The Insula: A Brain Stimulation Target for the Treatment of Addiction.

Author: Ibrahim C1,2, Rubin-Kahana DS1,3, Pushparaj A4,5, Musiol M5, Blumberger DM3,6, Daskalakis ZJ3,6, Zangen A7, Le Foll B1,2,3,8,9,10,11
Author Information:
1Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.
2Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
3Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
4Qunuba Sciences, Toronto, ON, Canada.
5Ironstone Product Development, Toronto, ON, Canada.
6Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
7Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
8Addictions Division, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
9Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
10Alcohol Research and Treatment Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada.
11Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Conference/Journal: Front Pharmacol.
Date published: 2019 Jul 2
Other: Volume ID: 10 , Pages: 720 , Special Notes: doi: 10.3389/fphar.2019.00720. eCollection 2019. , Word Count: 196


Substance use disorders (SUDs) are a growing public health concern with only a limited number of approved treatments. However, even approved treatments are subject to limited efficacy with high long-term relapse rates. Current treatment approaches are typically a combination of pharmacotherapies and behavioral counselling. Growing evidence and technological advances suggest the potential of brain stimulation techniques for the treatment of SUDs. There are three main brain stimulation techniques that are outlined in this review: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The insula, a region of the cerebral cortex, is known to be involved in critical aspects underlying SUDs, such as interoception, decision making, anxiety, pain perception, cognition, mood, threat recognition, and conscious urges. This review focuses on both the preclinical and clinical evidence demonstrating the role of the insula in addiction, thereby demonstrating its promise as a target for brain stimulation. Future research should evaluate the optimal parameters for brain stimulation of the insula, through the use of relevant biomarkers and clinical outcomes for SUDs.

KEYWORDS: addiction; brain stimulation; deep brain stimulation (DBS); insula; transcranial direct current stimulation (tDCS); transcranial magnetic stimulation (TMS)

PMID: 31312138 PMCID: PMC6614510 DOI: 10.3389/fphar.2019.00720