Interoceptive attention in opioid and stimulant use disorder

Abstract

Blunted anterior insula activation during interoceptive perturbations has been associated with stimulant (cocaine and amphetamine) use disorder (SUD) and is related to risk for and prognosis of SUD. However, little is known whether these interoceptive alterations extend to opioid use disorder (OUD). This exploratory study used the same experimental probe during functional magnetic resonance imaging (fMRI) to test the hypothesis that SUD and OUD exhibit interoceptive discrepancies characterized by subjective ratings and activation within the insula. Recently, abstinent individuals diagnosed with current SUD (n = 40) or current OUD (n = 20) were compared with healthy individuals (CTL; n = 30) on brain and self-report responses during an interoceptive attention task known to elicit insula activation. Participants selectively attended to interoceptive (heartbeat and stomach) and exteroceptive signals during blood-oxygenlevel-dependent fMRI recording. Groups and conditions were compared on (a) activation within probabilistic cytoarchitectonic segmentations of the insula and (b) self-reported stimulus intensity. First, SUD showed amplified ratings of heart-related sensations but attenuation of dorsal dysgranular insula activity relative to CTL. Amplified ratings were linked to drug use recency, while attenuation was normalized with greater past-year stimulant use. Second, SUD and OUD showed attenuation of dorsal dysgranular insula activity during attention to stomach sensations relative to CTL. Taken together, these results are consistent with altered neural processing of interoceptive signals in drug addiction, particularly as a function of SUD. Future studies will need to determine whether interoceptive metrics help to explain substance use disorder pathophysiology and are useful for predicting outcomes.

A Bayesian computational model reveals a failure to adapt interoceptive precision estimates across depression, anxiety, eating, and substance use disorders

“…While the literature on interoceptive dysfunction is mixed for anxiety disorders broadly, it is well-stablished in panic disorder (reviewed in [6]). A couple recent studies have also reported evidence of differences in interoceptive processing in both SUDs (e.g., blunted brain responses [7]) and eating disorders (e.g., stronger effects of prior beliefs on perception during low arousal [8]). The computational framework within which our findings were observed is also in line with several recent proposals about the role of interoceptive inference in guiding (predictive) autonomic control and the potential breakdown of this mechanism within different psychiatric conditions [10-15, 36, 38]; however, in contrast to previous emphasis on altered prior beliefs in these proposals, our results more selectively support the existence of deficits in adjusting precision estimates for afferent interoceptive signals-and do not provide strong support for the presence of altered priors.…”

Greater decision uncertainty characterizes a transdiagnostic patient sample during approach-avoidance conflict: a computational modelling approach

“…All participants provided written informed consent before they completed the study protocol, in accordance with the Declaration of Helsinki, and they were compensated for participation (ClinicalTrials.gov identifier NCT02450240). A number of previous papers have been published from the larger T1000 data set, [36][37][38][39][40][41][42][43][44][45][46] but none of these papers has included analyses or data from the AAC task.…”

Long-term stability of computational parameters during approach-avoidance conflict in a transdiagnostic psychiatric patient sample

“…ClinicalTrials.gov identifier: #NCT02450240. For previous papers published from the larger T1000 dataset, see [27][28][29][30][31][32][33][34][35][36][37] . With the exception of our previous paper 20 , none of these papers included analyses using the AAC task.…”