The neurocircuitry of impaired insight in drug addiction

Trends Cogn Sci. 2009 Sep;13(9):372-80. doi: 10.1016/j.tics.2009.06.004. Epub 2009 Aug 27.


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 self-awareness. 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Brain Mapping*
  • Cerebral Cortex / pathology*
  • Cerebral Cortex / physiopathology
  • Humans
  • Magnetic Resonance Imaging
  • Nerve Net / physiopathology
  • Neural Pathways / physiopathology
  • Substance-Related Disorders / pathology*
  • Substance-Related Disorders / psychology