The Silent Island Problem: Predicting Relapse through Insula Insights

Relapse is a big problem for those with stimulant use disorder, and while we know a lot about what kicks off drug use, we know less about why people relapse. A recent study by Stanford University took a closer look at this by using brain scans to track how people react to non-drug rewards and losses, like money.

The study followed 68 people who had been treated for stimulant use disorder and compared them to 42 non-drug users. Six months later, they found that 27 people remained drug-free, but 33 had relapsed.

A key finding was that people who had lower activity in a brain area called the “anterior insula” when anticipating losses were more likely to relapse. This connection held strong even when considering factors like craving, mood, and years of drug use. Those with lower insula activity also reported feeling less stressed by losses and were slower to react to avoid them—traits that independently predicted relapse.

The study also showed that the way the insula communicates with another brain region, the “nucleus accumbens” – the “reward center” in the forebrain - plays an important role in relapse. These insights offer a clearer picture of the neurobehavioral markers that predict relapse, suggesting new ways to help those at risk.

All in all, this study highlights the importance of understanding brain activity in predicting and preventing relapse, going beyond traditional self-report methods.

Fascinating, right?

The work appeared in Blunted Neurobehavioral Loss Anticipation Predicts Relapse to Stimulant Drug Use - ScienceDirect