The hyper-sentient addict: an exteroception model of addiction

Abstract

Background Exteroception involves processes related to the perception of environmental stimuli important for an organism's ability to adapt to its environment. As such, exteroception plays a critical role in conditioned response. In addiction, behavioral and neuroimaging studies show that the conditioned response to drug-related cues is often associated with alterations in brain regions including the precuneus/posterior cingulate cortex, an important node within the default mode network dedicated to processes such as self-monitoring. Objective This review aimed to summarize the growing, but largely fragmented, literature that supports a central role of exteroceptive processes in addiction. Methods We performed a systematic review of empirical research via PubMed and Google Scholar with keywords including ‘addiction’, ‘exteroception’, ‘precuneus’, and ‘self-awareness’, to identify human behavioral and neuroimaging studies that report mechanisms of self-awareness in healthy populations, and altered selfawareness processes, specifically exteroception, in addicted populations. Results Results demonstrate that exteroceptive processes play a critical role in conditioned cue response in addiction and serve as targets for interventions such as mindfulness training. Further, a hub of the default mode network, namely, the precuneus, is (i) consistently implicated in exteroceptive processes, and (ii) widely demonstrated to have increased activation and connectivity in addicted populations. Conclusion Heightened exteroceptive processes may underlie cue-elicited craving, which in turn may lead to the maintenance and worsening of substance use disorders. An exteroception model of addiction provides a testable framework from which novel targets for interventions can be identified.

A review of implicit and explicit substance self-concept as a predictor of alcohol and tobacco use and misuse

“…Specifically, recent reviews suggest that individuals who are addicted to alcohol or other substances may have impairments in neural circuits and/or cortical structures (e.g., the insula, anterior cingulate cortex, and posterior cortical midline structures) critical for self-awareness, introspection, interoception, exteroception, and controlled decision-making (36–38). Depending on the specific circuit or region of interest, different impairments or deficits related to self-awareness have been proposed.…”

“…Depending on the specific circuit or region of interest, different impairments or deficits related to self-awareness have been proposed. For example, a model by DeWitt and colleagues (36) suggests that individuals who are addicted to a substance become hypersensitive to substance-related cues over time. Those cues are posited to be increasingly “tagged” as self-relevant, which in turn, can lead to the development of a substance-related identity, which in turn can influence subsequent substance use.…”

“…A recent study made an attempt (73), but both experiments in the study yielded null results, suggesting that much remains to be learned with respect to feasibility of this approach. Finally, mindfulness techniques, which are thought to target self-relevant processes more broadly (36), might also offer a means to reduce the activation, and ultimately, strength of substance self-concept.…”

Youth with substance abuse histories exhibit dysfunctional representation of expected value during a passive avoidance task

“…It has been argued that exteroception, or neural representation of external/environmental stimuli, plays a key role in SA and that posterior midline structures, including PCC and precuneus, are dysfunctional during exteroception in SA positive individuals (see DeWitt et al, 2015). Specifically, DeWitt and colleagues (2015) argue that “heightened exteroceptive processes” confer risk for and/or are a result of SA. For example, for an individual with SA problems, a cue associated with drugs (e.g.…”

Cross-Cultural Effects of Cannabis Use Disorder: Evidence to Support a Cultural Neuroscience Approach

“…In addition to impairments in cognitive control, individuals with CUDs may have altered processing of self-awareness and self-relevant stimuli that may underlie increased sensitivity and awareness of cannabis-related cues in the environment [73]. Such impairments in cognitive control and hypersensitivity to cannabis-related cues along with associated changes in activations and connectivity in relevant brain networks may represent suitable neural markers for severity of CUDs and be assessed longitudinally for understanding and tracking the progression of CUDs.…”