Delay discounting and alcohol consumption correlate with dorsal anterior insula activation during choice in non‐treatment‐seeking heavy drinkers

Abstract

Background The anterior insular cortex (AIC), a prominent salience network node, integrates interoceptive information and emotional states into decision-making. While AIC activation during delay discounting (DD) in alcohol use disorder (AUD) has been previously reported, the associations between AIC activation, impulsive choice, alcohol consumption, and connectivity remain unknown. We therefore tested AIC brain responses during DD in heavy drinkers and their association with DD performance, alcohol drinking, and task-based connectivity. Methods Twenty-nine heavy drinkers (12 females; 31.5±6.1 years; 40.8±23.4 drinks/week) completed a DD task during functional MRI. Regions activated during delay discounting decision-making were tested for correlations with DD behavior and alcohol drinking. Psychophysiological interaction (PPI) models assessed task-dependent functional connectivity (FC) of activation during choice. Results DD choice activated bilateral anterior insular cortex, anterior cingulate cortex, and left precentral gyrus. Right dorsal (d) AIC activation during choice negatively correlated with discounting of delayed rewards and alcohol consumption. PPI analysis revealed FC of right dAIC to both anterior and posterior cingulate cortex (PCC)—key nodes in the midline default mode network. Conclusions Greater dAIC involvement in intertemporal choice may confer more adaptive behavior (lower impulsivity and alcohol consumption). Moreover, salience network processes governing discounting may require midline default mode (precuneus/PCC) recruitment. These findings support a key adaptive role for right dAIC in decision-making involving future rewards and risky drinking.