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The hidden island of addiction: the insula
Open accessAbstract
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.
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“Consistent with this hypothesis, imaging studies have reported differential activation of the insula during craving, possibly reflecting interoceptive cues and hypothesised to involve CRF activation (table 2, circuit 18).54,117,118”
From Neurobiology of addiction: a neurocircuitry analysis (2016) · cites this paper as [54]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The insula has long been implicated in drug cravings, the maintenance of drug-seeking behavior, and the regulation of distress during withdrawal [1,6,71].”
From The Insular Cortex: An Interface Between Sensation, Emotion and Cognition (2024) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions, including anxiety disorders, mood disorders, eating disorders, addictive disorders, and somatic symptom disorders.”
From Interoception and Mental Health: A Roadmap. (2018) · cites this paper as [102]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Drug addiction, another condition marked by interoceptive disturbances, has an overlapping neural circuitry and abnormal responses to interoceptive cues (101–104).”
From Interoception and Mental Health: A Roadmap. (2018) · cites this paper as [102]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The insula appears to have an interoceptive function that integrates autonomic and visceral information with emotion and motivation, thus providing conscious awareness of these urges.54”
From Neurobiology of addiction: a neurocircuitry analysis (2016) · cites this paper as [54]
In the citing paper
“For one, the AI, dACC and dlPFC activate synchronously in response to uncertainty in the environment; these regions overlap with areas implicated in negative mood states (Feinstein et al., 2006; Naqvi and Bechara, 2009; Davis and Hasson, 2016).”
From Cortico-striatal-thalamic loop circuits of the salience network: A central pathway in psychiatric disease and treatment (2016) · cites this paper as Naqvi and Bechara, 2009
In the citing paper
“It has also been associated with depression, anxiety or substance abuse (for reviews cf. Craig, 2009; Naqvi and Bechara, 2009).”
From Cognitive flexibility in adolescence: Neural and behavioral mechanisms of reward prediction error processing in adaptive decision making during development (2015) · cites this paper as Naqvi and Bechara, 2009
In the citing paper
“The insula, particularly its more anterior regions, is reciprocally connected to several limbic regions (e.g. ventromedial prefrontal cortex, amygdala, and ventral striatum) and appears to have an interoceptive function, integrating the autonomic and visceral information with emotion and motivation, thus providing conscious awareness of these urges (135).”
From Obesity and addiction: Neurobiological overlaps (2013) · cites this paper as [135]
In the citing paper
“The insula, particularly its more anterior regions, is reciprocally connected to several limbic regions (e.g. ventromedial prefrontal cortex, amygdala, and ventral striatum) and appears to have an interoceptive function, integrating the autonomic and visceral information with emotion and motivation, thus providing conscious awareness of these urges (135).”
From Obesity and addiction: Neurobiological overlaps (2013) · cites this paper as [135]
In the citing paper
“Consistent with this hypothesis, many imaging studies show differential activation of the insula during craving (135).”
From Obesity and addiction: Neurobiological overlaps (2013) · cites this paper as [135]
In the citing paper
“Consistent with this hypothesis, many imaging studies show differential activation of the insula during craving (95).”
From The Addictive Dimensionality of Obesity (2013) · cites this paper as [95]
In the citing paper
“The insula, particularly its more anterior regions, is reciprocally connected to several limbic regions and supports interoceptive functions, integrating the autonomic and visceral information with emotion and motivation and providing conscious awareness of these urges (95).”
From The Addictive Dimensionality of Obesity (2013) · cites this paper as [95]
In the citing paper
“Consistent with this hypothesis, many imaging studies show differential activation in the insula during craving (Naqvi and Bechara 2009).”
From Food and Drug Reward: Overlapping Circuits in Human Obesity and Addiction (2011) · cites this paper as Naqvi and Bechara 2009
In the citing paper
“The insula, particularly its more anterior regions, is reciprocally connected to several limbic regions (e.g., ventromedial prefrontal cortex, amygdala, and ventral striatum) and appears to have an interoceptive function, integrating the autonomic and visceral information with emotion and motivation, thus providing conscious awareness of these urges (Naqvi and Bechara 2009).”
From Food and Drug Reward: Overlapping Circuits in Human Obesity and Addiction (2011) · cites this paper as Naqvi and Bechara 2009
In the citing paper
“Moreover, the insula integrates emotional information to and from limbic and cortical areas and is involved in the representation of interoceptive responses to emotionally salient and rewarding stimuli, such as drug craving, urgency, and impulsivity (Bonson et al., 2002; Naqvi and Bechara, 2009; Villafuerte et al., 2011).”
From The effects of poor quality sleep on brain function and risk taking in adolescence (2013) · cites this paper as Naqvi and Bechara, 2009
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Citations
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Sariah, A., Liu, Z., Pu, W., Liu, H., Xue, Z., & Huang, X. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00016 · Cited by 23
“The insula plays a critical role in generating conscious, interoceptive signals into what one may subjectively experience as a feeling of desire, anticipation, or urge (88, 102).”
