On the Role of Insula in Drug Addiction
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Published
Mar 29, 2023
Abstract
Drug addiction is a chronic, relapsing brain disease with limited treatment options and a high recurrence rate. Neuromodulation techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation, hold great therapeutic promise in the treatment of drug addiction. The insula is a key brain region in drug addiction, and its value as a neuromodulatory target in drug addiction needs further exploration. This article presents preclinical and clinical evidence for the role of the insula in drug addiction and explores its promise as a target for the treatment of drug addiction.
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Keywords
Insula, Neuromodulation, Drug Addiction, Deep Brain Stimulation, Mechanism
References
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2. Substance use disorder treatment for people with co-occurring disorders: Updated 2020. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2020.
3. Bari A, DiCesare J, Babayan D, Runcie M, Sparks H, Wilson B. Neuromodulation for substance addiction in human subjects: A review. Neurosci Biobehav Rev 2018; 95:33-43. DOI: https://doi.org/10.1016/j.neubiorev.2018.09.013
4. Angres DH, Bettinardi-Angres K. The disease of addiction: Origins, treatment, and recovery. Dis Mon 2008; 54(10):696-721. DOI: https://doi.org/10.1016/j.disamonth.2008.07.002
5. Koob GF, Buck CL, Cohen A, Edwards S, Park PE, Schlosburg JE, Schmeichel B, Vendruscolo LF, Wade CL, Whitfield TW Jr, George O. Addiction as a stress surfeit disorder. Neuropharmacology 2014; 76(Pt B):370-382. DOI: https://doi.org/10.1016/j.neuropharm.2013.05.024
6. Xu L, Nan J, Lan Y. The Nucleus Accumbens: A common target in the comorbidity of depression and addiction. Front Neural Circuits 2020; 14:37. DOI: https://doi.org/10.3389/fncir.2020.00037
7. Droutman V, Read SJ, Bechara A. Revisiting the role of the insula in addiction. Trends Cogn Sci 2015; 19(7):414-420. DOI: https://doi.org/10.1016/j.tics.2015.05.005
8. Evrard HC. The organization of the primate insular cortex. Front Neuroanat 2019; 13:43. DOI: https://doi.org/10.3389/fnana.2019.00043
9. Fermin ASR, Friston K, Yamawaki S. An insula hierarchical network architecture for active interoceptive inference. R Soc Open Sci 2022; 9(6):220226. DOI: https://doi.org/10.1098/rsos.220226
10. Li X, Qin F, Liu J, Luo Q, Zhang Y, Hu J, Chen Y, Wei D, Qiu J. An insula-based network mediates the relation between rumination and interoceptive sensibility in the healthy population. J Affect Disord 2022; 299:6-11. DOI: https://doi.org/10.1016/j.jad.2021.11.047
11. Uddin LQ, Nomi JS, Hébert-Seropian B, Ghaziri J, Boucher O. Structure and function of the human insula. J Clin Neurophysiol 2017; 34(4):300-306. DOI: https://doi.org/10.1097/WNP.0000000000000377
12. Naqvi NH, Bechara A. The hidden island of addiction: The insula. Trends Neurosci 2009; 32(1):56-67. DOI: https://doi.org/10.1016/j.tins.2008.09.009
13. Namkung H, Kim SH, Sawa A. The insula: An underestimated brain area in clinical neuroscience, psychiatry, and neurology. Trends Neurosci 2017; 40(4):200-207. DOI: https://doi.org/10.1016/j.tins.2017.02.002. Erratum in: Trends Neurosci 2018; 41(8):551-554.
14. Strigo IA, Craig AD. Interoception, homeostatic emotions and sympathovagal balance. Philos Trans R Soc Lond B Biol Sci 2016; 371(1708):20160010. DOI: https://doi.org/10.1098/rstb.2016.0010
15. Paulus MP, Stewart JL. Interoception and drug addiction. Neuropharmacology 2014; 76(Pt B):342-350. DOI: https://doi.org/10.1016/j.neuropharm.2013.07.002
16. Molnar-Szakacs I, Uddin LQ. Anterior insula as a gatekeeper of executive control. Neurosci Biobehav Rev 2022; 139:104736. DOI: https://doi.org/10.1016/j.neubiorev.2022.104736
17. Naqvi NH, Gaznick N, Tranel D, Bechara A. The insula: A critical neural substrate for craving and drug seeking under conflict and risk. Ann N Y Acad Sci 2014; 1316:53-70. DOI: https://doi.org/10.1111/nyas.12415
18. Naqvi NH, Rudrauf D, Damasio H, Bechara A. Damage to the insula disrupts addiction to cigarette smoking. Science 2007; 315(5811):531-534. DOI: https://doi.org/10.1126/science.1135926
19. Abdolahi A, Williams GC, Benesch CG, Wang HZ, Spitzer EM, Scott BE, Block RC, van Wijngaarden E. Smoking cessation behaviors three months following acute insular damage from stroke. Addict Behav 2015; 51:24-30. DOI: https://doi.org/10.1016/j.addbeh.2015.07.001
20. Gaznick N, Tranel D, McNutt A, Bechara A. Basal ganglia plus insula damage yields stronger disruption of smoking addiction than basal ganglia damage alone. Nicotine Tob Res 2014; 16(4):445-453. DOI: https://doi.org/10.1093/ntr/ntt172
21. Yousefzadeh-Fard Y, Gharedaghi MH, Esmaeili S, Pourbakhtyaran E, Sadaghiani MS, Ghorbani A, Sahraian MA. Stroke modifies drug consumption in opium addicts: Role of the insula. Basic Clin Neurosci 2013; 4(4):307-14.
