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Martin P. Paulus, MD
Top-Down Modulation of Interoception: A New Frontier for Drug and Alcohol Addiction Treatments?
Professor of Psychiatry, University of San Diego
2 Riverside Circle, Roanoke, VA 24016
Interoception consists of receiving, processing, and integrating body-relevant signals with external stimuli to affect ongoing motivated behavior. In this seminar, Dr. Paulus will review the role of interoception and its neural basis with relevance to drug addiction. The insular cortex is the central nervous system hub to process and integrate these signals. Interoception is an important component of several addiction relevant constructs, including arousal, attention, stress, reward, and conditioning.
Imaging studies with drug-addicted individuals show that the insular cortex is hypoactive during cognitive control processes but hyperactive during cue reactivity and reward-related processes. It is proposed that interoception contributes to drug addiction by incorporating an “embodied” experience of prior drug use together with the individual’s internal state and predicted body states to modulate approach or avoidance behavior—that is, whether to take drugs.
This opens the possibility of two types of interventions. First, one may be able to modulate the embodied experience by enhancing insula reactivity where necessary, such as when engaging in risky behavior, or attenuating insula when exposed to drug-relevant cues. Second, one may be able to reduce the urge to act by increasing limbic motor cortex processing—that is, inhibiting the urge to use by employing cognitive training.