title: The insula: a critical neural substrate for craving and drug seeking under conflict and risk.
abstract: Drug addiction is characterized by the inability to control drug use when it results in negative consequences or conflicts with more adaptive goals. Our previous work showed that damage to the insula disrupted addiction to cigarette smoking-the first time that the insula was shown to be a critical neural substrate for addiction. Here, we review those findings, as well as more recent studies that corroborate and extend them, demonstrating the role of the insula in (1) incentive motivational processes that drive addictive behavior, (2) control processes that moderate or inhibit addictive behavior, and (3) interoceptive processes that represent bodily states associated with drug use. We then describe a theoretical framework that attempts to integrate these seemingly disparate findings. In this framework, the insula functions in the recall of interoceptive drug effects during craving and drug seeking under specific conditions where drug taking is perceived as risky and/or where there is conflict between drug taking and more adaptive goals. We describe this framework in an evolutionary context and discuss its implications for understanding the mechanisms of behavior change in addiction treatments.
authors.affiliation: Division on Substance Abuse, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, New York.
authors.forename: Nasir H
authors.initials: NH
authors.lastname: Naqvi
authors.forename: Natassia
authors.initials: N
authors.lastname: Gaznick
authors.forename: Daniel
authors.initials: D
authors.lastname: Tranel
authors.forename: Antoine
authors.initials: A
authors.lastname: Bechara
mesh_terms: D000818:Animals; D016739:Behavior, Addictive; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000502:physiology* / Q000503:physiopathology; D003220:Conflict, Psychological; D058999:Drug-Seeking Behavior; D006801:Humans; D008962:Models, Theoretical; D012907:Smoking; D019966:Substance-Related Disorders; D014029:Tobacco Use Disorder
keywords: addiction; craving; drug seeking; insula; risk