22. Stoeckel LE, Chai XJ, Zhang J, Whitfield-Gabrieli S, Evins AE. Lower gray matter density and functional connectivity in the anterior insula in smokers compared with never smokers. Addict Biol 2016; 21(4):972-981. DOI: https://doi.org/10.1111/adb.12262
23. Lin F, Wu G, Zhu L, Lei H. Region-specific changes of insular cortical thickness in heavy smokers. Front Hum Neurosci 2019; 13:265. DOI: https://doi.org/10.3389/fnhum.2019.00265
24. Connolly CG, Bell RP, Foxe JJ, Garavan H. Dissociated grey matter changes with prolonged addiction and extended abstinence in cocaine users. PLoS One 2013; 8(3):e59645. DOI: https://doi.org/10.1371/journal.pone.0059645
25. Meade CS, Bell RP, Towe SL, Hall SA. Cocaine-related alterations in fronto-parietal gray matter volume correlate with trait and behavioral impulsivity. Drug Alcohol Depend 2020; 206:107757. DOI: https://doi.org/10.1016/j.drugalcdep.2019.107757
26. Sutherland MT, McHugh MJ, Pariyadath V, Stein EA. Resting state functional connectivity in addiction: Lessons learned and a road ahead. Neuroimage 2012; 62(4):2281-2295. DOI: https://doi.org/10.1016/j.neuroimage.2012.01.117
27. Yuan K, Yu D, Bi Y, Li Y, Guan Y, Liu J, Zhang Y, Qin W, Lu X, Tian J. The implication of frontostriatal circuits in young smokers: A resting-state study. Hum Brain Mapp 2016; 37(6):2013-2026. DOI: https://doi.org/10.1002/hbm.23153
28. Fedota JR, Matous AL, Salmeron BJ, Gu H, Ross TJ, Stein EA. Insula demonstrates a non-linear response to varying demand for cognitive control and weaker resting connectivity with the executive control network in smokers. Neuropsychopharmacology 2016; 41(10):2557-2565. DOI: https://doi.org/10.1038/npp.2016.62
29. Fedota JR, Stein EA. Resting-state functional connectivity and nicotine addiction: Prospects for biomarker development. Ann N Y Acad Sci 2015; 1349(1):64-82. DOI: https://doi.org/10.1111/nyas.12882
30. Geng X, Hu Y, Gu H, Salmeron BJ, Adinoff B, Stein EA, Yang Y. Salience and default mode network dysregulation in chronic cocaine users predict treatment outcome. Brain 2017; 140(5):1513-1524. DOI: https://doi.org/10.1093/brain/awx036
31. Cisler JM, Elton A, Kennedy AP, Young J, Smitherman S, Andrew James G, Kilts CD. Altered functional connectivity of the insular cortex across prefrontal networks in cocaine addiction. Psychiatry Res 2013; 213(1):39-46. DOI: https://doi.org/10.1016/j.pscychresns.2013.02.007
32. Sullivan EV, Müller-Oehring E, Pitel AL, Chanraud S, Shankaranarayanan A, Alsop DC, Rohlfing T, Pfefferbaum A. A selective insular perfusion deficit contributes to compromised salience network connectivity in recovering alcoholic men. Biol Psychiatry 2013; 74(7):547-555. DOI: https://doi.org/10.1016/j.biopsych.2013.02.026
33. Janes AC, Krantz NL, Nickerson LD, Frederick BB, Lukas SE. Craving and cue reactivity in nicotine-dependent tobacco smokers is associated with different insula networks. Biol Psychiatry Cogn Neurosci Neuroimaging 2020; 5(1):76-83. DOI: https://doi.org/10.1016/j.bpsc.2019.09.005
34. Hanlon CA, Dowdle LT, Gibson NB, Li X, Hamilton S, Canterberry M, Hoffman M. Cortical substrates of cue-reactivity in multiple substance dependent populations: Transdiagnostic relevance of the medial prefrontal cortex. Transl Psychiatry 2018; 8(1):186. DOI: https://doi.org/10.1038/s41398-018-0220-9
35. Lynch WJ, Nicholson KL, Dance ME, Morgan RW, Foley PL. Animal models of substance abuse and addiction: Implications for science, animal welfare, and society. Comp Med 2010; 60(3):177-188.
36. Kuhn BN, Kalivas PW, Bobadilla AC. Understanding addiction using animal models. Front Behav Neurosci 2019; 13:262. DOI: https://doi.org/10.3389/fnbeh.2019.00262
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How to Cite
Shah, R. (2023). On the Role of Insula in Drug Addiction. Science Insights, 42(3), 843–849. https://doi.org/10.15354/si.23.re223
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Review
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