Drug craving? - Just zap your insula!

An important factor that contributes to drug-seeking in addicted individuals is the negative feelings that result from abstinence. Such mood states are monitored by the interoceptive sensory system, and particularly by a brain area called the insular cortex, known to process emotional information. Thus this abstract from Contreras et al. is of interest:

Addiction profoundly alters motivational circuits so that drugs become powerful reinforcers of behavior. The interoceptive system continuously updates homeostatic and emotional information that are important elements in motivational decisions. We tested the idea that interoceptive information is essential in drug craving and in the behavioral signs of malaise. We inactivated the primary interoceptive cortex in amphetamine-experienced rats, which prevented the urge to seek amphetamine in a place preference task. Interoceptive insula inactivation also blunted the signs of malaise induced by acute lithium administration. Drug-seeking and malaise both induced Fos expression, a marker of neuronal activation, in the insula. We conclude that the insular cortex is a key structure in the perception of bodily needs that provides direction to motivated behaviors.

The therapeutic intervention was an injection of 2% lidocaine (a sodium channel blocker to inhibit nerve activity) into the left and right insula to cause a transient shutdown of insular nerve activity (injecting adjacent cortex was not effective). Although this is a sledgehammer approach with possible dire side effects, it suggests that therapeutic interventions in the insula may help to alleviate drug cravings, .