The hidden island of addiction: the insula

Abstract

Most prior research on the neurobiology of addiction has focused on the role of subcortical systems, such as the amygdala, the ventral striatum and mesolimbic dopamine system, in promoting the motivation to seek drugs. Recent evidence indicates that a largely overlooked structure, the insula, plays a crucial part in conscious urges to take drugs. The insula has been highlighted as a region that integrates interoceptive (i.e. bodily) states into conscious feelings and into decision-making processes that involve uncertain risk and reward. Here, we propose a model in which the processing of the interoceptive effects of drug use by the insula contributes to conscious drug urges and to decision-making processes that precipitate relapse.

Dissociable relations between amygdala subregional networks and psychopathy trait dimensions in conduct‐disordered juvenile offenders

“…These regions are highly interconnected with BLA and CMA subregions, forming an amygdalo‐cortico‐striatal circuit dedicated, among other things, to various aspects of reward processing [Haber, 2011; Haber and Knutson, 2010; Naqvi and Bechara, 2009]. Within this circuitry, cortical and striatal regions seem to accommodate reward evaluation (e.g., magnitude, probability, and immediacy) and action planning, while BLA and CMA apparently serve attention modulation and stimulus‐reward learning [Haber, 2011; Haber and Knutson, 2010; Peck and Salzman, 2014].…”

“…Echoing earlier work on amygdala subregional networks and their dissociable relations with psychopathy trait dimensions [Yoder et al, 2015], we hypothesized that both BLA and CMA connectivity would relate to the interpersonal dimension of psychopathy, while its affective dimension would relate primarily to CMA and its behavioral dimension primarily to BLA connectivity. Specifically, as interpersonal traits index a self‐centered, manipulative, and reward‐oriented interaction style [Andershed et al, 2007; Cooke and Michie, 2001; Neumann et al, 2006; Seara‐Cardoso and Viding, 2014], we speculated that these traits would relate to BLA and CMA connectivity with regions supporting sociocognitive [Andrews‐Hanna et al, 2010; Li et al, 2014] and reward‐related [Haber, 2011; Naqvi and Bechara, 2009] processes. In contrast, as affective psychopathic traits index callousness and lack of negative emotionality [Andershed et al, 2007; Cooke and Michie, 2001; Neumann et al, 2006; Seara‐Cardoso and Viding, 2014], it may seem reasonable to assume an association between these traits and connectivity of CMA with regions serving affective saliency and emotional responding [Etkin et al, 2011; Pessoa, 2011; Seeley et al, 2007].…”

The cerebellum in drug craving

“…Furthermore, the activation of the insula encodes a prediction of the dynamic representation of interoceptive drug effects (such as the bitter taste or the local anaesthesia induced by 8 cocaine snorting) elicited by drug cues, which ultimately contributes partially to the conscious craving perception (Myrick et al, 2004;Naqvi and Bechara, 2009).…”

The cortical surface area of the insula mediates the effect of DBH rs7040170 on novelty seeking

“…Hence, we speculate that a small regional surface area of insular cortex could lead to decreased tendency of impulsivity and to risky behaviors through the insula's role in the processing of interoceptive cues as conscious feeling, such as urge (Naqvi and Bechara, 2009), thus associated with a lower NS score. Thus, we believe that the left insular surface area represents a promising biomarker for delineating the brain structural substrate for human NS trait and for understanding the neurobiological correlates for NS-related psychiatric conditions, such as ADHD (Jacob et al, 2014) and substance abuse (Bell et al, 2014).…”