The role of interoception in addiction: A critical review

Interoception refers to a collection of processes by which the state of the body is transmitted back to the brain, giving rise to awareness of the internal milieu, and motivating behavioural responses to homeostatically regulate internal state. Recent work has begun to explore the relevance of this construct to drug addiction: drugs of abuse and drug-related stimuli induce pronounced peripheral changes, and damage to a brain region known to support interoception (the insula) disrupts nicotine dependence. This article critically reviews existing accounts of addiction that suggest impaired interoception contributes to drug abuse. Conceptually, we argue that existing addiction interoception models could be usefully extended by considering (i) the multiple components of the bodily feedback system (signal, perception, and appraisal) and (ii) how individual differences in these three components impact on cognitive–affective processing in addiction. Empirically, whilst no studies have examined direct behavioural measures of interoception in addicted populations, several indirect lines of experimental work that pertain to this altered interoception hypothesis are presented. Clinical implications are discussed.

► Interoception merges bodily signals and affective processes critical for addiction. ► Interoceptive disturbances partly shape cognitive–affective processing in addiction. ► Peripheral signals mimicking drug action trigger central appetitive responses and craving. ► Central inactivation of interoception hubs blocks body-related craving feelings. ► Therapies blocking peripheral input or blending appraisal may be effective.