BackgroundBates, M. E., Lesnewich, L. M., Uhouse, S. G., Gohel, S., & Buckman, J. F. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00624 · Cited by 25
O'Connor, D. A., Rossiter, S., Yücel, M., Lubman, D. I., & Hester, R. (2012) · NeuroImage · doi:10.1016/j.neuroimage.2012.05.040 · Cited by 22
“The insula, which has been implicated in reward-related urges and decision-making processes that involve risk and reward (Naqvi and Bechara, 2009), has previously shown reduced activity during strategic attempts to inhibit craving over cocaine-cues (Volkow et al.”
Karila, L., Leroy, C., Dubol, M., Trichard, C., Mabondo, A., Marill, C., Dubois, A., Bordas, N., Martinot, J.-L., Reynaud, M., et al. (2016) · Neuropsychopharmacology · doi:10.1038/npp.2016.28 · Cited by 27
McGonigle, J., Murphy, A., Paterson, L. M., Reed, L. J., Nestor, L. J., Nash, J., Elliott, R., Ersche, K. D., Flechais, R., Newbould, R. D., et al. (2016) · Journal of Psychopharmacology · doi:10.1177/0269881116668592 · Cited by 21
“With regard to addiction, the insula appears also to be involved with critical functions such as craving, and the landmark description that damage to its structure substantially increased the likelihood of smoking cessation (Garavan, 2010; Naqvi and Bechara, 2009).”
Caruana, F. (2017) · Emotion Review · doi:10.1177/1754073917723461 · Cited by 24
Sex effects on cortical morphological networks in healthy young adults
Ge, R., Liu, X., Long, D., Frangou, S., & Vila‐Rodriguez, F. (2021) · NeuroImage · doi:10.1016/j.neuroimage.2021.117945 · Cited by 20
Chen, Y., Chaudhary, S., Wang, W., & Li, C. R. (2021) · Addiction Neuroscience · doi:10.1016/j.addicn.2021.100003 · Cited by 22
Jiang, W., Cai, L., & Wang, Z. (2023) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-023-02932-w · Cited by 20
“In fact, abnormal activation of the insula has been observed in many SUDs including NicD, MJD, and AlcD [60, 61].”
Watanabe, Y. (2013) · Medical Science Monitor · doi:10.12659/msm.889234 · Cited by 22
“, the decision to eat) that involve uncertain risk and reward [39–41].”
BackgroundRoss, J. A., & Bockstaele, E. J. V. (2020) · European Journal of Neuroscience · doi:10.1111/ejn.14714 · Cited by 20
“In line with these observations, the anterior insula has emerged as a critical mediator of drug cue reactivity, and the conscious urge to take drugs (Droutman, Read, & Bechara, 2015; Ibrahim et al., 2019; Menon & Uddin, 2010; Naqvi & Bechara, 2009).”
BackgroundResultLorenzetti, V., Gaillard, A., Beyer, E., Kowalczyk, M. A., Kamboj, S. K., Manning, V., & Gleeson, J. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04789-7 · Cited by 24
Lawn, W., Mitchener, L., Freeman, T. P., Benattayallah, A., Bisby, J. A., Wall, M. B., Dodds, C. M., Curran, H. V., & Morgan, C. J. A. (2019) · Addiction Biology · doi:10.1111/adb.12802 · Cited by 21
“The anterior cingulate has long been linked with reward‐related decision‐making,(39,40) while the insula is thought to be important in interoception and conscious urges to use drugs.(19) Indeed, cigarette smokers with damage to the insula appeared to have a greater chance of cessation.”
BackgroundKlugah‐Brown, B., Jiang, C., Agoalikum, E., Zhou, X., Zou, L., Yu, Q., Becker, B., & Biswal, B. B. (2021) · Human Brain Mapping · doi:10.1002/hbm.25471 · Cited by 24
“The insula has increasingly been noted as addiction rele- vant region, probably via its important role in interoceptive processing, decision making, and/or risky behavior which may pro- mote substance abuse despite being aware of the negative conse- quences (Naqvi & Bechara, 2009).”
BackgroundFoll, B. L., Pushparaj, A. P., Pryslawsky, Y., Forget, B., Vemuri, K. V., Makriyannis, A., & Trigo, J. M. (2013) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2013.10.009 · Cited by 20
“Naqvi and Bechara, following their initial publication described above, conducted a review of such functional imaging studies inwhich the insulawas observed to be activated during drug urges (Naqvi and Bechara, 2009).”
