title: Under pressure: adolescent substance users show exaggerated neural processing of aversive interoceptive stimuli.
abstract: OBJECTIVE
  Adolescents with substance use disorders (SUD) exhibit hyposensitivity to pleasant internally generated (interoceptive) stimuli and hypersensitivity to external rewarding stimuli. It is unclear whether similar patterns exist for aversive interoceptive stimuli. We compared activation in the insular cortex and other brain regions during the anticipation and experience of aversive stimuli between adolescents with SUD and those without.
  
  
  METHODS
  Cross-sectional experimental study with two groups.
  
  
  METHODS
  Adolescents (ages 15-17 years) with an alcohol or marijuana SUD (n=18) and healthy comparison subjects (CON, n=15). Participants were recruited by distributing flyers at local high schools.
  
  
  METHODS
  Keck Imaging Center, University of California San Diego, CA, USA.
  
  
  METHODS
  Behavioral and neural responses to a continuous performance task with inspiratory breathing load recorded during an fMRI session. Questionnaires assessed life-time drug use, anxiety, sensation-seeking, impulsivity, affect and bodily awareness. Visual analog scales assessed drug craving and breathing load responses.
  
  
  RESULTS
  Across subjects, experience of breathing load elicited greater bilateral anterior and posterior insula (AI and PI, respectively) activation than anticipation (F(1,31)=4.16, P<0.05). SUD exhibited greater left AI and bilateral PI activation during breathing load than anticipation, compared with CON (F(1,31)=4.16, P<0.05). In contrast, CON showed greater activation during anticipation than breathing load in left PI, compared with SUD (F(1,31)=4.16, P<0.05).
  
  
  CONCLUSIONS
  Adolescents with alcohol and marijuana substance use disorders may be hypersensitive to aversive interoceptive stimuli.
authors.affiliation: University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.
authors.forename: Lotte
authors.initials: L
authors.lastname: Berk
authors.affiliation: City University of New York Queens College, Department of Psychology, New York, NY, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Stewart
authors.affiliation: University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.
authors.forename: April C
authors.initials: AC
authors.lastname: May
authors.affiliation: University of Amsterdam, Developmental Psychology, Amsterdam, the Netherlands.
authors.forename: Reinout W
authors.initials: RW
authors.lastname: Wiers
authors.affiliation: University of Florida, Department of Physiology, Gainesville, FL, USA.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Davenport
authors.affiliation: University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.|Laureate Institute for Brain Research, Tulsa, OK, USA.|Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Paulus
authors.affiliation: University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.|Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Susan F
authors.initials: SF
authors.lastname: Tapert
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000503:physiopathology*; D000704:Analysis of Variance; D059031:Anticipation, Psychological / Q000502:physiology; D002245:Carbon Dioxide / Q000032:analysis; D002540:Cerebral Cortex / Q000502:physiology*; D066249:Craving / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000503:physiopathology*; D008606:Mental Processes / Q000502:physiology*; D009483:Neuropsychological Tests; D010775:Photic Stimulation; D011597:Psychomotor Performance / Q000502:physiology; D012119:Respiration
chemical_list: D002245:Carbon Dioxide
keywords: Adolescence; alcohol; breathing load; cannabis; fMRI; interoception