As detailed above, interoception is strongly related to reward, urge, and craving, and alliesthesia emphasizes that through interoceptive processing these constructs are dependent on the pre-existing internal state of the individual, which may undergo positive/negative alliesthetic changes. Thus, three components appear critical for how an individual responds to drugs: (1) the internal or homeostatic state as signaled via afferents converging to the insular cortex; (2) the cognitive state of the individual, which includes a “contextualized” representation of the interoceptive state (Shipp, 2005); and (3) the learned associations of the external stimulus (e.g. the drug of choice) with previous outcomes including predicted internal states. These components clearly differ across individuals who are initially exposed to drugs and those who have been taking drugs for years. In particular, as a person transitions from impulsive to compulsive use, predominantly positive reinforcement mechanisms (approach behaviors) are supplemented with negative reinforcement mechanisms (avoidance behaviors). In other words, as individuals progress from initial exposure to continued and compulsive use they may experience a progressive attenuation of the positive hedonic aspects of the drug (negative alliesthesia) and develop an increasing sensitization to the negative emotional processes (positive alliesthesia) associated with the withdrawal from the drug-induced state. This transition is consistent with the idea the sensitization of antireward systems aimed at opposing the positively valenced hedonic effects of drugs dominate the motivational state of the addicted individual (Koob and Le Moal, 2008). The stimuli and associated interoceptive state predicting withdrawal are clearly distinct from the stimuli and interoceptive state predicting intoxication. Nevertheless, the interoceptive state is a crucial component determining whether an individual is likely to take a drug again or shows an inability to to resist taking a drug despite the evidence of aversive consequences. . (Paulus, Tapert, and Schulteis 2009, 8)
References
Paulus, Martin P., Susan F. Tapert, and Gery Schulteis. 2009. “The role of interoception and alliesthesia in addiction.” Pharmacology, biochemistry, and behavior 94 (1): 1–7. doi:10.1016/j.pbb.2009.08.005.0