A Systematic Review of Interoception in Substance Use Disorders

Abstract Purpose of Review Despite the growing number of studies on interoception in addiction research, a comprehensive review of these findings is still lacking. The goal of this paper was to conduct a systematic review of empirical studies to assess the evidence for interoceptive deficits in individuals with substance use disorders (SUDs), identify gaps in the existing literature, and propose directions for future research. Recent Findings From 1,544 papers identified in APA PsycINFO, PubMed, CINAHL, and Embase using predefined search terms, 39 studies met eligibility criteria. Of these, 14 studies addressed alcohol use disorder, 12 heterogeneous substance use, 6 opioid use disorder, 4 nicotine use, 2 cocaine use disorder, and 1 cannabis use. Regarding interoceptive dimensions (accuracy, sensibility, awareness), 12 studies assessed accuracy only, 19 sensibility only, and 8 both; only one additionally evaluated interoceptive awareness. Behavioral tasks (e.g., heartbeat counting task) and self-report questionnaires (e.g., Multidimensional Assessment of Interoceptive Awareness; MAIA) were the most common measures of interoceptive accuracy and sensibility, respectively. Neuroimaging studies were scarce, with only 4 examining neural correlates. Summary Across studies of interoception in SUDs, the most consistent finding is reduced interoceptive accuracy relative to healthy controls, particularly in alcohol use disorder; findings for other substances show greater variability. Evidence for interoceptive sensibility is mixed, and research on interoceptive awareness remains sparse. The literature is constrained by a narrow focus on two interoceptive dimensions, a heavy reliance on the cardiac domain, and the widespread use of the heartbeat counting task, which has been criticized for its validity. Future research should assess multiple interoceptive dimensions across modalities, develop and validate more robust measures, and appropriately address potential confounders such as smoking status.