BackgroundResultINFLUENCE OF DOPAMINERGIC SYSTEM ON INTERNET ADDICTION
Jović, J., & Đinđić, N. (2011) · Acta Medica Medianae · doi:10.5633/amm.2011.0112 · Cited by 24
“Many studies have shown that the inter-insular activity is in correlation with the impulse control level of an individual under examination (30-33).”
BackgroundAlienation and identification in addiction
Gerrans, P. (2022) · Philosophical Psychology · doi:10.1080/09515089.2022.2067034 · Cited by 20
“…salience attribution, inhibitory control and memory consolidation . . . (Baler & Volkow, 2006) A more detailed version of this idea is provided by Navqui et al. in their explanation of the way lesion to the AIC disrupts addiction (Bechara, 2005; Naqvi & Bechara, 2009; Naqvi et al., 2014, 2007).”
BackgroundMethodChronic activation of fear engrams induces extinction‐like behavior in ethanol‐exposed mice
Cincotta, C., Murawski, N. J., Grella, S. L., McKissick, O. P., Doucette, E., & Ramirez, S. (2020) · Hippocampus · doi:10.1002/hipo.23263 · Cited by 19
“…cFos data in Figure 2, we propose that our chronic stimulation protocol bypassed numerous brain-wide systems previously implicated in mediating addiction-related behaviors, such as the insular cortex, which governs interoceptive feelings of drug craving and withdrawal (Naqvi & Bechara, 2009).”
BackgroundBiochemical Correlates of Video Game Use: From Physiology to Pathology. A Narrative Review
Carpita, B., Muti, D., Nardi, B., Benedetti, F., Cappelli, A., Cremone, I. M., Carmassi, C., & Dell’Osso, L. (2021) · Life · doi:10.3390/life11080775 · Cited by 20
“They found a significant increase in resting glucose metabolism among IGD subjects in the right middle orbitofrontal gyrus, the left caudate nucleus of the striatum (which is supposed to be strongly implicated in addiction and reward processing [66,67]) and the right insula (which plays a pivotal role in conscious urg…”
BackgroundA three-dimensional model of neural activity and phenomenal-behavioral patterns
Martino, M., & Magioncalda, P. (2023) · Molecular Psychiatry · doi:10.1038/s41380-023-02356-w · Cited by 21
Metacognitive Control of Categorial Neurobehavioral Decision Systems
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“…associated with drug use become powerful incentives, initiating both automatic (i.e., implicit) motivational processes that drive ongoing drug use and relapse in addiction to conscious (i.e., explicit) feelings of urge to take drugs” (Naqvi and Bechara, 2008, p. 61; see also Naqvi et al., 2006).”
BackgroundStoker, A. K., & Markou, A. (2015) · Current topics in behavioral neurosciences · doi:10.1007/978-3-319-13482-6_5 · Cited by 22
“Compared with the mesolimbic and habenulo-interpeduncular neurocircuits, the insula and dorsal striatum are thought to be recruited in later stages of drug dependence when drug-taking behavior becomes more habitual (for reviews, see Everitt et al. 2008; Naqvi and Bechara 2009).”
BackgroundMeng, Z., Liu, C., Hu, X., & Ma, Y. (2009) · PLoS ONE · doi:10.1371/journal.pone.0007742 · Cited by 20
“However, little is known about the role of the somatosensory system in this drug-related associative learning behavior, although the interoceptive system is found monitors bodily changes at initial stages of drug using [15,16].”
Alcohol sensory processing and its relevance for ingestion
Brasser, S. M., Castro, N., & Feretic, B. (2014) · Physiology & Behavior · doi:10.1016/j.physbeh.2014.09.004 · Cited by 22
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“The IC receives multimodal sensory inputs including gustation, visceral information, thermal sensation and pain via the sensory thalamus [25,26].”
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“…& Pessiglione, 2015; Volkow, Fowler, & Wang, 2003), (2) feelings of desire, reward anticipation, or urge (anterior insula and caudate nucleus; Naqvi & Bechara, 2009; Paulus & Stewart, 2014; Verdejo-Garcia, Clark, & Dunn, 2012), and (3) the processing of visual information (the lateral…”
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The interplay between brain 5-hydroxytryptamine levels and cocaine addiction
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“This area processes information that is derived from homoeostatic forebrain structures (amygdala, hypothalamus), systems concerned with reward and salience processing (ventral striatum), as well as the orbitofrontal, dorsolateral prefrontal and anterior cingulate cortices (Goldstein et al., 2009; Naqvi and Bechara, 20…”
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“Furthermore, the insula activity increases after deprivation of a drug, and decreased insula activity is associated with less drug use in drug users (Naqvi and Bechara, 2009; Sinha, 2011).”
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“493 Finally, we must note that insula spans a large portion of the brain and - across humans, 494 primates, and rodents – its function varies depending on subregion (Naqvi and Bechara, 2009; 495 Droutman et al., 2015b; Gogolla, 2017).”
