The Neurocircuitry of Impaired Insight in Drug Addiction

By Rita Z. Goldstein, A. Craig, Antoine Bechara, Hugh Garavan, Anna Rose Childress, Martin P. Paulus, Nora D. Volkow. Trends in Cognitive Sciences, 2009

629 citations recorded by the source corpus.

More than 80% of addicted individuals fail to seek treatment, which might reflect impairments in recognition of severity of disorder. Considered by some as intentional deception, such `denial' might instead reflect dysfunction of brain networks subserving insight and selfawareness. Here we review the scant literature on insight in addiction and integrate this perspective with the role of: (i) the insula in interoception, self-awareness and drug craving; (ii) the anterior cingulate in behavioral monitoring and response selection (relevant to disadvantageous choices in addiction); (iii) the dorsal striatum in automatic habit formation; and (iv) drug related stimuli that predict emotional behavior in addicted individuals, even without conscious awareness. We discuss implications for clinical treatment including the design of interventions to improve insight into illness severity in addiction.

Subfields: Experimental and Cognitive Psychology, Psychiatry and Mental health

View Paper: https://www.semanticscholar.org/paper/23d39762ed24e1c8641281caf854666804762aa1

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Citations in the corpus

Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support (2017, background): “This intervention-determined approach is based on evidence suggesting that individuals are often unable to recognize when states of vulnerability and/or opportunity emerge [64, 65] and initiate the type of support ann.”
A Convergent Functional Architecture of the Insula Emerges Across Imaging Modalities (2012, positive): “, 2009a; Uddin andMenon, 2009), addiction (Goldstein et al., 2009), anxiety disorders (Paulus and Stein, 2006) and behavioral-variant fronto-temporal dementia (Seeley, 2010) further underscores the importance of this heterogeneous area to our understanding of brain function.”
Cognitive Bias Modification and Cognitive Control Training in Addiction and Related Psychopathology (2013, background): “Note that this review is not exhaustive and that other neurocognitive mechanisms have been implied in the development of addiction, such as decreased self-insight (Goldstein et al., 2009).”
Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications (2011, background): “Indeed, studies have recently suggested that addicted individuals are not fully aware of the severity of their illness (that is, their drug seeking and taking behaviour and its consequences) and this may be associated with deficits in the control networ”
Self-Evaluation of Decision-Making: A General Bayesian Framework for Metacognitive Computation (2017, background): “…judgment and decision-making (Lichtenstein, Fischhoff, & Phillips, 1982), education (Veenman, Wilhelm, & Beishuizen, 2004), social psychology (Heatherton, 2011), consciousness science (Lau & Rosenthal, 2011), and clinical disorders (David, Bedford, Wiffen, & Gilleen, 2012; Goldstein et al., 2009).”
Dopamine neurons encoding long-term memory of object value for habitual behavior (2015, neutral): “In contrast, people with drug abuse are persistently and often unconsciously attracted by visual cues associated with addictive drugs (Goldstein et al., 2009).”