中国科学院心理健康重点实验室知识库

摘要 内感受，即人对身体内部信号的感知、整合解释和调节能力，在药物成瘾的形成、发展和治疗过程中起到重要作用.长期的药物使用导致成瘾者无法准确地识别管理来自身体内部的信号，并对与药物效应相关的身体信号过分敏感，其背后的神经基础是以岛叶为核心的内感受处理中枢的损伤.内感受的功能障碍可能导致个体对药物的过度依赖和无法自控.受损的内感受通过影响线索诱发的药物渴求、增加负性情绪和冲动、损伤风险决策能力导致成瘾者的复吸.本文探究内感受的损伤特征及其在药物成瘾过程中的作用，有助于识别药物成瘾形成的诱因、评估成瘾严重程度，为干预提供一个外周、中枢、行为和主观报告相结合的多维度靶点.未来的研究可从多模态评估内感受能力、建立内感受神经和心理表征的对应关系、探究不同药物的内感受损伤特征共性和特异性等方向进一步明确内感受在药物成瘾中的作用，并探索内感受作为跨诊断和共病干预的靶点的可行性.

Substance use disorders (SUD) are a serious problem worldwide. Interoception is defined as a person's ability to perceive, integrate, interpret, and regulate the internal signals of the body. It plays an important role in the formation, development, and treatment of SUD. Interoception is involved in the key processes of addiction, such as reward salience, negative emotional experiences, and diminished cognitive control. Individuals with SUD (iSUD) often use drugs to alleviate negative emotional states and physical discomfort associated with withdrawal symptoms. When exposed to drugs, the insula maintains homeostasis by modifying interoceptive processing. This alteration enhances the sensitivity of the impulsive system and inhibits the reflective system, thus reducing the conflicting signals related to motivation and withdrawal. The impaired interoception associated with the process of drug use is a significant factor contributing to the inability of iSUD to suppress drug cravings, ultimately leading to relapse.

Impaired interoception may lead to relapse in iSUD by enhancing the intensity of cue-induced drug craving, increasing negative emotions and impulsivity, and diminishing their ability to risk-based decision-making. This study explored the characteristics of interoceptive impairment and its role in the development of substance use disorders. It sheds light on the

factors contributing to the formation of these disorders, assesses the severity of addiction, and provides a multidimensional target for intervention that combines peripheral, central, behavioral, and subjective assessments.

Individuals with SUD have difficulty accurately recognizing and managing bodily signals. Furthermore, drug type may impact interoceptive accuracy. Specifically, interoceptive accuracy tends to decrease in individuals addicted to alcohol, heroin, marijuana, and nicotine, while it increases in cocaine addicts. Additionally, iSUD exhibits heightened sensitivity to physical signals associated with the effects of drugs. The underlying neural mechanism of these phenomena is the damage to the interoceptive processing center in the insula. This damage is characterized by a reduction in insula cortex thickness and weakened connections between the insula and brain regions responsible for executive control. Long-term drug use confers reward value upon drug-related cues. When iSUD are exposed to drug-related cues, the central brain regions involved in interoception are activated and show an enhancement in connectivity between the insula and the ventral striatum.

Current research primarily relies on cross-sectional measurements and correlation analyses, lacking longitudinal and causal studies. The measurements of impaired interoceptive ability in iSUD predominantly focus on changes in central brain regions, despite a lack of investigation into potential alterations in peripheral receptors and transmission pathways. To enhance the understanding of the role of interoception in substance use disorders, future studies can integrate subjective and objective measurements, adopt multi-modal approaches for interoception assessment, establish the correspondence between interoceptive neural processes and psychological representations, investigate both commonalities and speciflcities in interoception impairment patterns among patients with different types of substance use disorders, and explore the feasibility of interoception as a target for cross-diagnostic and comorbidity intervention.