BackgroundFukunaga, R., Bogg, T., Finn, P., & Brown, J. W. (2012) · Psychology of Addictive Behaviors · doi:10.1037/a0030633 · Cited by 20
“Recently, activity in the insula has been associated with subjective cue-induced drug urges that result in subjective experiences of “craving” (Naqvi & Bechara, 2009; Naqvi, Rudrauf, Damasio, & Bechara, 2007; Verdejo-García & Bechara, 2009).”
Dissecting Antisocial Behavior
Baskin-sommers, A. R. (2016) · Clinical Psychological Science · doi:10.1177/2167702615626904 · Cited by 21
“The insula is associated with the integration of an internal state with another’s experience, making it important for decision making and empathic functioning (Decety & Jackson, 2006; Naqvi & Bechara, 2009).”
BackgroundAltered brain activation during reward anticipation in bipolar disorder
Long, X., Wang, X., Tian, F., Cao, Y., Xie, H., & Jia, Z. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02075-w · Cited by 22
“Activation of the insula is correlated with subjective affective experience of rewards since the insula plays an important role in interoception [95].”
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Osorio‐Gómez, D., Miranda, M. I., Guzmán-Ramos, K. R., & Bermúdez‐Rattoni, F. (2023) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2023.1103770 · Cited by 20
“According to recent research, the insular cortex participates in mediating several processes related to craving and drug-seeking (Contreras et al., 2007; Naqvi and Bechara, 2009; Moschak et al., 2018) through the upregulation of opioidergic signaling, leading to an altered subcortical function and downstream activity…”
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Ertl, N., Lawn, W., Mokrysz, C., Freeman, T. P., Alnagger, N., Borissova, A., Fernandez‐Vinson, N., Lees, R., Ofori, S., Petrilli, K., et al. (2023) · Journal of Psychopharmacology · doi:10.1177/02698811231189441 · Cited by 18
“In particular, the increased connectivity with the ECN of the anterior cingulate cortex (ACC) and insula is noteworthy, as these regions have been implicated in the development of compulsive drug use and addiction (ACC: Peoples, 2002; Zhao et al., 2021; insula: Droutman et al., 2015; Naqvi and Bechara, 2009).”
BackgroundOh, H., Lee, J., Gosnell, S. N., Patriquin, M. A., Kosten, T. R., & Salas, R. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106457 · Cited by 18
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“…insular cortex (AIC) has recently become an area of interest in both anxiety (Paulus and Stein, 2006) and addiction (Goldstein et al., 2009; Naqvi and Bechara, 2009) because of its unique role as both an integrator and evaluator of internal, homeostatic information from the external…”
BackgroundModulation of autonomic activity in neurological conditions: Epilepsy and Tourette Syndrome
Nagai, Y. (2015) · Frontiers in Neuroscience · doi:10.3389/fnins.2015.00278 · Cited by 18
“Alternatively, the relationship with premonitory urges and compulsive behavior may be an important mechanism: damage to the viscerosensory insula cortex is observed to inhibit addictive urges and compulsions to smoke (Gray and Critchley, 2007; Naqvi and Bechara, 2009).”
BackgroundAddicott, M. A., Luber, B. M., Nguyên, D. T., Palmer, H., Lisanby, S. H., & Appelbaum, L. G. (2019) · Brain Connectivity · doi:10.1089/brain.2018.0652 · Cited by 18
“Insula function is highly relevant to drug cravings and addiction (Garavan, 2010; Naqvi and Bechara, 2009), as well as other psychiatric disorders, including post-traumatic stress disorder, social anxiety, and phobias (Etkin and Wager, 2007).”
Neural Substrates of Youth and Adult Antisocial Behavior
Waller, R. E., Dotterer, H. L., Murray, L., & Hyde, L. W. (2018) · Cambridge University Press eBooks · doi:10.1017/9781316847992.040 · Cited by 17
Joshi, D., Puaud, M., Fouyssac, M., Belin‐Rauscent, A., Everitt, B. J., & Belin, D. (2020) · European Journal of Neuroscience · doi:10.1111/ejn.14889 · Cited by 18
“The anterior insular cortex (AIC) has been increasingly implicated in the pathophysiology, and associated behavioural manifestations of, drug addiction (Naqvi & Bechara, 2009; Verdejo-Garcia et al., 2012).”
BackgroundNewton‐Fenner, A., Hewitt, D., Henderson, J. R., Roberts, H., Mari, T., Gu, Y., Gorelkina, O., Giesbrecht, T., Fallon, N. B., Roberts, C. A., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286969 · Cited by 19
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“Interestingly, previous studies have found that the activation of the VAN in SUD was correlated with self-rated craving and urgency for intaking substance, indicating an important role of redirecting attentional resources in addiction (Kühn & Gallinat, 2011; Naqvi & Bechara, 2009).”
