The insula and drug addiction: an interoceptive view of pleasure, urges, and decision-making
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We have recently shown that damage to the insula leads to a profound disruption of addiction to cigarette smoking (Naqvi et al., Science 315:531-534, 2007). Yet, there is little understanding of why the insula should play such an important role in an addictive behavior. A broad literature (much of it reviewed in this issue) has addressed the role of the insula in processes related to conscious interoception, emotional experience, and decision-making. Here, we review evidence for the role of the insula in drug addiction, and propose a novel theoretical framework for addiction in which the insula represents the interoceptive effects of drug taking, making this information available to conscious awareness, memory and executive functions. A central theme of this framework is that a primary goal for the addicted individual is to obtain the effects of the drug use ritual upon the body, and representations of this goal in interoceptive terms by the insula contribute to how addicted individuals feel, remember, and decide about taking drugs. This makes drug addiction like naturally motivated behaviors, such as eating and sex, for which an embodied ritual is the primary goal.
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Many of the insula's connectivity constitute areas known to be involved in addiction.
“Many of the insula’s connectivity constitute areas known to be involved in addiction”
From The Insula: A Brain Stimulation Target for the Treatment of Addiction (2019) · cites this paper as Naqvi and Bechara, 2010
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“It has recently been proposed that interoception may play a key function in the drug use disorder process that integrates incentive salience with cognitive control and decision making processes (Naqvi and Bechara, 2009, 2010; Naqvi et al., 2007).”
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- Authors
- Naqvi, N. H., & Bechara, A.
- Affiliations
- New York State Psychiatric Institute (US)
- University of Southern California (US)
- Corresponding author
- Naqvi, Nasir H.
- ORCID
- Bechara, Antoine
- Venue
- Brain Structure and Function
- Published
- 2010-05-29
- Volume
- 214
- Issue
- 5-6
- Pages
- 435-450
- ISSN
- 1863-2653 (ISSN-L)
- 1863-2661
- PMC
- PMC3698865
- OpenAlex
- W1976397511
- Cited by
- 598
- References
- 112
- Citations by year
- 2026: 23 · 2025: 28 · 2024: 29 · 2023: 32 · 2022: 30 · 2021: 41 · 2020: 98 · 2019: 46 · 2018: 44 · 2017: 38 · 2016: 38 · 2015: 36 · 2014: 28 · 2013: 46 · 2012: 22
- FWCI
- 3.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Brain Structure and Function (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R25MH086466)
- National Institute on Drug Abuse (R01DA023051)
- National Institute of General Medical Sciences (T32GM007337)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- insula, drug addiction, interoception, decision-making, executive function, memory, embodied ritual, conscious awareness
- MeSH terms
- Animals, Awareness, Cerebral Cortex, Humans, Impulsive Behavior, Self Concept, Substance-Related Disorders, Pleasure
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