The set of brain regions identified with substance dependence in general is supported by previous evidence. The insula performs a central role in the perception of the internal state of the body (34). Disruption of the insula could alter regulation of the intense positive and negative bodily states associated with drug taking and withdrawal, biasing the individual toward relapse as a maladaptive response to anticipated challenges to physiological homeostasis (35). It has been reported that smokers who have suffered brain damage involving the insula have subsequently lost the urge to smoke (36). The parietal cortex has been associated with attention and working memory (37, 38). Disruption of these processes could interfere with self-awareness about a substance use problem and the management of stressful situations. The medial orbitofrontal region of interest defined by FreeSurfer (also known as the ventromedial prefrontal cortex) encodes the subjective value of future rewards during decision making (39). Lesions of this region produce disadvantageous choices on gambling tasks that model real-life decisions (40). Altered neural activity in the insula and the medial orbital and parietal cortex has