Learning and memory processes in behavioural addiction: A systematic review
Ngetich, R. K., Villalba-García, C., Soborun, Y., Vékony, T., Czakó, A., Demetrovics, Z., & Németh, D. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105747 · Cited by 22
Nicotine Addiction: Mechanisms and Consequences
Rosenthal, D. G., Weitzman, M. L., & Benowitz, N. L. (2011) · International Journal of Mental Health · doi:10.2753/imh0020-7411400102 · Cited by 18
“Imaging studies have shown that these drug-activated cues activate specific cortical regions of the brain (namely the insula) associated with certain basic emotions [21, 60, 61].”
BackgroundSayer, R. D., Amankwaah, A. F., Tamer, G. G., Chen, N., Wright, A. J., Tregellas, J. R., Cornier, M.-A., Kareken, D. A., Talavage, T. M., McCrory, M. A., et al. (2016) · Nutrients · doi:10.3390/nu8010021 · Cited by 17
“The insula is also characterized by a high density of dopamine and μ-opioid receptors that contribute to its role in reward processing [31,32].”
Nasser, H. M., Lafferty, D. S., Lesser, E. N., Bacharach, S. Z., & Calu, D. J. (2017) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2017.11.010 · Cited by 17
“The more anterior regions have reciprocal connections to limbic regions while the posterior regions receive inputs from thalamic and sensory systems (Naqvi & Bechara, 2009).”
BackgroundZhang, R., Jia, W., Wang, Y., Zhu, Y., Liu, F., Li, B., Liu, F., Wang, H., & Tan, Q. (2019) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2019.07.023 · Cited by 18
Wang, M., Zheng, H., Zhou, W., Jiang, Q. Y., & Dong, G. (2021) · Addiction Biology · doi:10.1111/adb.13046 · Cited by 17
“, ventromedial prefrontal cortex, amygdala and ventral striatum).(44) The hyperconnectivity between the insula and ventral striatum would exaggerate the salience of the reward for addicts and contribute to maintaining reward-driven behaviour, which has been shown in smokers.”
BackgroundTsurugizawa, T., Abe, Y., & Bihan, D. L. (2017) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x16685104 · Cited by 16
“Especially, ethanol directly deactivates interneurons in the ventral tegmental area, resulting in the facilitation of dopamine secretion in the NAc(14) and the insular cortex.(15) This alteration of dopaminergic pathway also leads to the alcohol addiction.”
BackgroundVisceral adiposity and insular networks: associations with food craving
Contreras‐Rodríguez, O., Cano, M., Vilar‐López, R., Schmidt‐RioValle, J., Verdejo‐Román, J., Navas, J. F., Martín-Pérez, C., Fernández‐Aranda, F., Menchón, J. M., Soriano‐Mas, C., et al. (2018) · International Journal of Obesity · doi:10.1038/s41366-018-0173-3 · Cited by 20
Watanuki, S. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.984647 · Cited by 17
“The connected network between the ventral part of the anterior insula, sometimes along with the dorsal part of the anterior and the posterior part of the insula, and these sub-cortical regions is associated with reward processing such as rewardseeking and addiction (Naqvi and Bechara, 2009; Naqvi et al., 2014; Droutma…”
BackgroundBosker, W. M., Neuner, I., & Shah, N. J. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.04.008 · Cited by 18
“These regions are involved in decision-making related to substance use (Naqvi and Bechara, 2009) and poor insight in problematic substance use (Goldstein et al.”
BackgroundDoes unilateral insular resection disturb personality? A study with epileptic patients
Hébert-Seropian, B., Boucher, O., Sénéchal, C., Rouleau, I., Bouthillier, A., Leporé, F., & Nguyen, D. K. (2017) · Journal of Clinical Neuroscience · doi:10.1016/j.jocn.2017.04.001 · Cited by 16
The 100 Most Cited Papers Concerning the Insular Cortex of the Brain: A Bibliometric Analysis
Yeung, A. W. K. (2018) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2018.00337 · Cited by 16
“It is often investigated in clinical topics such as addiction (Naqvi and Bechara, 2009), anorexia nervosa (Wagner et al.”
BackgroundKim, S., Kim, M.-K., Shin, Y., Kim, H. E., Kwon, J. H., & Kim, J. (2021) · Journal of Behavioral Addictions · doi:10.1556/2006.2021.00005 · Cited by 16
Hill-Bowen, L. D., Riedel, M. C., Salo, T., Flannery, J. S., Poudel, R., Laird, A. R., & Sutherland, M. T. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109625 · Cited by 18
The neuroscience of free will: implications for psychiatry
Pierre, J. M. (2013) · Psychological Medicine · doi:10.1017/s0033291713002985 · Cited by 16
“Much of this neural decision making occurs unconsciously, with the insular cortex integrating the somatic signals from the amygdala and VMPC in order to produce a subjective feeling of a conscious urge to use drugs that is then implemented into action in the SMA (Naqvi & Bechara, 2008; Li et al. 2010).”
