Aims: Adolescents with substance use disorders (SUD) exhibit hyposensitivity to pleasant internally generated (interoceptive)
stimuli and hypersensitivity to external rewarding stimuli. It is unclear whether similar patterns exist for aversive interoceptive
stimuli. We compared activation in the insular cortex and other brain regions during the anticipation and experience of aversive
stimuli between adolescents with SUD and those without.
Design: Cross-sectional experimental study with two groups.
Adolescents (ages 15-17 years) with an alcohol or marijuana SUD (n = 18) and healthy comparison subjects (CON, n = 15). Participants
were recruited by distributing flyers at local high schools.
Setting: Keck Imaging Center, University of California
San Diego, CA, USA.
Measurements: Behavioral and neural responses to a continuous performance task with inspiratory
breathing load recorded during an fMRI session. Questionnaires assessed life-time drug use, anxiety, sensation-seeking, impulsivity,
affect and bodily awareness. Visual analog scales assessed drug craving and breathing load responses.
subjects, experience of breathing load elicited greater bilateral anterior and posterior insula (AI and PI, respectively)
activation than anticipation (F(1,31) = 4.16, P < 0.05). SUD exhibited greater left AI and bilateral PI activation during
breathing load than anticipation, compared with CON (F(1,31) = 4.16, P < 0.05). In contrast, CON showed greater activation
during anticipation than breathing load in left PI, compared with SUD (F(1,31) = 4.16, P < 0.05).
Adolescents with alcohol and marijuana substance use disorders may be hypersensitive to aversive interoceptive stimuli.