Interoception and drug addiction

Abstract

The role of interoception and its neural basis with relevance to drug addiction is reviewed. Interoception consists of the receiving, processing, and integrating body-relevant signals with external stimuli to affect ongoing motivated behavior. The insular cortex is the central nervous system hub to process and integrate these signals. Interoception is an important component of several addiction relevant constructs including arousal, attention, stress, reward, and conditioning. Imaging studies with drug-addicted individuals show that the insular cortex is hypo-active during cognitive control processes but hyperactive during cue reactivity and drug-specific, reward-related processes. It is proposed that interoception contributes to drug addiction by incorporating an “embodied” experience of drug uses together with the individual’s predicted versus actual internal state to modulate approach or avoidance behavior, i.e. whether to take or not to take drugs. This opens the possibility of two types of interventions. First, one may be able to modulate the embodied experience by enhancing insula reactivity where necessary, e.g. when engaging in drug seeking behavior, or attenuating insula when exposed to drug-relevant cues. Second, one may be able to reduce the urge to act by increasing the frontal control network, i.e. inhibiting the urge to use by employing cognitive training.

Damage to insula abolishes cognitive distortions during simulated gambling

“…Animal models have corroborated these effects of insula damage on drug self-administration, with lesions centered on posterior, granular insula (43,44). Therapeutic strategies to reduce insula responsivity, such as mindfulness-or meditationbased techniques (45,46) or GABAergic medications (47), may usefully augment cognitive therapy for psychological distortions in the treatment of problem gambling.…”

Interoception beyond homeostasis: affect, cognition and mental health

“…Clinical advances are represented within this section of the theme issue, though many clinical areas informed by the study of interoception, including medically unexplained symptoms [26], somatization [27] and addiction [28], are equally important though not explicitly covered within this issue. Garfinkel et al [29] examine interoceptive dimensions across respiratory and cardiac axes and define how these relate to the expression of anxiety symptoms.…”

Pleasure junkies all around! Why it matters and why ‘the arts’ might be the answer: a biopsychological perspective

“…Craving is a painful state of wanting, similar to hunger [5,11]. Craving increases the incentive value of any stimulus related to the 'drug' (A-system; [24,28,29]). The more the individual has to resist or wait for the 'drug', the higher its incentive value and motivation to obtain it [25,30].…”

“…social media, gambling, football, extreme sports, drugs, see §5). Rather, the above suggests that the arts can help overwrite the detrimental effects of dysfunctional urges and craving (caused by the hyper-activation of the amygdala [11] and the hypo-activation of the insula [24], by focusing the mind into one coherent state which activates the A-and I-systems alike. It is true that not all art has a resolution or grand finale which soothes the senses after a turmoil of action and strong emotional discharge-and could thus induce craving (A-system hyper-activation).…”