BackgroundInfluentialQEEG and LORETA in Teenagers With Conduct Disorder and Psychopathic Traits
Calzada‐Reyes, A., Alvarez‐Amador, A., Galán‐Garcia, L., & Valdés-Sosa, M. J. (2016) · Clinical EEG and Neuroscience · doi:10.1177/1550059416645712 · Cited by 16
Klugah‐Brown, B., Wang, P., Jiang, Y., Becker, B., Hu, P., Uddin, L. Q., & Biswal, B. B. (2022) · Cerebral Cortex · doi:10.1093/cercor/bhac168 · Cited by 14
Effects of Persistent Binge Drinking on Brain Structure in Emerging Adults: A Longitudinal Study
García, J. M. P., Cadaveira, F., Canales-Rodríguez, E. J., Suárez‐Suárez, S., Holguı́n, S. R., Corral, M., Blanco‐Ramos, J., & Doallo, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.935043 · Cited by 15
Constructing Craving: Applying the Theory of Constructed Emotion to Urge States
Wilson, S. J. (2022) · Current Directions in Psychological Science · doi:10.1177/09637214221098055 · Cited by 18
“For example, conditions designed to induce craving (e.g., exposure to substance-related cues) are associated with increased activity in the insula (Garavan, 2010; Naqvi & Bechara, 2009).”
BackgroundAbnormal resting‐state effective connectivity in reward network among long‐term male smokers
Zhang, M., Gao, X., Yang, Z., Han, S., Zhou, B., Niu, X., Wang, W., Wei, Y., Cheng, J., & Zhang, Y. (2022) · Addiction Biology · doi:10.1111/adb.13221 · Cited by 16
“It may prove the hypothesis that severely dependent individuals engage in more interoception awareness and show more negative physical experiences relative to craving because of their decreased sensitivity to rewards.(52,53) F IGURE 3 EC difference between long-term smokers and healthy controls (A) weaken EC in long-t…”
BackgroundAlcohol use disorder‐associated structural and functional characteristics of the insula
Manuweera, T., Kisner, M. A., Almira, E., & Momenan, R. (2022) · Journal of Neuroscience Research · doi:10.1002/jnr.25113 · Cited by 15
“The posterior insula then, relays signals to the anterior insula where somatic- marker representation links the association to memory (Naqvi & Bechara, 2009; Naqvi et al., 2014).”
BackgroundLetzen, J. E., Seminowicz, D. A., Campbell, C. M., & Finan, P. H. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.12.011 · Cited by 16
Wang, C., Huang, P., Shen, Z., Qian, W. P., Wang, S., Jiaerken, Y., Luo, X., Li, K., Zeng, Q., Zhou, C., et al. (2020) · Addiction Biology · doi:10.1111/adb.12919 · Cited by 13
“Additionally, the insula is thought to play a core role in interoceptive awareness of internal, subjective states, including craving to smoke.(29) Recently, a fMRI study showed that reduced rsFC between the NAc and insula at baseline was associated with poor smoking cessation outcomes after a 3-week quit attempt.”
BackgroundToward an Integrative Conceptualization of Maladaptive Consumer Behavior
Clithero, J. A., Karmarkar, U. R., & Hsu, M. (2021) · Journal of the Association for Consumer Research · doi:10.1086/714364 · Cited by 15
Cerritelli, F., Galli, M., Consorti, G., D’Alessandro, G., Kołacz, J., & Porges, S. W. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251838 · Cited by 15
“Our results are not consistent with the hypothesis proposed by Naqvi and Bechara [28]: the interpretation framework between the awareness of the interoception and smoking takes into account that the insula— which can be affected by nicotine making the interoceptive information available to conscious awareness.”
BackgroundResultKirson, D., Bagsic, S. R. S., Murphy, J., Chang, H., Vlkolinský, R., Pucci, S. N., Prinzi, J., Williams, C. A., Fang, S. Y., Roberto, M., et al. (2022) · Neuropharmacology · doi:10.1016/j.neuropharm.2022.108980 · Cited by 17
Physical Exercise to Redynamize Interoception in Substance use Disorders
Brevers, D., Billieux, J., de Timary, P., Desmedt, O., Maurage, P., Perales, J. C., Suárez‐Suárez, S., & Bechara, A. (2023) · Current Neuropharmacology · doi:10.2174/1570159x21666230314143803 · Cited by 14
“At the cerebral level, the insular cortex plays a key role in the subjective perception of the body signal associated with craving [39, 49, 51, 56-58].”
