Research progress in the effects of interoceptive impairment on substance use disorders and their mechanisms
Substance use disorders(SUD)are a serious problem worldwide.Interoception is defined as a person's ability to perceive,integrate,interpret,and regulate the internal signals of the body.It plays an important role in the formation,development,and treatment of SUD.Interoception is involved in the key processes of addiction,such as reward salience,negative emotional experiences,and diminished cognitive control.Individuals with SUD(iSUD)often use drugs to alleviate negative emotional states and physical discomfort associated with withdrawal symptoms.When exposed to drugs,the insula maintains homeostasis by modifying interoceptive processing.This alteration enhances the sensitivity of the impulsive system and inhibits the reflective system,thus reducing the conflicting signals related to motivation and withdrawal.The impaired interoception associated with the process of drug use is a significant factor contributing to the inability of iSUD to suppress drug cravings,ultimately leading to relapse.Impaired interoception may lead to relapse in iSUD by enhancing the intensity of cue-induced drug craving,increasing negative emotions and impulsivity,and diminishing their ability to risk-based decision-making.This study explored the characteristics of interoceptive impairment and its role in the development of substance use disorders.It sheds light on the factors contributing to the formation of these disorders,assesses the severity of addiction,and provides a multidimensional target for intervention that combines peripheral,central,behavioral,and subjective assessments.Individuals with SUD have difficulty accurately recognizing and managing bodily signals.Furthermore,drug type may impact interoceptive accuracy.Specifically,interoceptive accuracy tends to decrease in individuals addicted to alcohol,heroin,marijuana,and nicotine,while it increases in cocaine addicts.Additionally,iSUD exhibits heightened sensitivity to physical signals associated with the effects of drugs.The underlying neural mechanism of these phenomena is the damage to the interoceptive processing center in the insula.This damage is characterized by a reduction in insula cortex thickness and weakened connections between the insula and brain regions responsible for executive control.Long-term drug use confers reward value upon drug-related cues.When iSUD are exposed to drug-related cues,the central brain regions involved in interoception are activated and show an enhancement in connectivity between the insula and the ventral striatum.Current research primarily relies on cross-sectional measurements and correlation analyses,lacking longitudinal and causal studies.The measurements of impaired interoceptive ability in iSUD predominantly focus on changes in central brain regions,despite a lack of investigation into potential alterations in peripheral receptors and transmission pathways.To enhance the understanding of the role of interoception in substance use disorders,future studies can integrate subjective and objective measurements,adopt multi-modal approaches for interoception assessment,establish the correspondence between interoceptive neural processes and psychological representations,investigate both commonalities and specificities in interoception impairment patterns among patients with different types of substance use disorders,and explore the feasibility of interoception as a target for cross-diagnostic and comorbidity intervention.
substance use disordersinteroceptionrelapsecraving
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