Neural and Behavioral Correlates of Impaired Insight and Self-Awareness in Substance Use Disorder

Clinical insight is an emerging interest in substance use disorder research, but is difficult to study empirically. We reviewed recent research examining the behavioral and neural correlates of several psychological processes tapping into self-awareness that may in turn contribute to insight.

Individuals with substance use disorder exhibit deficits in self-monitoring (especially self-report / behavior dissociations), metacognition, alexithymia, readiness for behavior change, and interoception. Behavioral impairments have been further linked to neural abnormalities in a diverse network of brain regions encompassing cortical midline areas, insula, and frontal cortex, among others. Various treatment modalities may target these deficits, though corresponding effects on neural circuitry remain to be determined.

Compromised insight in substance use disorder may be relevant to a constellation of behaviors that suggest a lack of behavioral awareness linked to drug use. Future work needs to refine and advance the measurements, continuing to investigate insight problems in addiction that may become important therapeutic targets.