BackgroundSelf-citationStippekohl, B., Walter, B., Winkler, M. H., Mucha, R. F., Pauli, P., Vaitl, D., & Stark, R. M. (2012) · Psychopharmacology · doi:10.1007/s00213-012-2670-8 · Cited by 14
“…and mesocortical structures known to be part of a neuronal addiction network (Everitt and Robbins 2005; Bechara 2005; Volkow et al. 2003, 2004; Naqvi and Bechara 2009): nucleus accumbens (Nacc), orbitofrontal cortex (OFC), subcallosal cortex (SUBCC), medial frontal cortex (MFC), insula,…”
BackgroundLe, T. M., Malone, T., & Li, C. R. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.109248 · Cited by 15
Musial, M. P. M., Beck, A., Rosenthal, A., Charlet, K., Bach, P., Kiefer, F., Vollstädt‐Klein, S., Walter, H., Heinz, A., & Rothkirch, M. (2022) · Biological Psychiatry · doi:10.1016/j.biopsych.2022.05.024 · Cited by 16
“function have repeatedly been associated with addictive behavior (13,14,17).”
BackgroundTakei, H., Fujita, S., Shirakawa, T., Koshikawa, N., & Kobayashi, M. (2010) · Neuroscience · doi:10.1016/j.neuroscience.2010.07.061 · Cited by 14
Wang, F., JING, X., Yang, J., Wang, H., Xiang, R., Han, W., Liu, X., & WU, C. (2016) · Physiological Research · doi:10.33549/physiolres.933106 · Cited by 14
“Because the insular cortex contains a high density of D1 dopamine receptors and receives strong dopaminergic innervation (Naqvi and Bechara 2009), the increase of FosB/ΔFosB expression in the insular cortex may be modulated by the D1 receptor and related to downstream transcriptional pathway.”
BackgroundBlunted Frontostriatal Blood Oxygen Level–Dependent Signals Predict Stimulant and Marijuana Use
Blair, M. A., Stewart, J. L., May, A. C., Reske, M., Tapert, S. F., & Paulus, M. P. (2018) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2018.03.005 · Cited by 14
“Evidence from fMRI studies has led researchers to theorize that frontal lobe and striatum form a functional circuit with insular cortex and anterior cingulate cortex (ACC); these regions coordinate to integrate emotional and autonomic information about rewards into goal-oriented behavior (31,32).”
BackgroundInfluentialAddiction: Informing drug abuse interventions with brain networks
Steele, V. R., Ding, X., & Ross, T. J. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-813838-0.00006-6 · Cited by 14
Jones, E. C., Liebel, S. W., Hallowell, E. S., & Sweet, L. H. (2018) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2018.12.011 · Cited by 15
“, 2004) and substance use disorders (Naqvi and Bechara 2009), have been linked to the insula.”
BackgroundLongitudinal link between trait motivation and risk-taking behaviors via neural risk processing
Li, M., Lauharatanahirun, N., Steinberg, L. D., King‐Casas, B., Kim‐Spoon, J., & Deater-Deckard, K. D. (2019) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2019.100725 · Cited by 18
Real-Time Regulation and Detection of Brain States from fMRI Signals
Sitaram, R., Lee, S., Ruíz, S., & Birbaumer, N. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-382235-2.00009-3 · Cited by 14
Florence, L. L. A., Lassi, D. L. S., Kortas, G. T., Lima, D. R., Périco, C. D. A.-M., de Andrade, A. G., Torales, J. C., Ventriglio, A., Berardis, D. D., Aquino, J. P. D., et al. (2022) · Brain Sciences · doi:10.3390/brainsci12030386 · Cited by 13
Tang, V. M., Goud, R., Zawertailo, L. A., Selby, P. L., Coroiu, A., Sloan, M. E., Chenoweth, M. J., Buchman, D. Z., Ibrahim, C., Blumberger, D. M., et al. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115340 · Cited by 15
Lin, E. R.-H., Veenker, F., Manza, P., Yonga, M.-V., Abey, S. K., Wang, G., & Volkow, N. D. (2024) · Brain Sciences · doi:10.3390/brainsci14121285 · Cited by 15
“Neuroimaging studies demonstrated insula activity in response to drug cues in patients addicted to cigarettes, cocaine, and alcohol, and correlated insula activity with self-reported cravings [160,164–167].”
Toward an interdisciplinary science of consumption
Preston, S. D. (2011) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2011.06163.x · Cited by 13
Virtually ‘in the heat of the moment’: insula activation in safe sex negotiation among risky men
Smith, B. J., Xue, F., Droutman, V., Barkley‐Levenson, E. E., Melrose, A. J., Miller, L. C., Monterosso, J. R., Bechara, A., Appleby, P. R., Christensen, J. L., et al. (2017) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsx137 · Cited by 13
“It is linked to deviations from homeostasis that give rise to the feeling of urge and desire (Naqvi and Bechara, 2009; Xue et al., 2010; Berntson et al., 2011; Droutman et al., 2015a,b), and it drives a salience and attention network (Sridharan et al., 2008; Uddin, 2014).”
