinking to cope with negative moods, presumably reflecting a deficit of emotional self-regulation in alexithymia and associated use of externalized means to cope with distress.…”

Section: Introductionmentioning

confidence: 99%

“…The relevance of this for alexithymia’s relationship with alcohol misuse is unclear, however; for example, a study of alcohol expectancies in AUD patients found that alexithymia was associated with stronger beliefs in negative effects of alcohol intoxication, in addition to increased alcohol-induced assertiveness in social situations (Thorberg et al, 2016 ). A recent review by Wiśniewskiet al ( 2021 ) concluded that based on limited findings to date, deficits in interoceptive accuracy, but elevated interoceptive sensibility, may underlie some features of AUD such as alcohol craving and impaired emotion regulation; this could reflect bidirectional influences between risk factors and the neurotoxic effects of heavy alcohol consumption on brain regions involved in both interoception and emotion, such as the insula (also see review by Lovelock et al, 2021 ). Some of the same brain areas have been reported to show abnormalities in alexithymia, including the insula and frontal regions implicated in both interoception and emotions (Gu et al, 2013 ; Stevens et al, 2011 ; Xu et al, 2018 ), processes that have been theoretically linked to each other since the 19th century (Dewey, 1894 ).…”

Section: Introductionmentioning

confidence: 99%

Alexithymia and Alcohol Use: Evaluating the Role of Interoceptive Sensibility with the Revised Multidimensional Assessment of Interoceptive Awareness

Lyvers

Thorberg

2023

J Psychopathol Behav Assess

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Alexithymia has been linked to risky or problematic alcohol use, with a common interpretation invoking deficient emotion regulation and use of alcohol to cope with distress. An alternative explanation positing a general deficit of interoception in alexithymia suggested that poor awareness of internal cues of overconsumption may promote excessive drinking. The present study assessed predictions based on these hypotheses in 337 young adult alcohol users recruited online. Participants completed validated questionnaire indices of alcohol use, alexithymia, emotion regulation, interoceptive sensibility, and sensitivity to reward and punishment. Alcohol use was positively correlated with alexithymia and reward sensitivity, and negatively correlated with emotion regulation as expected, but was uncorrelated with interoceptive sensibility. Alexithymia was not significantly correlated with most dimensions of interoceptive sensibility but was highly negatively correlated with emotion regulation. Hierarchical regression controlling for demographic variables indicated that alexithymia, emotion regulation, sex, and sensitivity to reward and punishment were significant predictors of alcohol use levels. Bootstrapped mediation test controlling for all other variables indicated mediation of the association between alexithymia and alcohol use by deficient emotion regulation but not interoceptive sensibility. Results supported the emotion regulation deficit interpretation of the association of alexithymia with alcohol use. Limitations concerning interoception measurement, online samples, self-report measures, cross-sectional designs, and collection of data during the COVID-19 pandemic are discussed. Future research could follow up on these findings by testing interoceptive accuracy in addition to interoceptive sensibility in relation to alexithymia and alcohol use.

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Alcohol use and interoception – A narrative review

Cited by 24 publications

References 154 publications

Relationship of Interoceptive Accuracy With Risky Decision-Making and Treatment Outcomes in Male Patients With Alcohol Use Disorder

Relationship of Interoceptive Accuracy With Risky Decision-Making and Treatment Outcomes in Male Patients With Alcohol Use Disorder

Insular volumetry in severe alcohol use disorder and Korsakoff's syndrome through an anatomical parcellation: Let us go back to basics

Alexithymia and Alcohol Use: Evaluating the Role of Interoceptive Sensibility with the Revised Multidimensional Assessment of Interoceptive Awareness

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