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      A Triadic Neurocognitive Approach to Addiction for Clinical Interventions

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          According to the triadic neurocognitive model of addiction to drugs (e.g., cocaine) and non-drugs (e.g., gambling), weakened “willpower” associated with these behaviors is the product of an abnormal functioning in one or more of three key neural and cognitive systems: (1) an amygdala-striatum dependent system mediating automatic, habitual, and salient behaviors; (2) a prefrontal cortex dependent system important for self-regulation and forecasting the future consequences of a behavior; and (3) an insula dependent system for the reception of interoceptive signals and their translation into feeling states (such as urge and craving), which in turn plays a strong influential role in decision-making and impulse control processes related to uncertainty, risk, and reward. The described three-systems account for poor decision-making (i.e., prioritizing short-term consequences of a decisional option) and stimulus-driven actions, thus leading to a more elevated risk for relapse. Finally, this article elaborates on the need for “personalized” clinical model-based interventions targeting interactions between implicit processes, interoceptive signaling, and supervisory function aimed at helping individuals become less governed by immediate situations and automatic pre-potent responses, and more influenced by systems involved in the pursuit of future valued goals.

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              How do you feel--now? The anterior insula and human awareness.

              The anterior insular cortex (AIC) is implicated in a wide range of conditions and behaviours, from bowel distension and orgasm, to cigarette craving and maternal love, to decision making and sudden insight. Its function in the re-representation of interoception offers one possible basis for its involvement in all subjective feelings. New findings suggest a fundamental role for the AIC (and the von Economo neurons it contains) in awareness, and thus it needs to be considered as a potential neural correlate of consciousness.

                Author and article information

                1Psychological Medicine Laboratory, Faculty of Medicine, Université Libre de Bruxelles , Brussels, Belgium
                2Department of Psychology, Brain and Creativity Institute, University of Southern California , Los Angeles, CA, USA
                Author notes

                Edited by: Antonio Verdejo-García, Universidad De Granada, Spain

                Reviewed by: Giovanni Martinotti, Catholic University of Rome, Italy; Agnes J. Jasinska, National Institute on Drug Abuse, USA

                *Correspondence: Xavier Noël, Psychological Medicine Laboratory, Faculty of Medicine, Brugmann-Campus, Université Libre de Bruxelles, 4 Place Van Gehuchten, 1020 Brussels, Belgium e-mail: xnoel@

                This article was submitted to Addictive Disorders and Behavioral Dyscontrol, a section of the journal Frontiers in Psychiatry.

                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                27 December 2013
                : 4
                Copyright © 2013 Noël, Brevers and Bechara.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Figures: 1, Tables: 0, Equations: 0, References: 164, Pages: 14, Words: 13670
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