Interoceptive accuracy and interoceptive sensibility in individuals with alcohol use disorder–Different phenomena with different clinical correlations?

Abstract

Background: Interoception may contribute to substance use disorder as it relates to the body's experience of substance use or withdrawal. However, only a few studies have directly investigated associations between interoception and alcohol use. The objective of this study was to compare individuals with alcohol use disorder (AUD) and healthy controls on interoceptive sensibility and accuracy. Methods: The sample was comprised of two groups: individuals meeting criteria for AUD (N = 114) and healthy controls (N = 110) not meeting criteria for AUD. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy-with a behavioral measure (the Schandry test). In addition, associations between interoception and other well-recognized correlates of AUD (sleep problems, depressive and anxiety symptoms, impulsivity) were tested. Barratt's Impulsiveness Scale, Brief Symptom Inventory, and Athens Insomnia Scale were utilized to assess psychopathological symptoms as covariates. Results: When controlling for level of anxiety, sleep problems, age, sex and education, individuals with AUD scored significantly higher on self-reported interoceptive sensibility and lower on interoceptive accuracy in comparison to healthy controls. Higher interoceptive sensibility was associated with more severe sleep problems and anxiety symptoms.

Association Between Interoception and Emotion Regulation in Individuals With Alcohol Use Disorder

“…On the other hand, adolescents diagnosed with substance use disorder demonstrated altered insula response to pleasant interoceptive stimuli (14). Prior work indicates that individuals with AUD are characterized by lower interoceptive accuracy and higher sensibility in comparison to healthy controls (6). In this sample, interoceptive sensibility was also associated with high levels of anxiety, depression, and more severe sleep problems.…”

“…However, to the best of our knowledge, associations between emotion regulation and interoception have not been investigated among individuals with AUD. This could have utility given the significance of both interoception and emotion regulation within this clinical sample (6,20). Moreover, evidence for a common neurobiological underpinning for processes associated with interoception, emotion regulation, and craving lend support to a plausible connection between these constructs.…”

“…Sensing body-related information includes interoceptive sensibility (the tendency to focus on internal body sensations) and accuracy (precision in perceiving real internal processes measured behaviorally, e.g., heartbeat perception). Prior work with clinical populations (2)(3)(4)(5), including individuals with alcohol use disorder (AUD) (6) demonstrated that interoceptive sensibility is not associated with accuracy. A specific phenomenon that is related to correspondence between interoceptive accuracy and sensibility is interoceptive awareness (defined as metacognitive awareness of one's interoceptive accuracy).…”

“…Importantly, therapeutic interventions aimed at improving interoception awareness skills, such as mindfulness-based approaches, were shown to be effective in women's substance abuse treatment (15). In addition to general interoceptive abilities, sensitivity to one specific type of interoceptive sensationpain, was shown to be an important factor contributing to the development and course of AUD (6,16,17). Interestingly, it was shown that consuming alcohol may differentially influence pain sensations in individuals with AUD and healthy controls.…”

Perceptual insensitivity to the modulation of interoceptive signals in depression, anxiety, and substance use disorders

“…For example, aside from the panic disorder studies already discussed, a recent review concluded that—while work to date has a number of important limitations—the cumulative evidence suggests that individuals with moderate depression symptoms appear to show impaired interoceptive accuracy 45 . Other preliminary work has also linked alcohol use disorder with low interoceptive accuracy 46 , and there are several neuroimaging studies suggesting altered interoceptive processing within substance users 33 , 47 – 49 . Thus, we sought to confirm whether our hypothesized interoceptive processing deficit was present across these diagnostic categories.…”