W hy do I nsula-Striatum only regulate Com pulsive Drinking? Com pulsive intake: Conflict Recruits Cortical Circuits Habitual intake: No Conflict, recruits more striatal, less cortical areas Our therapies target “Mom ents of Crisis” ( at risk of relapsing) I f one has no conflict, then the therapy w on’t do anything
W hy do I nsula-Striatum only regulate Com pulsive Drinking? Com pulsive intake: Conflict Recruits Cortical Circuits Habitual intake: No Conflict, recruits more striatal, less cortical areas Our therapies target “Mom ents of Crisis” ( at risk of relapsing) I f one has no conflict, I f one has no conflict, then the therapy w on’t do anything then the therapy w on’t do anything
W hat does I nsula “do norm ally?” ( Not there just to let us get addicted)
How to Deal w ith Challenges that get in the w ay of Rew ard
Challenges are I m portant! The Salience Netw ork m ediates im portant events mPFC I nsula Seeley et al., 2007
Short im portant things
Alcohol cues prom ote drinking Activity in aI NS and friends PREDI CTS future intake and relapse Myrick 2004; Filbery 2008; Claus 2013
Alcohol cues prom ote drinking I nsula activity PREDI CTS real-w orld intake and relapse Heavy social drinkers Heavy social drinkers m PFC I nsula Striatum Myrick 2004; Filbery 2008; Claus 2013
Alcohol cue “autom atically captures attention” Heavy social drinkers Heavy social drinkers m PFC I nsula Striatum Myrick 2004; Filbery 2008; Claus 2013
I f you gam ble and “alm ost w in” I nsula activation predicts the desire to gam ble m ore Greater Insula activity for almost win Luke 2011 Greater desire to keep gambling
Partial I nsula Stroke: Give up smoking without effort Quitting was hard Quitting was easy Naqvi and Bechara 2007 Science
Long im portant things
I nsula cells active for 3 hours ( pressing a lever to get cocaine) Guillem et al., 2010
I nsula cells active for 3 hours ( pressing a lever to get cocaine) Being “on” Guillem et al., 2010
I nsula key for anxiety: • Overvalue negative info • Sustained attention • Relief Seeking w hen bad feeling aw akened ( subconscious and conscious levels) Paulus and Stein 2006
A gam e: is m y heart beat in tim e w ith m usic rhythm ? Critchley et al., 2004
A gam e: is m y heart beat in tim e w ith m usic rhythm ? More basal anxiety Better ability to feel body Critchley et al., 2004
Aw areness innately com es w ith som e anxiety More basal anxiety Better ability to feel body Critchley et al., 2004
“Feeling of knowing” Insula pleasant music Most singular sense of Self in the moment maternal affiliation Moment of recognizing happy voices Decision making smile self-recognition time perception Craig, 2009
Mindfulness as a therapy: Likely effective because it reprograms “fast reactivity to importance” memories Both (1) being reactive, and (2) learning to be less reactive, mediated through the Insula The Insula is all about having awareness and using awareness to impact what happens Sim ply being aw are reprogram s I nsula at it’s m ost basic substance
Mindfulness as a therapy: Likely effective because it reprograms “fast reactivity to importance” memories Both (1) being reactive, and (2) learning to be less reactive, mediated through the Insula The Insula is all about having awareness and using awareness of importance to impact what happens
Insula: critical for important things Balancing awareness and non-awareness to help carry out importance-directed actions This system regulates both positive and negative situations Addiction takes over the system : Alcohol becom es the m ost im portant thing
W hat is harm ful drinking? W hy do w e call it “harm ful?” Binging How m uch alcohol is harm ful? Apologize ahead of tim e for bringing up uncom fortable observations
Thoughts/ urges/ cues w hich “autom atically” push one forw ard W hat is harm ful drinking? W hy do w e call it “harm ful?” Binging How m uch alcohol is harm ful? I know I shouldn’t do it but I do it anyways Apologize ahead of tim e for bringing up Repeated practice in “giving in to urges” uncom fortable observations
Thoughts/ urges/ cues w hich “autom atically” push one forw ard Costs: W hat is harm ful drinking? • Organ Dam age Harm to Others • And Self W hy do w e call it “harm ful?” Binging How m uch alcohol is harm ful? I know I shouldn’t do it but I do it anyways Apologize ahead of tim e for bringing up Repeated practice in “giving in to urges” uncom fortable observations Costs: Becom es “habitual” • • Pay less attention to negative info (“it’ll be fine” becomes habit) Can’t m uster as m uch w ill to overcom e (gotten good at giving in) •
How m uch alcohol is harm ful? ( and is there a “healthy” level?)
A lot of alcohol
Risk is Proportional to I ntake Binge drinking is harmful at multiple levels (Health, Social, Family, Job, Legal Costs) • Disease risk in multiple organs • Injury to self and others • Lost wages and productivity
Excessive intake prom otes liver disease Zakhari & Li 2007
Binge-level alcohol increases leakage of bacterial factors from gut into blood Bacterial toxins Bacterial DNA Bala et al. 2014
Alcohol seen as such a toxin by the body: W illing to turn it into form aldehye to get rid of it ALDH2 m utation: ~ 5 6 0 m illion people w ith alcohol “flush response” Higher risk of m any diseases But also Likely m any adaptations for alcohol: Earliest m am m als like alcohol- living shrew s Even archebacteria have strong ALDH2
Alcohol seen as such a toxin by the body: W illing to turn it into form aldehye to get rid of it ALDH2 m utation: ~ 5 6 0 m illion people w ith alcohol “flush response” Higher risk of m any diseases But also Likely m any adaptations for alcohol: Earliest m am m als like alcohol- living shrew s Even archebacteria have strong ALDH2
Moderate alcohol
Risk of Harm
Possible benefit of 1 drink per day 5 drinks Risk of per day Harm
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