BackgroundSelf-citationJones, R., & Bhattacharya, J. (2012) · Journal of Behavioral Addictions · doi:10.1556/jba.1.2012.005 · Cited by 14
“…on the basis of the reduced insula activation in OCD patients during natural reward (Figee et al., 2011) and the strong link between the insula and craving in addiction (Naqvi & Bechara, 2008; Paulus, 2007), we predicted that the main generator of urge-related neural activity to be the insula.”
Kim‐Spoon, J., Herd, T., Brieant, A. E., Peviani, K. M., Lauharatanahirun, N., Lee, J., Deater-Deckard, K. D., Bickel, W. K., & King‐Casas, B. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13285 · Cited by 13
“The insular cortex, while known to be a key region in the neural representation of risk, also plays an important role in translating interoceptive signals into conscious feelings and behavioral biases during risk/reward-related decision making (Naqvi & Bechara, 2009).”
BackgroundResultBrunyé, T. T. (2020) · Journal of Cognitive Enhancement · doi:10.1007/s41465-020-00186-0 · Cited by 14
Abnormal white matter tracts of insula in smokers
Wang, C., Wang, S., Huang, P., Shen, Z., Qian, W. P., Luo, X., Li, K., Zeng, Q., Gu, Q., Yu, H., et al. (2020) · Brain Imaging and Behavior · doi:10.1007/s11682-020-00389-1 · Cited by 13
Filbey, F. M., Beaton, D., & Prashad, S. (2020) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110183 · Cited by 13
“, the appetitive cue in this context) (Garavan, 2010; Naqvi and Bechara, 2009; Pelchat et al., 2004; Wang et al., 2004).”
BackgroundShen, Y., & Ward, H. B. (2020) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2020.1841784 · Cited by 13
Mackenzie, R. (2010) · Neuroethics · doi:10.1007/s12152-010-9074-4 · Cited by 13
“Disrupting one aspect of addiction, such as preventing the insular cortex from sensing bodily needs through interoception, may create aversion [ 85 ] but may also impact upon subjective experience and mood [86] as modulated by the associated neuromechanisms.”
BackgroundKoob, G. F., Kandel, D. B., Baler, R., & Volkow, N. D. (2015) · Wiley eBooks · doi:10.1002/9781118753378.ch22 · Cited by 14
Appetitive Needs and Addiction
Sussman, S. Y., & Pakdaman, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.004 · Cited by 12
Connectome‐based predictive modelling of smoking severity in smokers
Lin, X., Zhu, X., Zhou, W., Zhang, Z., Li, P., Dong, G., Meng, S., Deng, J., & Lü, L. (2022) · Addiction Biology · doi:10.1111/adb.13242 · Cited by 12
Larsen, J. K., Hollands, G. J., Garland, E. L., Evers, A. W. M., & Wiers, R. W. H. J. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105408 · Cited by 12
Niu, X., Zhang, M., Gao, X., Dang, J., Sun, J., Tao, Q., Yan, L., Wang, W., Wei, Y., Han, S., et al. (2024) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2024.101472 · Cited by 12
“It has been suggested that the insula may be involved in the initiation and maintenance of addiction by translating interoceptive signals into feelings of craving, anticipation, or impulsiveness that a person subjectively experiences(Naqvi and Bechara, 2009); (Verdejo-Garcia et al., 2012).”
Background
Metadata
- Authors
- Naqvi, N. H., & Bechara, A.
- Affiliations
- New York State Psychiatric Institute (US)
- University of Southern California (US)
- Corresponding author
- Bechara, Antoine
- ORCID
- Bechara, Antoine
- Venue
- Trends in Neurosciences
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 32
- Issue
- 1
- Pages
- 56-67
- ISSN
- 0166-2236 (ISSN-L)
- PMC
- PMC3698860
- OpenAlex
- W2036074427
- Semantic Scholar
- 2c3d49d333514ca29ffa128dca631e5f5cfbfe5b
- Cited by
- 833
- References
- 148
- Citations by year
- 2026: 29 · 2025: 26 · 2024: 32 · 2023: 45 · 2022: 58 · 2021: 44 · 2020: 107 · 2019: 38 · 2018: 37 · 2017: 42 · 2016: 53 · 2015: 48 · 2014: 49 · 2013: 60 · 2012: 52
- FWCI
- 3.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Trends in Neurosciences (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA023051)
- National Institute of General Medical Sciences (T32GM007337)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- insula, addiction, drug craving, interoception, relapse, decision-making, risk and reward, neurobiology of addiction
- MeSH terms
- Animals, Cerebral Cortex, Humans, Models, Biological, Neural Pathways, Substance-Related Disorders
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